Questions? Let us Help!
We know that choosing a healthcare provider and forming a treatment plan can be an intimidating time filled with questions and uncertainty. We at Oceana Vein Specialists want to help with any uncertaintly you may have and hope that the following section will assist you in your descision making process. Please find below several common questions that patients usually have leading up to picking a vein provider.
Q. Does health insurance pay for varicose vein treatment?
A. Varicose veins are a medical condition and will be covered if a few conditions are met. First, ultrasound is performed and must show abnormal blood flow in the vein and enlarged size of vein. Next, a history of symptoms are noted (such as swollen legs, pain, restlessness, burning) and physical exam performed to identify the severity of disease to determine if symptoms are controlled by conservative treatment (compression stockings, exercise, weight loss if necessary and leg elevation). Most insurance companies require that these conservative treatments be attempted for a period of time before procedures will be approved. We will work with your insurance company to determine if your treatment can be covered. We accept most major insurances including Medicare and Medicaid.
Q. How quickly after treatment can I return to normal activities?
A. Many patients can resume normal activities immediately. It is recommended that strenuous activities or prolonged periods of standing be avoided for a period of a few weeks.
Q. How soon after treatment will my symptoms improve?
A. Most patients report an improvement in symptoms within 1-2 weeks following treatment. Many patients report immediate relief.
Q. Is there any bruising or scarring after the procedure?
A. Typically there is no significant bruising or scarring after treatment. There may be minimal bruising at the vein insertion site, which typically resolves within days to weeks.
Q. What types of doctors can perform vein procedures.
A. A wide variety of doctors can legally perform vein procedures, including family medicine, internal medicine, emergency medicine, vascular surgeons, and Vascular and Interventional Radiologists. There is a wide range of expertise and experience when it comes to vein care, with some physicians only completing weekend training courses while other have completed extensive multi-year dedicated training. It is important to research your potential vein care provider and choose a physician that has received dedicated fellowship training in the diagnosis and care of venous disease.
Q. What is a Vascular and Interventional Radiologist?
A. Vascular and Interventional Radiologists are board-certified physicians who specialize in minimally invasive image guided procedures. They offer the most in-depth knowledge of the least invasive treatments available, as well as expertise in imaging techniques used to guide these minimally invasive procedures. Ultrasound, X-rays and CT scans are used to advance a catheter in the body, usually in an artery or vein, to treat at the source of the disease non-surgically. As the inventors of angioplasty and vascular stenting, first used in the legs to treat peripheral arterial disease, Interventional Radiologists pioneered minimally invasive modern medicine.
Q. What is Interventional Radiology Training?
A. Interventional radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional Radiologists are board-certified physicians with additional training in image guided minimally invasive procedures. After medical school, several additional years of training are required in order to be become an Interventional Radiologist (1 year Internship, 4 years of Diagnostic Radiology residency, 1 year of Vascular and Interventional Radiology fellowship).
Q. What are varicose veins?
A. Varicose veins are swollen, bulging, blue veins that are close to the surface of the skin. Varicose veins have damaged, abnormal internal valves that cause them to hold more blood than normal and cause venous blood to reverse flow (venous reflux). Venous blood is no longer sent back to the heart efficiently, and it pools within these dilated abnormal veins. Usually, normal valves help facilitate the return of blood back to the heart. Without these functioning valves, blood pools within the legs and causes the veins to bulge and dilate. This pooling effect causes fluid to accumulate in the surrounding tissue, making the affected leg swell and feel heavy. Varicose veins may occur in any part of the leg but are more commonly seen in the back of the calf or on the inside of the leg between the groin and the ankle.
Q. Who is at risk for varicose veins?
A. Conditions contributing to varicose veins include family history of vein disease, prolonged standing, past venous disease, obesity, pregnancy, and hormonal changes at menopause. Additionally, women suffer from varicose veins significantly more than men.
Q. What are the signs/symptoms of varicose veins?
A. The most common signs/symptoms of varicose veins include; Leg pain, leg aching or cramping, burning/itching of the skin, leg or ankle swelling, heavy feeling in the legs, skin discoloration or texture changes, restless legs, open wounds or sores.
