Lasers are used for  a number of  medical applications throughout the body.  Recently, a novel technique using laser energy delivered endovenously (directly inside the vein) has been developed to treat varicose veins.  Endovenous laser treatment is performed under local anesthesia in Dr. Mackay’s office.  There is little to no scarring and a relatively short recovery period after the procedure.

Procedure
At your first visit, Dr. Mackay will interview you and take a medical history and examine your legs. Duplex ultrasound imaging (a machine which allows the doctor to see the blood vessels and record their size and shape) will be scheduled if necessary.  Photographs of the treatment areas will be taken.

You will return to the office periodically for Dr. Mackay to examine the treated vein. Doppler and duplex ultrasound evaluation will be done and additional photos may be taken.  Additional treatment sclerotherapy may be advised.

Repeat endovascular laser treatment using modified parameters is very rarely needed.

Risks and Discomforts
Results after endovenous laser treatment have been excellent.  It’s important to remember that each patient's results may vary; your symptoms of varicose veins may improve, remain the same, or worsen.

For most people, needle punctures into the vein do not cause any serious problems. However, they may cause dizziness, minimal bleeding, bruising, discomfort, pain, and rarely infection. Local anesthesia will be used to minimize discomfort. Rarely, people can have an allergy to lidocaine.

The potential side effects are thermal injury (burn) to the overlying skin or intervening tissue, perforation of the vein, breakage of the laser fiber, superficial phlebitis (inflammation of the vein), hyperpigmentation (darkening of the overlying skin), or neovascularization (growth of new veins).

Potential Complications of Not Undergoing Treatment
The potential complications of not undergoing treatment are often a worsening of the condition (an increase in the number of veins or enlargement in the existing veins).  In case of large varicose veins, spontaneous superficial phlebitis or bleeding may occur.  Patients with varicose veins associated with underlying venous insufficiency may develop ankle swelling and/or skin changes (eczema, hyperpigmentation, ulceration).

Alternative Treatments 
Since varicose veins and spider veins are not life threatening treatment is not mandatory. Some patients may get adequate symptomatic relief by wearing graduated compression stockings. Alternative treatments for varicose veins include surgical ligation and stripping, ambulatory phlebectomy, ultrasound-guided sclerotherapy, VNUS closure, or a combination of these treatments.

Potential Benefits
The potential benefits of the procedure are reduction in the size or closure of the treated varicose veins and improvement in varicose vein-related symptoms. Results to date, although early, have been very promising with essentially no recurrence and good cosmetic appearance.

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