Advanced Care for a Full Spectrum of Vein Diseases

A minimally invasive treatment that collapses and closes dysfunctional superficial veins that show signs of venous insufficiency or reflux. After treatment, blood flow is naturally rerouted through nearby healthy veins - improving appearance, restoring venous drainage and relieving symptoms such as pain, swelling and irritation.

This outpatient procedure is often done in the doctor’s office with a local anesthetic. Using ultrasound guidance, the doctor inserts a very thin catheter into the vein through a tiny opening in the skin. Ablation therapies include those that are heat based (thermal/laser) or non-heat-based (glue or cyanoacrylate). Ablation causes the vein to close off and, over time, shrink and disappear. The procedure is very well tolerated.

Endovenous ablation is very safe and leaves virtually no scars. Although complications are rare, they may include infection, bleeding, bruising and/or swelling around the treated area. Less common but possible risks include nerve damage and blood clots. Patients should discuss the risks and benefits of endovenous ablation treatment with their vascular surgeon.

A minimally invasive treatment, sclerotherapy is used to target smaller dysfunctional skin veins such as varicose and spider veins. It is particularly useful in patients with recurrent varicose veins and veins located in atypical locations. Sclerotherapy may be used for both medically necessary and cosmetic treatments of varicose veins. During the procedure, a chemical solution is injected directly into the vein. The medicine irritates the lining of the veins and causes the vein to close off and eventually be reabsorbed by the body. After treatment, blood flow is naturally rerouted through nearby healthy veins.

This is an office-based procedure and does not require anesthesia. Small veins will disappear in weeks while larger veins may take longer to fade - typically months. For some patients, multiple treatments may be necessary to achieve the desired results.

Sclerotherapy is a very safe and effective procedure with good results. Although complications are rare, they may include skin discoloration, itching, inflammation, swelling or the formation of small ulcers around the treated area. Less common but possible risks include nerve damage and blood blots. Patients should discuss the risks and benefits of sclerotherapy with their vascular surgeon.

Phlebectomy is a minimally invasive surgical procedure that permanently removes varicose veins through tiny incisions in the skin. It is often referred to as ambulatory phlebectomy (AP) because it can be performed in the doctor’s office under local anesthesia with minimal downtime. The incisions are small and heal very well.

The procedure is done by inserting a small hook through an incision in the skin and pulling the affected vein from the body, removing it completely. After treatment, blood flow is naturally rerouted through nearby healthy veins.

Phlebectomy is very safe and may be recommended as an alternative treatment in patients who, for whatever reason, are not medically eligible for endovenous ablation or sclerotherapy. Since the veins are fully removed from the body, the results are permanent. However, it does not prevent additional varicose veins from developing over time.

Patients should discuss the risks and benefits of ambulatory phlebectomy with their vascular surgeon and follow all pre-operative instructions carefully - certain medications may need to be reduced or stopped prior to the surgery.

Compression therapy refers to the use of special medical-grade compression socks or stockings, which, are designed to support the veins in your legs, improve drainage of venous blood out of the legs and back to the heart, reduce swelling and lessen pain. It is often recommended for patients who have symptoms associated with chronic venous insufficiency and to optimize results after a venous intervention. They are very important in maintaining both the health of your veins and your leg skin.

Compression stockings work by exerting external pressure on the veins and muscles of the lower legs, helping the blood to flow more efficiently and prevent blood from pooling in the legs. Increased emptying of the veins in the legs via walking and compression therapy allows the veins to loosen, decreasing venous pressure and helping to keep the blood moving towards the heart. They also reduce edema (abnormal fluid build-up) in the legs and ankles and improve the skin changes that sometimes occur with chronic venous insufficiency.

Percutaneous means “through the skin” and thrombectomy is a surgical procedure to remove a blood clot (thrombus) from a blood vessel. Therefore, a percutaneous venous thrombectomy is a minimally invasive procedure to remove a blood clot from a vein through a small incision in the skin.

During the procedure, which takes approximately 2-3 hours, the surgeon inserts special instruments through the skin and into the vein. Using continuous image guidance, the doctor dilates (expands) the vein and pushes out or removes the clot. This procedure may be used to treat patients with deep vein thrombosis (DVT).

After the procedure, compression bandages are applied to the leg to reduce swelling. Patients may be kept for observation for up to six hours after the procedure during which time they will be asked to walk for 15 minutes, rest for 45 minutes, and repeat.

Venous angioplasty is a minimally invasive, image-guided procedure to treat narrowed or blocked veins. Stenting is the placement of a mesh metal tube (stent) inside the vein to keep it open. Both procedures are typically done in the hospital.

