VEIN CLINIC

Vein Treatments

• What are Varicose Veins?
• Sclerotherapy
• Echosclerotherapy
• EVLT
• Compression Therapy
• Frequently asked Questions

What are Varicose Veins?

Veins and arteries, while both part of the circulatory system, function quite differently from each other.  “Poor circulation” is a nonspecific term which often refers to arterial blockages.  Arteries bring oxygen-rich blood from the heart to the extremities and can be thought of like a tube or hose.  Veins, unlike arteries, have one-way valves and channel oxygen-depleted blood back toward the heart.  If the valves of the veins don’t function well, blood doesn’t flow efficiently.  The veins become enlarged because they are congested with blood.  These enlarged veins are commonly spider veins or varicose veins.  Spider veins are small red, blue or purple veins on the surface of the skin.   Varicose veins are larger distended veins that are located somewhat deeper than spider veins.

Pain in legs is frequently related to abnormal leg veins.  Symptoms often made worse by prolonged standing, including feelings of fatigue, heaviness, aching, burning, throbbing, itching, cramping, and restlessness of the legs.  Leg swelling can occur.  Severe varicose veins can comprise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower leg.

Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem.  In addition to a physical examination, non-invasive ultrasound is often used.

What Causes Varicose Veins?

Heredity is the number one contributing factors causing varicose and spider veins.  Women are more likely to suffer from abnormal leg veins.  Up to 50% of American women may be affected.  Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease.  It is very common for pregnant women to develop varicose veins during the first trimester.  Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge.  In addition, the enlarged uterus causes increased pressure on the veins.  Varicose veins due to pregnancy often improve within 3 months after delivery.  However, with successive pregnancies, abnormal veins are more likely to remain.  Other predisposing factors include aging, standing occupations, obesity and leg injury.

When and How are the Veins Treated?

The most commonly asked questions are: “Do veins require treatment?” and “What treatment is best?”  Veins that are cosmetically unappealing or cause pain or other symptoms are prime candidates for treatment.  There are two general treatment options:  conservative measures, such as compression stockings, and corrective measures such as sclerotherapy, surgery and light source/laser treatment.  In some cases, a combination of treatment methods works best.

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SCLEROTHERAPY

Sclerotherapy involves the injection of special medications into varicose veins which cause irritation of the inner walls resulting in collapse and permanent closure of these veins.  The majority of varicose veins can be treated by sclerotherapy.  Even the saphenous veins may be removed by this method.  Sclerotherapy is done in the surgical centre and does not require loss of time from work or other activities.  It does not entail anesthesia and there is no scarring.

Following images: (top) ultrasound guided sclerotherapy; (middle) sclerosing agent injected in vein; (bottom) vein begins to disappear.

What can I expect from Sclerotherapy?

Sclerotherapy requires several treatment sessions, depending on your individual needs.  Each session takes about one hour and involves from 5 to 40 injections, according to the size and number or veins.  Most patents find the injections minimally uncomfortable – like a pin prick.  Bruising is normal and will fade in 2-3 weeks.  There is no need for time off work and moderate exercise is encouraged following treatment.  Compression stockings are worn for 7 days during the day following sclerotherapy treatment.

Are there any complications?

When larger veins are injected, it is fairly common to develop a firm, tender cord or lumps along the vein.  This is normal and simply indicated the vein has responded to the injections.  Occasionally, a brownish pigmentation may develop in the skin overlying a treated vein.  This gradually fades over a period of several months, but in unusual instances, some discoloration remains.  There are several rare but potentially serious complications.  As with the use of any medication, allergic reactions can occur, ranging from a slight rash or itch to a severe systemic reaction.  There have vein occasional reports of deep vein thrombosis and pulmonary embolism in the medical literature.  It is remotely possible to inject an artery or infuse medication outside a vein.  This can result in a skin ulcer or loss of tissue with resultant scarring.

Your first visit or consultation

At your consultation a Registered Nurse will take a general health history from you along with your blood pressure and leg measurements.  Pictures of your legs will also be taken for your record.  The doctor will then examine your legs from groin to toes.  A full duplex ultrasound of both of your legs will be done by the physician and then finally, the diagnosis of your problem will be reviewed with you and your treatment plan will be discussed.

Will the Varicose Veins recur?

The veins treated by sclerotherapy are destroyed and cannot reappear again unless the treatment has been incomplete.  However, sclerotherapy cannot alter your inherited tendency to form new varicosities.

How will the blood circulate?

Many patients ask how the blood will get back to the heart after the veins have been closed by sclerotherapy.  In fact, 90% of our blood return is handled by the deep venous system, which is never treated.  Only the superficial veins, which carry 10% of the blood, can become varicosed.  Moreover, varicose veins are not functioning properly so the blood has already found other veins to circulate through.

