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Varicose Vein Removal
Part 1 of 3 with Dr Alissa Brotman-O’Neill
The most common reason to visit a vein center in NJ is for the evaluation of spider and varicose veins. Most of us have an image of varicose veins and it’s simply not pretty. They are large veins that bulge out from underneath the skin and twist and turn on themselves. Varicose veins are larger than spider veins, but share a common pathology in venous insufficiency.
What is Venous Insufficiency?
Venous insufficiency is a common medical condition that affects nearly 25-30% of Americans. It has a strong genetic predisposition and becomes progressively worse as we age. Because it is genetic, the condition can affect the young and old.
So what gives? Venous insufficiency occurs when the veins in our legs become overwhelmed due to dysfunctional valves. Blood moves in one direction from the legs towards your heart. This is a considerable amount of work against gravity and the veins underneath our skin don’t have much muscle to perform the job. For this reason, individuals are at risk when their work requires prolonged standing or sitting during the day. Over time, excess blood accumulates in the legs and increases the pressure in our veins. Ultimately, that pressure is released into newly formed spider and varicose veins.
Varicose Vein Treatment
Varicose veins are now treated through minimally invasive procedures, which help the vein seal off and heal from within. Our vein doctors in NJ today will discuss their preferred methods for varicose vein treatment.
Our first vein doctor to discuss her preferred vein treatment methods is Dr Alissa-Brotman O’Neill.
Dr. Alissa Brotman-O’Neill is an accomplished vascular surgeon and vein specialist in Princeton NJ. She also has a satellite vein clinic in Mt. Laurel NJ. She is skilled in applying cutting-edge, minimally-invasive endovascular technology for the treatment of spider and varicose veins. Dr. Brotman O’Neill is a leader within the field of venous disease and currently serves as the President-elect of the NJ Vascular Surgical Society.
I don’t think you will find too much debate about what the best varicose vein treatments are between top vein specialists. We are in a unique time where modern medicine is mostly practiced with minimally-invasive techniques. This is the same for varicose vein treatment. Vein doctors generally have 1 or 2 preferred tools they use for vein removal. As a vascular surgeon, I have trained in both simple and complex vein disease. This sort of sets me apart from many of my colleagues.
Because varicose veins are often attributed to venous insufficiency, the goal of vein treatment is to fix the underlying problem. In this case, it is the dysfunctional saphenous veins that are just underneath the skin. In the past, vein stripping was performed, however, this procedure is out-dated and completely unnecessary at this time. Instead, I prefer RF vein ablation as the main tool for vein treatment.
What is RF Vein Ablation?
RF vein ablation is a minimally invasive technique now considered the gold standard of vein treatment. It has a success rate well over 95% and is performed under local anesthesia. There are no cuts or sutures involved. That is the very definition of a minimally-invasive procedure. After RF ablation, patients can immediately return to most of their normal activities. There is no pain with RF ablation, other than setting up the local anesthesia. After treatment, most patients will take up to a week to notice the difference in how their legs feel.
RF vein ablation is great for the underlying problem, however most patients also want to get rid of their spider veins and varicose veins on the surface. Treating the underlying problem makes this more realistic. I subsequently will work with my patients to determine a plan on sclerotherapy or microphlebectomy that best suits the needs of the individual.
Sclerotherapy gets a lot of attention because it is used to treat spider veins successfully. Sclerotherapy is a medical solution (sclerosant) injected directly into tiny veins that causes veins to collapse and disappear. It is ideal for spider veins and reticular veins, however, varicose veins are unlikely to resolve with sclerotherapy alone.
Foam sclerotherapy is a mixture of air and the sclerosant that gives the medication a little more volume. Varicose veins can then be injected visually or with ultrasound guidance. Over time, the medication will lead to the breakdown of the vein and also cause it to collapse. Larger veins take time to disappear which can be disappointing for patients. It’s also not uncommon to require multiple foam sclerotherapy sessions to achieve the end result. During the healing phase, large varicose veins injected with sclerotherapy can cause hemosiderin staining and phlebitis.
It is for this reaons, I also utilize microphlebectomy for larger veins. This procedure is still minimally-invasive and completely done under local anesthesia. It is not vein stripping which is what gets patients concerned.
During microphlebectomy, the veins are marked on the skin and tiny incisions are made (that will disappear). The varicose veins are then direcly removed from underneath the skin using a very fine tool. The procedure takes about 45 minutes to 1 hour and after completion, the visible varicose veins are completely removed. Any smaller varicose veins or spider veins can be injected with sclerotherapy.
Dr Alissa Brotman-O’Neill is a board-certified vascular surgeon and vein specialist at Princeton NJ and Mt Laurel NJ. She is also board-certified in Vascular Imaging with RPVI.
The Princeton Vascular Center is one of the premier vein centers in NJ with several locations across the state. As part of our committment to be the best vein center near me, our vein doctors are sourced from the best training programs in the country and board-certified. To schedule a consultation with one of our top vein specialists, you can book an appointment online, or call 609-257-2095.