Vein & Vascular FAQs

What is the difference between Hamilton Vascular and vein spas?

Most vein spas focus only on cosmetic procedures, like unsightly varicose or spider veins. At Hamilton Vascular, we can definitely fix cosmetic conditions, but we look beyond the surface. If we find underlying conditions, you can rest assured that we will come up with a comprehensive plan to treat them.

Will eliminating my varicose or spider veins harm my circulation?

No. Spider and varicose veins are veins that are no longer working properly. By eliminating them, your body will actually re-route blood flow to healthy veins, resulting in better circulation and a reduction in pain.

What is the difference between laser ablation (EVLT) and radiofrequency ablation (RFA)?

Patients treated with radiofrequency ablation experience fewer complications, less bruising, less pain, and an increase in quality of life faster than those treated with endovenous laser ablation. RFA is more precise, only heating the vein as much as it needs to shut it down. Lasers, however, can use excessive heat which leads to more complications. 

What is the recovery time for vein and vascular procedures?

The actual recovery time will vary depending on what specific procedure you receive, but we can say that most patients can return to their normal daily activities immediately. In some instances, more complex procedures may require a rest period of 24 hours.

Is heredity a major cause of vein and vascular issues?

Yes, it is. If your mother, father, or siblings had problems with their veins, you will be at a more increased risk. There are preventive steps you can take. Maintaining a healthy weight, getting plenty of exercise, and avoiding smoking are essential to avoiding vein and vascular issues.

What is a Vascular and Interventional Radiologist?

Interventional radiologists are board-certified physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. Interventional Radiologists use x-rays, ultrasound, and other imaging to advance a catheter in the body, usually into a vein or an artery to treat at the source of the disease with minimally invasive techniques.. As the inventors of angioplasty and the catheter-delivered stent, which were first used in the legs to treat peripheral arterial disease, interventional radiologists pioneered minimally invasive modern medicine. Today many conditions that once required surgery can be treated nonsurgically by interventional radiologists. Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery.

What is Interventional Radiology Training?

Interventional radiology is a recognized medical specialty by the American Board of Medical Specialties. Interventional radiologists are board-certified physicians with additional advanced training in minimally invasive, targeted treatments performed using imaging to guide them. Their board certification includes both Vascular and Interventional Radiology and Diagnostic Radiology which are administered by the American Board of Radiology.

What training does a Physician Assistant receive?

Physician assistants have been trained for thousands of hours, have graduate level education, and are certified – their training is similar to physicians. Our physicians and mid-levels truly work as a team and communicate extensively. They work closely with each other to discuss cases, diagnoses and treatments. Throughout your treatment, you will work with both doctors and mid-levels though your treatment is always supervised by the doctor. At Hamilton Vascular, our Physician Assistants maintain certification in ACLS and venous ultrasound and have received extensive specialty training in venous interventional techniques by Dr. Hamilton and other MDs.

What are varicose veins?

Varicose veins—which afflict 10% to 20% of all adults—are swollen, twisted veins that are close to the surface of the skin. Because valves in these veins are damaged, they hold more blood at a higher pressure than normal. This pressure forces fluid into the surrounding tissue, making the affected leg swell and feel heavy. Unsightly and uncomfortable, varicose veins can contribute to swelling in the ankles and feet and itching of the skin. They may occur in almost any part of the leg but are most often seen in the back of the calf or on the inside of the leg between the groin and the ankle. Left untreated, patient symptoms are likely to worsen and could lead to venous ulceration.

What causes varicose veins?

The normal function of leg veins – both the deep veins in the leg and the superficial veins – is to carry blood back to the heart. During walking, for instance, the calf muscle acts as a pump, contracting veins and forcing blood back to the heart. To prevent blood from flowing in the wrong direction, veins have numerous valves. If the valves fail (a cause of venous reflux), blood flows back into the superficial veins and down the leg. This backwards flow results in veins enlarging and becoming varicose. The process is like blowing air into a balloon without letting the air flow out again- the balloon swells. To succeed, treatment must stop this reverse flow at the highest site or sites of valve failure. In the legs, veins close to the surface of the skin drain into larger veins, such as the saphenous vein, which run up to the groin. Damaged valves in the saphenous vein are often the cause of reversed blood flow back down into the surface veins.

Why does it occur more in the legs?