Helpful hints for treatment:

Before Treatment:

• avoid aspirin for one week to reduce bruising
• do not wax or shave your legs the day or treatment
• avoid using skin lotion prior to treatment (tape will not stick)
• remember to bring your support hose
• re-schedule if ill with fever or taking antibiotics
• avoid injections for two weeks period prior to vacation or travel
• eat regular meals to prevent feeling faint

After Treatment:

• wear support hose for 5 to 7 days
• walk for 10 minutes immediately following the injections
• walk or exercise regularly between treatments but avoid high impact exercise for 3 days
• elevate your legs for 10 minutes immediately following the injections
• if legs are uncomfortable, walk for 20 minutes, then elevate
• drink 6 – 8 glasses of water daily
• avoid sun tanning and hot baths in the week after treatment
• apply ice to lumpy, healing veins if tender
• if you have concerns, including pain, swelling, rash or hives call the office at (403(580-3545.

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ECHOSCLEROTHERAPY

Ultrasound guided sclerotherapy, also known as echo-sclerotherapy, is used to treat veins that are difficult to see and reach.  By using an ultrasound machine, deeper veins are easier to visualize, dramatically lowering the need for surgery.  This technique is appropriate for veins buried deep below the skin and for veins that recur after surgery.

A medication (sclerosant), which closes the insufficient vein, will be carefully injected and monitored on the ultrasound screen.  You will be asked to wear compression stockings for one week following the treatment to provide compression to assist in the collapse of the vein network. Success rates are high, but in some cases, a second injection will be needed at a later date. If a second injection does not close the vein, surgery will be recommended.

Possible Side Effects:

• The most common complication is an inflammation of the injected vein. It usually appears the first week and consists of a hard, tender cord along the injected site. The pain is usually minor and is relieved by the application of ice and the use of support stockings.
• There is always the possibility of an allergic reaction. This rare complication may range from a slight tingling sensation with red blotches on the skin to an anaphylactic reaction.
• Rare cases of deep vein thrombosis and pulmonary embolus can occur (<0.1% and 0.01% respectively)
• There are 2 other rare accidental complications that may arise from the sclerosing agent spilling in to the subcutaneous tissue, or introduced into an artery. Both will result in an ulcer that will eventually leave a scar. Permanent muscle damage is remotely possible. Feel free to call us with any concerns.

Return Visits:

You will need to come for a re-assessment of the vein after approximately four weeks. An ultrasound will determine how well the veins responded to treatment. There is no fee for this recheck, however, if a second treatment is required, the usual fee would apply.

Pre-Echosclerotherapy Information

1. Prior to the echosclerotherapy session, it is necessary to treat smaller veins with a dilute solution of medication to be sure the patient will not have an allergic reaction. This set of injections is done on a separate date.
2. You must have a medium strength pair of support stockings to wear home after the procedure.
3. The procedure itself takes 20-30 minutes, however scanning and bandaging add on time, so plan to be at the clinic for 60 minutes.
4. Try to avoid aspirin for 1 week prior to the procedure.
5. Eat a good breakfast!
6. Stand as much as you can the day of the procedure so your veins are easier to visualize. You may also want to stop wearing your support stockings a couple of days before the procedure.
7. Bring a pair of shorts to wear at the clinic, and some comfortable loose clothing for your travel home.
8. Long distance auto or air travel should be avoided for 4 weeks after your treatment.
9. You must notify us 48 hours in advance of an appointment change.

Post Echosclerotherapy Instructions

1. You will be asked to go for a walk for 30-60 minutes right after your echosclerotherapy treatment. 
2. Any leg discomfort should respond to leg elevation, leg exercise or ibuprofen.
3. If there is localized tenderness or lumpiness in the treated vein, apply ice for 15 minutes, four times a day.
4. At any time, if you are having more than mild discomfort, the clinic may be contacted.
5. Wear your compression stocking for the first 24 hours and then during the day for the next 6 days.
6. Exercise for 60 minutes each day until your next appointment.

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Frequently Asked Questions

Q: How much will treatment cost?

A: Treatment costs vary from patient to patient, depending on the extent of the vein problem that you have. Following your assessment by Dr. Wardell, a treatment plan will be tailor made to your specific problem and needs.  At your initial consultation, Dr. Wardell will review your history, do a detailed venous examination and discuss the reasons you are seeking treatment.

Q: What can I do to prevent varicose veins?

A:

• Seek prompt treatment for your varicose and spider veins as they appear. Early intervention can delay progression of varicose disease and the complications of varicose veins.

• Wear support stockings – especially if you spend a lot of time sitting or standing.

• Exercise regularly.

• Maintain a healthy weight.

