What are varicose and spider veins?
Varicose and spider veins are veins that have walls which have become weak and stretched out causing them to become larger and more visible on the surface. This occurs because they have stopped working properly which results in pooling of blood and increased pressure inside the vein. They most commonly occur on the legs but can be seen on other areas of the body.
What are symptoms of malfunctioning veins?
Heaviness or tiredness of the legs, especially towards the end of the day, is a common symptom of incompetent veins. Pain can be also experienced and often described as aching or cramping of the calf and/or thigh. Restlessness or itchiness of the legs can be another symptom of vein insufficiency. Additionally, swelling or edema is frequently due to malfunctioning veins.
What are the risk factors?
There are many factors to the cause of varicose veins but genetics or family history appears to be one of the greatest predictors. Aging, obesity, pregnancy, and smoking also increase the risk of problem veins. Hormones play a significant role with women being more affected than men. Finally, long periods of standing or sitting as well as previous injury to the body or the vein itself can have negative affects to vein function.
What is Sclerotherapy?
Sclerotherapy is a treatment where a solution is injected into a vein. It is a procedure that can treat a wide range of veins, from small spider veins to larger varicose veins. The injection is performed directly into the vein causing irritation to the inner lining which results in collapse and closure of the vein.
Once the vein is closed, the previously experienced symptoms start to improve and often within days after the procedure. Both the visibility of the vein as well as the ability to feel the vein after the treatment can range from days for smaller veins to months for larger varicosities.
What is endovenous laser ablation (EVLT or EVLA)?
Endovenous laser ablation is one of the newest procedures established for treating large incompetent veins. EVLT uses a thin laser fiber to deliver a concentrated and precise amount of energy to the vein, resulting in long term closure.
The procedure is performed using a form of local anesthetic. Most veins, even very long segments, are able to be treated with a single poke of a needle to access the vein. Unlike surgery for vein stripping, it does not require general anesthesia which is one of the biggest risks with most surgeries. This results in virtually no downtime with minimal to no discomfort.
Is the consultation or the treatments covered by OHIP or RAMQ?
The consultation is covered under the Ontario Health Insurance Plan (OHIP) and partially under the Régie de l’assurance maladie Québec (RAMQ). Sclerotherapy of larger vein are most often covered under OHIP and a portion of the treatment appointment can be covered under RAMQ. Endovenous laser ablation is unfortunately not covered under OHIP or RAMQ.
The portion of the consultation and vein treatments that are not covered under RAMQ or OHIP can be submitted to personal health insurance for possible reimbursement. The spider vein or smaller vein treatments are often not reimbursed by personal health insurance.
Will the treatments hurt?
Sclerotherapy for spider veins and small veins is most often done with very small needles similarly used for injecting insulin or botox. Most patients describe the sensation similar to a mosquito bite. Sclerotherapy of varicose veins often only requires a butterfly needle which is commonly used for blood tests.
Local anesthetic is used when larger needles are required during sclerotherapy as well as for endovenous laser ablation. Certain veins can be sore after the treatment; however most patients don’t find it severe enough to take any pain medication.
How many treatment appointments are needed?
The number of treatments required varies with each individual. The initial assessment will help give an estimate number of appointments so patients can have an idea. It is always difficult to know the exact number due to the wide range in the type, size and number of concerning veins as well as the variability in response to treatment.
The number of appointments required to treat spider veins or smaller veins vary from patient to patient. People with fewer veins may only require 2 to 3 appointments where patients with a larger quantity may require 7 to 8 appointments or more.
Sclerotherapy of varicose veins can range from a single appointment to treat multiple smaller varicose veins to requiring 1-2 appointments to treat the entire length of a single larger varicose vein.
Regarding endovenous laser ablation (EVLT), the entire targeted segment of vein is typically treated in one appointment and additional veins can be done in the same appointment if required.