Gravity is the culprit. The distance from the feet to the heart is the furthest blood has to travel in the body. Consequently, those vessels experience a great deal of pressure. If vein valves can’t handle it, the backflow of blood can cause the surface veins to become swollen and distorted.

Who is at risk for varicose veins?

Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes during menopause, work or hobbies requiring extended standing, and past vein diseases such as thrombophlebitis (i.e. inflammation of a vein as a blood clot forms.) In addition, women suffer from varicose veins more than men, and the incidence increases to 50% for people over age 50.

What are the symptoms?

Varicose veins can cause an achy feeling while feet and ankles may swell towards the end of the day. Varicose veins can get sore and inflamed, causing redness of the skin around them. In some advanced cases, patients may develop venous ulcerations.

What is the short term treatment for varicose veins?

ESES (pronounced SS) is an easy way to remember the conservative approach. It stands for Exercise Stockings Elevation and Still. Exercising, wearing compression hose, elevating and resting the legs will not make the veins go away or necessarily prevent them from worsening because the underlying disease (venous reflux) has not been addressed. However, it may provide some symptomatic relief. Weight reduction is also helpful. If there are inflamed areas or an infection, topical antibiotics may be prescribed. If ulcers develop, medication and dressings should be changed regularly. There are also potentially longer-term treatment alternatives for visible varicose veins, such as sclerotherapy and phlebectomy.

What is sclerotherapy?

A chemical injection, such as a saline or detergent solution, is injected into a vein causing it to “spasm” or close up. Other veins then take over its work. It is most effective on smaller surface veins, less than 1-2mm in diameter.

What is ambulatory phlebectomy?

Ambulatory phlebectomy is a surgical procedure for treating surface veins. Multiple small incisions are made along a varicose vein and it is removed using surgical hooks or forceps. This procedure is typically done under local anesthesia and in our office.

What is vein stripping?

Vein stripping is a procedure that is generally no longer used in the U.S. Historically, if the source of the reverse blood flow is due to damaged valves in the saphenous vein, the vein may be removed by a surgical procedure known as vein stripping. Under general anesthesia, all or part of the vein is tied off and pulled out. The legs are bandaged after the surgery but swelling and bruising may last for weeks.

When is radiofrequency ablation (RFA) used?

RFA is used to eliminate reverse blood flow in the saphenous vein. The reverse blood flow is stopped without physically removing the vein, and is performed without general anesthesia. Like other venous procedures, the RFA procedure involves risks and potential complications. Each patient should consult their doctor to determine whether or not they are a candidate for this procedure, and if their condition presents any special risks. Rare, but potential complications reported in medical literature include numbness or tingling (paresthesia), skin burns, blood clots and temporary tenderness in the treated limb.

What is the main difference between arteries and veins?

In simplest terms, arteries pump oxygen-rich blood FROM the heart, veins return oxygen-depleted blood TO the heart.

What are the three main categories of veins?

Deep leg veins return blood directly to the heart and are in the center of the leg, near the bones. Superficial leg veins are just beneath the skin and have less support from surrounding muscles and bones than the deep veins which may cause an area of weakness in the wall. When ballooning of the vein occurs, the vein becomes varicose. Perforator veins serve as connections between the superficial system and the deep system of leg veins.

What are venous leg ulcers?

Venous ulcers are areas of the lower leg where the skin has died and exposed the flesh beneath. Ulcers can range from the size of a penny to completely encircling the leg. They are painful, odorous open wounds which weep fluid and can last for months or even years. Most leg ulcers occur when vein disease is left untreated. They are most common among older people but can also affect individuals as young as 18.

How does it work to treat superficial venous reflux?

Since valves can’t be repaired, the only alternative is to re-route blood flow through healthy veins. Traditionally, this has been done by surgically removing (stripping) the troublesome vein from your leg. The radiofrequency ablation (RFA) procedure provides a less invasive alternative to vein stripping by simply closing the problem vein instead. Once the diseased vein is closed, other healthy veins take over and empty blood from your legs.

How is the RFA different from vein stripping?