Q: Should I seek treatment before pregnancy or wait until I have had my family?

A: Do not postpone treatment of varicose or spider veins. The elevated hormones of pregnancy can aggravate venous leg pain and worsen pre-existing varicose veins. It is wise to obtain treatment before you become pregnant. This way you can delay the progression of your vein problem and the onset of complications.
We can also help you with advice regarding leg care during and after pregnancy.

Q: Do men get varicose veins? Do they come for treatment?

A: Absolutely! Varicose veins are hereditary in many cases or related to standing occupations. Thus, they affect both men and women. Unfortunately, in the past, men were less likely to seek treatment. This is changing as men become more aware of the complications associated with varicose veins such as pain, swelling, bleeding, inflammation, ulcers and even blood clots. Frequently, men are also embarrassed about the appearance of their veins.

Q: Does treatment make sense for elderly people?

A: Yes. A reduction in activity as we age leads to pooling of blood in the veins. Thus, older people are more likely to experience the long-term complications of varicose veins. Timely treatment will help prevent these complications.

Q: Are there any complications?

A: When larger veins are injected, it is fairly common to develop a firm, tender cord or lumps along the vein. This is normal and simply indicates the vein has responded to the injection. Occasionally, a brownish pigmentation may develop in the skin overlying a treated vein. This gradually fades over a period of several months, but in unusual instances, some discoloration remains. There are several rare but potentially serious complications. As with the use of any medication, allergic reactions can occur, ranging from a slight rash or itch to a severe systemic reaction. There have been occasional reports of deep vein thrombosis and pulmonary embolism in the medical literature. It is remotely possible to inject an artery or infuse medication outside a vein. This can result in a skin ulcer or loss of tissue with resultant scarring.

Q: Will the varicose veins recur?

A: The veins treated by sclerotherapy are destroyed and cannot reappear again unless the treatment has been incomplete. However, sclerotherapy cannot alter your inherited tendency to form new varicosities.

Q: How will the blood circulate?

A: Many patients ask how the blood will get back to the heart after the veins have been closed by sclerotherapy. In face, 90% of our blood return is handled by the deep venous system, which is never treated. Only the superficial veins, which carry 10% of the blood, can become varicosed. Moreover, varicose veins are not functioning properly so that the blood has already found other veins to circulate through.

The EVLT Procedure

The latest and most promising therapy for varicose veins is Endovenous Laser Therapy (EVLT). It is an advanced, imaging-guided technique used to treat varicose veins resulting from a build up of back pressure due to leaky valves.

A catheter bearing a laser fiber is inserted under ultrasound guidance into the long saphenous vein through a small puncture at the level of the knee. The catheter is then advanced (also under ultrasound guidance) to the level of the groin. Local anesthetic is delivered around the entire length of vein to be treated (tumescent anesthesia). The laser fiber is then activated resulting in obliteration of the saphenous vein. As the laser is activated, the resulting heat at the tip produces a reaction in the walls of the vein, causing them to stick together. The varicosities associated with this vein then disappear as blood from the lower leg reroutes through the deeper circulation. The catheter is then slowly withdrawn and the saphenous vein is sealed along its entire length.

Foam sclerosant may be added through the catheter as required to treat large side branches.

Endovenous Laser Therapy is performed at Sante Surgi Centre in our procedure room under local anesthesia. This technique, which requires only a small nick in the skin at the level of the knee, takes about an hour to complete. Patients walk out under their own power and can usually return to work the next day.

A compression stocking is applied which must be worn for a full 7 days continuously (day and night).  Following the first 7 days a compression stocking must be worn for 5 weeks during the day.

The reported success rate for EVLT in the treatment of varicose veins is over 95%.

Following Endovenous Laser Therapy, patients can expect to recover quickly. There may be minor discomfort or “tightness” along the course of the treated vein for 2 or 3 weeks. Minor bruising is not uncommon, but usually clears quite quickly (within 1 to 2 weeks). Post-procedure pain is much less than comparable surgery.

EVLT treats the main superficial veins. Most visible varicose veins are branches of these main veins. Following EVLT it may take 6 to 8 weeks for these branches to shrink and in many cases disappear completely. After 8 weeks troublesome remaining branches may require ultrasound guided sclerotherapy. At Sante Surgi Centre, we typically use a combination of EVLT and foam sclerotherapy (administered at the same time as EVLT) to maximize the chance of a successful result.  Three additional follow-up foam sclerotherapy session are included with Endovenous Laser Therapy at Sante Surgi Centre.

Advantages of EVLT can be summarized as early recovery and less pain, no general anesthetic required, few or no scars, high success rate and low complication rate.

Disadvantages of EVLT are that it is not covered by provincial health insurance plans and long term success rates are unknown (though to date EVLT appears to be as good as if not superior to surgery).