Patients undergoing a venous angioplasty are typically given a mild sedative through an IV to help them relax during the procedure and the area where the incision will be made is numbed with a local anesthetic. A tiny incision is made and a thin guide wire is inserted into the affected vein. A thin, flexible tube called a catheter is placed over the guide wire and both are then moved to the part of the vein where the blockage or narrowing is located. A special contrast material injected into the blood vessel helps the veins show up clearly on X-ray images, helping the doctor navigate to the area of concern.

When the catheter reaches the narrowed or blocked area, a special balloon that is attached to the catheter is inflated to widen the passage through the vein. A stent may then be positioned in the area opened by the balloon. The catheter and the balloon are then removed and the stent is left in place to keep the vein passage open. Patients may be observed for several hours after the procedure and some may be kept in the hospital overnight.

Patients should discuss the risks and benefits of venous angioplasty and stenting with their vascular surgeon and follow all pre-operative instructions carefully - including any directions given for not eating or drinking before the procedure and/or stopping certain medications.

Also known as thrombolytic therapy, venous lysis is a procedure for patients with a vein that is completed blocked by a blood clot. With lysis, versus other treatments, the clot is not removed but instead is dissolved by injecting a clot-dissolving drug (tPA) directly into the clot.

A catheter is placed into the blocked vein to deliver the drug and the doctor may also use special instruments to break up the clot, allowing blood to flow while waiting for the medication to work. Most clots will dissolve within 24 hours but some may take several days; therefore, the administration of clot-dissolving medication may be continued for up to 48 hours.

Venous lysis is an essential, often life-saving procedure and should be performed as soon as a clot is identified to avoid permanent damage to the internal organs, including the heart, lungs and brain. The main risk associated with this therapy is severe bleeding - if bleeding is noted, treatment will be stopped immediately.

The gonadal vein is the blood vessel that carries blood away from the testicles (in men) and the ovaries (in women) and returns it to the heart. If this vein malfunctions, it can become enlarged with blood and cause pain and symptoms of pelvic congestion syndrome. Gonadal vein embolization is a minimally invasive, outpatient procedure that uses tiny particles (embolic agents) to close off the vein so it can no longer enlarge with blood.

The procedure is done with the patient lightly sedated so there will not be any discomfort. A small catheter is inserted in a leg vein and advanced into the gonadal vein using X-ray guidance. The particles are put in place to block blood flow to the vein and the catheter is removed. After treatment, blood flow is naturally rerouted through nearby healthy veins.

The inferior vena cava (IVC) vein is the largest vein in the body, responsible for returning blood from the lower body back to the heart. An IVC filter is a small metal device implanted in the vein to prevent blood clots from traveling to the lungs. It is a treatment option for patients with deep vein thrombosis who are unable to take blood thinner medications, either permanently or temporarily.

The IVC filter does exactly what its name suggests - it filters the blood traveling through the vein and traps any blood clots or blood clot fragments that may have broken loose and prevents them from traveling to the lung and potentially causing a dangerous pulmonary embolism. The trapped clot will ultimately be broken down by the body’s natural blood thinners - anticoagulants.

IVC filters can be temporary or permanent based on each patient’s medical profile, including their ability to take blood thinners and their overall risk for the formation of blood clots.

When determined to no longer be necessary, temporary IVC filters can be removed on an outpatient basis, typically under minimal sedation and with local anesthesia. Patients will be observed for a few hours after the procedure and discharged to home the same day in most cases. Normal activities may be resumed the next day.

Although most types of venous disease can be successfully managed with minimally invasive procedures, in some patients, surgery may be required to repair faulty valves, remove advanced vein obstructions or treat reflux problems such as those often associated with chronic venous insufficiency.

Valve reconstructions and vein bypass surgeries can be complex and are performed in an operating room under general anesthesia. Patients will typically be kept in the hospital for several days after the procedure and their daily activities may be restricted for up to six weeks.

The vascular surgeons at University Hospitals have the experience and advanced expertise to perform these microsurgical procedures and achieve optimal outcomes for their patients.

Embolization therapy is a minimally invasive and highly effective way to manage abnormal venous bleeding; to permanently close off blood vessels that are malfunctioning or supplying blood to a tumor; or, to eliminate abnormal connections between arteries and veins.

The surgeon makes a very small incision and inserts a thin, flexible tube (catheter) into the blood vessel being treated and, using X-ray imaging, the catheter is guided to the area of concern. Medications or synthetic materials (embolic agents) are then permanently placed within the vein to block blood flow. The closed vein eventually shrivels and is reabsorbed by the body. Blood flow will naturally reroute to nearby healthy veins. After the procedure, the doctor will withdraw the catheter, apply light pressure to stop any bleeding and cover the tiny incision with a bandage - no stitches are typically needed.

Patients should discuss the risks and benefits of embolization therapy with their vascular surgeon and follow all pre-operative instructions carefully - including any directions given for not eating or drinking before the procedure and/or stopping certain medications.