Jeffrey W. Kronson, MD

It is commonly thought that a patient should wait until all children are borne before proceeding with treatment for venous insufficiency, commonly presenting as varicose veins. In fact, addressing the "venous reflux" will make symptoms more tolerable during pregnancy when the uterus enlarges, compresses the veins and causes valve dysfunction.

Many different pathways of relux are present in our venous sytems so it is not surprising that a new vein popped up after EVLT. There are other places where the vein can be sealed to prevent this from happening. Unless most of the superficial "reflux" has been addressed (sometimes meaning more than one procedure), the spider veins will keep recurring.

You have a mildly prominent external jugular vein that is visible when you speak. Pick a favorite female singer and watch them hit the high notes. All the veins stick out on their neck becasue of incressed venous pressure with the air you exhale. This normal. One could have it removed but it would be hard to find a surgeon to do it. The scar would be worse. Hopefully, you can try to accept that is normal. Check out Gwen Stefani or Mariah Carey.

Very small lipomata can be removed as described through a "punch biopsy" size hole as they can be expressed through it  with pressure. However, larger ones require local anesthesis in the operating room. A smaller incision (than the size of the lesion) can still be made and heal with nice cosmetic results in these larger lesions.

Compression stockings help with varicose veins when they are worn by the patient, but not after they are removed. They act by compressing the valves in the veins, making them partially functional and lessing the venous reflux, or backward flow of blood, away from the heart. They squeeze some of the fluid out of the leg and can reduce swelling but of course, as soon as they are removed, their effectiveness stops.

Many insurance companies demand that the patient jump through this hurdle of "conservative therapy" before allowing the vascular specialist to procede with any procedure to treat the veins. Once the stocking therapy is documented for at least 6-8 weeks and the patient is continuing with symptoms, often a procedure to provide a long-lasting therapy for the vein problem is authorized.

Like most questions on this site, it depends. Chronic venous insufficiency, of which varicose veins are one consequence, is the most common disease in North America. In fact, if you add up diseases 2-5, they don't exceed CVI. It affects one in eight Americans, with over half being symptomatic.

Symptoms occur often and can range from pain, fatigue in the legs, bursting feelings, itchiness, burning and swelling all the way up to ulceration and skin breakdown.

Seeing a vascular specialist allows one entry into the system. A duplex ultrasound should be performed (a noninvasive pain-free test) that evalutes the patient's venous valves. Most PPO's allow treatment for symptomatic legs that have 500 milliseconds of reflux. That means the blood is flowing the wrong way in the veins for over half a second (away from the heart).

If this is present, insurance will often cover an ablation procudeure to rid one of reflux and removal of the varicose veins (often called microphlebectomy).

If reflux is not present (which it almost always is with large painful veins) the treatment may be considered cosmetic and then it's on the patient to cover the cost of laser/sclerotherapy or surgery. Hope this helps.

I have performed over 2500 VNUS Closure procedures and find that, although not infallible, the procedure releives 90% of symptoms in 90% of patients. As the Great Saphenous Vein is the main source of venous reflux (chronic venous insufficiency) in over 85% of patients, ablating it alleviates the problem. Though endovenous laser ablation is effective , the complication rates are, in fact, slightly higher and the time to perform the procudere is slightly longer. However, both are good options.

I do not recommend abalting the saphenous vein witrh sclerotherapy, foam or otherwise.

Asclera (Piloocanol) was recently approverd for use in the US after a long patent fight. It was used frequently in the 60's and 70's (80's?) by many vascular surgeons but there was a disagreement  about-wait for it- money and it was taken off the market. it was "smuggled" in by vascular surgeons for subcutaneous injection of spider telangiectasia and reticular veins for years from both Mexico and Europe as it was significantly more effective than either Sodium morrhuate or Sodium Tetradecol in many surgeons' opinions.

I have found it to be useful but it works better in combination with other therapy such as IR/RF laser. Hopet his helps.