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Frequently Asked Questions:

Q: How do I get to Sante Surgi Centre?

A: Sante Surgi Centre is located at 1424 Southview Drive SE (Suite #107) in Medicine Hat Alberta. There is plenty of parking located on site.

Q: What will happen during my consultation?

A: Following a thorough medical history, you will have a physical exam and complete ultrasound for evaluation of your leg veins. Digital photographs of your leg veins may be taken. The doctor will then discuss treatment options with you.

Q: How long will my EVLT treatment take?

A: EVLT treatment of a single leg typically takes about an hour. Occasionally, the procedure may last a little longer or shorter depending on the length of vein requiring treatment and other technical factors.

Q: What happens after EVLT?

A: Walking immediately after the procedure is encouraged. Normal daily activity can be resumed immediately. Vigorous physical activity such as working out or playing spots can usually be resumed within a week.
Following treatment, you will be required to wear a compression stocking day and night for 7 days. This helps the treated vein to seal properly. You will then be required to wear the compression stocking while you are up and active during the day for another five weeks. However, you may take the stocking off to shower or to go to bed.

Q: Can I drive immediately after EVLT?

A: No. If you are undergoing EVLT you should come with someone to drive you home since you may have received some mild sedation and will require some time to become accustomed to the compression stocking and bandages.

Q: What do I need to bring?

A: For your initial consultation, you should bring accurate lists of current medications and dosages as well as lists of allergies. These form a part of our record should you require further treatment.

Q: What about bathing and showering?

A: For the first 7 days (while the compression stocking is on) you should avoid getting the treated leg(s) wet. Careful sponge bathing is probably the best way to steer clear of soaking the compression stocking. Once you are no longer wearing the compression stocking during the day (i.e. after the first 7 days), you may bathe and shower normally.

Q: How successful is EVLT?

A: EVLT is a new therapy and data is still being gathered. Initial experience suggests that EVLT will have a success rate of over 95% (equal or better than surgical ligation).

Q: Is EVLT covered by AHC?

A: AHC does not cover EVLT, routine or ultrasound guided sclerotherapy laser or other cosmetic treatment of varicose veins.

Q: How much does EVLT cost?

A: The price for a cosmetic venous consult (including ultrasound evaluation) is $75.00. This cost will be deducted from any vein treatment you receive at Sante Surgi Centre within 90 days.

The price for EVLT starts at $2200.00 for one leg and $4000.00 for both legs when performed at the same time.

At Sante Surgi Centre, EVLT includes micro foam injection of the treated leg(s) at the time of EVLT as well as up to three follow-up micro foam sclerotherapy treatments.

We accept Interac, Visa, American Express or Mastercard payment.
EVLT is a tax-deductible medical procedure in Canada.

Financing is available through Medicard. Your choice... Fixed, equal monthly payments or Credit Card ... So easy! More people throughout Canada prefer Medicard to finance their procedures. Medicard is accepted across Canada for: Cosmetic Treatments Plastic Surgery Laser Eye Surgery Hair Restoration Orthodontics Dentistry Infertility Diagnostic Veterinary Treatments and more... Medicard's financing programs ensure that you don't delay your treatment due to cost concerns by offering you a variety of financing terms with convenient monthly payments. We will pay your doctor or service provider in full now and you can repay us in affordable monthly payments. Visit the Medicard Website to find out more about Medicard and how to apply (Note: Medicard will open in a new browser, Santé Surgi Centre is not affiliated with Medicard in any way other than we accept Medicard as a form of payment)

COMPRESSION THERAPY

As part of our complete health approach to vein care, we professionally measure each of our clients for compression stockings.  All of our staff are professionally certified fitters.  Stockings are an integral part of treatment here at Santé Vein Clinic.

We carry a complete line of Sigvaris compression stockings to suit your lifestyle.  Our stockings come in many different colors and styles.  We have socks, pantyhose, thigh highs in cottons, sheer and our new ultra sheer line.

WHY WEAR STOCKINGS?

Our stockings help by compensating for the weak valves in our legs.  They will stimulate the muscles in your legs to push the blood more efficiently back towards the heart.  This improves circulation and helps prevent the back flow of blood through the vein.

Benefits

• Helps prevent DVT or “Economy Class Syndrome” while traveling
• Improves the effectiveness of your vein treatment by 25% or more
• Improves circulation
• Helps prevent symptoms of aching, heavy, tired throbbing legs
• Helps prevent the recurrence of further varicose and spider veins

Before and After Photos
(NOTE: These photos depict actual results in selected cases. Your results may vary)

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SANTÉ SURGICAL CENTRE
#107 1424 Southview Dr
Medicine Hat, AB
(403) 580-3545