Q. What are initial treatment options for varicose veins?
A. The initial treatment options for varicose veins is conservative management. This includes exercise, compression stockings, leg elevation, leg rest and weight loss. These approaches may provide temporary symptom relief but will not make the varicose veins go away or prevent them from worsening, as the underlying disease process of venous reflux has not been addressed. There are longer-term treatment options for the treatment of visible varicose veins, such as sclerotherapy, microphlebectomy, and endovenous thermal ablation.
Q. What is the goal of minimally invasive treatment for varicose veins?
A. The goal of treatment is to stop the pooling of blood and stop the reversal of blood flow within these abnormal veins. In the legs, these dilated varicose veins connect into larger surface veins, such as the saphenous vein, which connects the veins of the leg to the more central body veins leading to the heart. The treatment is to minimally invasively remove this connecting vein, which ultimately stops the pooling of blood within these varicose veins at the skin surface. The first step in this process is endovenous thermal ablation, which effectively closes these superficial bulging varicose veins, while keeping the larger deep venous system intact.
Q. What is sclerotherapy?
A. Sclerotherapy is a technique to treat small surface veins. Sclerotherapy involves injecting a small volume of irritant solution into a vein, ultimately causing it to close up over time. This technique is most often used in small surface spider veins (1-2mm in size) and may have to be repeated over several treatment sessions.
Q. What is ambulatory microphlebectomy?
A. As with sclerotherapy, ambulatory phlebectomy is a procedure for treating surface varicose veins. Microphlebectomy involves making a few tiny 1mm incisions along the course of a varicose vein and removing portions of the vein through these tiny incisions. This procedure is performed at Oceana Vein Specialists in our office using local anesthesia.
Q. How is ambulatory microphlebectomy different than ‘vein stripping’?
A. Vein stripping is mostly a procedure of the past, which involves several larger incisions to be made to remove the larger veins of the legs. Vein stripping is performed in the hospital under general anesthesia, and is currently not the gold standard of care for vein treatment. Vein stripping is not the same as microphlebectomy. Microphlebectomy involves tiny 1mm incisions and is performed in the office under local anesthesia, and is generally well tolerated among patients.
Q. What is endovenous thermal ablation?
A. Endovenous thermal ablation is a generic name to describe the procedure to close and shutdown the main superficial feeder vein in the leg (the Great Saphenous Vein or the Small Saphenous Vein). There are 2 different types of endovenous thermal ablation procedure, depending on the energy source used to heat and damage the vein (one using radiofrequency and the other using laser). The general concept between these two procedures is similar. A small treatment catheter (similar to an IV) is inserted into the damaged vein and advanced to the upper leg region, all while being directly visualized with the Ultrasound machine. The physician will then numb the region of the vein using local anesthesia (lidocaine mixture). Once the area is numb, the treatment catheter will be activated which will heat and shut the damaged vein. This procedure usually takes about 45 minutes and you will be able to walk immediately after the procedure and resume normal activity.
Q. What are the two types of endovenous thermal ablation?
A. Radiofrequency Ablation (The Closure Procedure) and endovenous laser ablation (The VenaCure Procedure).
Q. How is radiofrequency ablation (The Closure Procedure) different than endovenous laser ablation (The VenaCure Procedure).
A. Studies have reported that patients treated with radiofrequency ablation experience less pain, fewer complications, less bruising and had improvements in quality of life faster than those treated with endovenous laser ablation. Due to these beneficial outcomes Oceana Vein Specialists solely perform Radiofrequency Ablation (The Closure Procedure).
For more information and study results, please visit:
Q. What anesthesia will be used?
A. Oceana Vein Specialists perform all of our Vein ablation procedure using local anesthesia (a small injection of lidocaine solution to numb the region).
Q. Is RFA (The Closure Procedure) covered by my insurance?
A. Insurance companies determine coverage for the radiofrequency ablation procedure based on medical necessity. Most of the time, private insurance, Medicare, and MediCal will pay for the ablation procedure. It is important that you receive treatment from an office that is experienced with dealing with insurance companies and can advocate on your behalf for coverage. Since Oceana Vein Specialists is dedicated 100% to vein care, we are highly experienced at obtaining and verifying insurance coverage for venous procedures.