During a stripping procedure, the surgeon makes an incision in your groin and ties off the vein, after which a stripper tool is threaded through the saphenous vein and used to pull the vein out of your leg through a second incision just above your calf. In the RFA procedure, there is no need for groin surgery. Instead, the vein remains in place and is closed using a special (Closure) catheter inserted through a small puncture. This may eliminate the bruising and pain often associated with vein stripping (i.e., that may result from the tearing of side branch veins while the saphenous vein is pulled out). Vein stripping is usually performed in an operating room, under a general anesthetic, while the RFA (VNUS Closure procedure) is performed on an outpatient basis, typically using local or regional anesthesia.

Is an RFA (VNUS Closure) procedure painful?

Patients report feeling little, if any, pain during the procedure. Your physician will give you a local or regional anesthetic to numb the treatment area.

How long does an RFA procedure take?

The procedure typically takes about few minutes, though patients normally spend one hour at the medical facility due to normal pre- and post-treatment procedures.

Will the procedure require any anesthesia?

The vein treatment can be performed under local, regional, or general anesthesia.

What happens to the treated vein left behind in the leg?

The vein simply becomes fibrous tissue after treatment. Over time, the vein will gradually incorporate into surrounding tissue. One study reported that 89% of treated veins are indistinguishable from other body tissue one year after the Closure procedure was performed.

Is the RFA procedure suitable for everyone?

Only a physician call tell you if the procedure is a viable option for your vein problem. Experience has shown that many patients with superficial venous reflux disease can be treated with the RFA (VNUS Closure) procedure.

Is age an important consideration for the RFA vein procedure?

The most important step in determining whether or not the procedure is appropriate for you is a complete ultrasound examination by your physician or qualified clinician. Age is not the only factor in determining whether or not the vein procedure is appropriate for a patient. The RFA procedure has been used to treat patients across a wide range of ages and has very high efficacy rates.

How effective is the RFA (VNUS Closure) procedure?

Published data suggests that two years after treatment, 90% of the treated veins remain closed and free from reflux, the underlying cause of varicose veins.

Are there any potential risks and complications associated with the procedure?

As with any medical intervention, potential risks and complications exist with the procedure. All patients should consult their doctors to determine if their conditions present any special risks. Your physician will review potential complications of the procedure at the consultation, and can be reviewed in the safety summary. Potential complications can include: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia (numbness or tingling) and/or skin burn.

Is there any scarring, bruising, or swelling after the procedure?

Patients report minimal scarring, bruising, or swelling following their vein procedure.

How soon after treatment will my symptoms improve?

Most patients report a noticeable improvement in their symptoms within 1-8 weeks following the procedure. Many patients report immediate relief.

How quickly after treatment can I return to normal activities?

Many patients can resume normal activities immediately. For a few weeks following the treatment, your doctor may recommend a regular walking regimen and suggest you refrain from very strenuous activities (heavy lifting, for example) or prolonged periods of standing.

What are patients saying about the RFA (VNUS Closure) procedure?

98% of patients who have undergone the procedure are willing to recommend it to a friend or family member with similar leg vein problems.



How much does it cost?

Your Patient Care Coordinator can gather some insurance information and run a free quote before you get started. Treatment costs depend on your condition, what tests you require, and what type of insurance you have. We are pleased to accept most major commercial insurers as well as Medicare, Medicaid, and Tricare. Please note, we practice completely transparent and up-front billing.

Does health insurance pay for varicose vein treatment?

Health insurance coverage varies by provider and by policy. However most health insurance policies will pay for varicose vein treatment depending on the conditions below -

Abnormal Blood Flow: Most policies require abnormal blood flow in the veins which is evaluated by a Duplex vascular ultrasound. This test is non-invasive (no needles).

Severity of Disease: If the patient has pain from the varicose veins not controlled by conservative therapy (including compression stockings, exercise, weight loss if necessary and leg elevation) or skin changes due to the varicose veins (including a reddish rash known as venous eczema, dark skin around the ankles or ulceration) then insurance is more likely to cover the treatment.

Cosmetic: If the varicose veins are only unsightly and don’t cause any physical problems, this issue is cosmetic and is not covered by health insurance.

We will work with your insurance company to determine if your treatment can be covered. We accept most major insurances including Medicare and Medicaid.

Is the RFA (Closure) treatment covered by my insurance?

Many insurance companies are paying for the vein procedure in part or in full. Most insurance companies determine coverage for all treatments, including the radiofrequency ablation procedure, based on medical necessity. The VNUS Closure procedure has positive coverage policies with most major health insurers. Your physician can discuss your insurance coverage further at the time of consultation.


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