FAQs on Vein Disease & Treatment Answered by Dr. Wright

Q: In laser ablation, what does the laser actually do? Is it painful for vein patients? Are lasers better than sclerotherapy?

A: When a vein is refluxing, and its valves are not functioning properly, laser ablation is a quick and comfortable procedure to treat incompetent saphenous veins. Under local anesthetic, the refluxing saphenous vein below the skin, which is generally the cause of varicose veins, is accessed via a small puncture. Into this entrance a laser fiber is inserted, and the laser guided through the vain, and then fired. The laser light interacts with the water in your veins to heat seal the vein closed. This is a safe and procedure, and local anesthetic provides maximum comfort. The vein will close and problems associated with refluxing veins, including cramping and pain, cease.


Q: Do varicose veins always hurt?

A: Not all varicose veins cause symptoms, but in most cases, varicose veins announce themselves with not only visible, ropy veins but leg pain, cramping, fatigue, heaviness, tenderness and burning. Some people report an itching feeling from varicose veins, while some feel restlessness in the legs. Sometimes varicose veins do not produce symptoms of pain but can simply manifest as thick, ropy veins. In any case, this is a medical condition that requires treatment, as untreated varicose veins are not just a cosmetic issue, they are a medical problem and can cause ulcers and blood clots if left untreated.


Q: Is the endovenous laser ablation painful? How long does the operation take?

A: Great Question. I actually did a study on the comfort levels of patients undergoing endovenous laser ablation. Endovenous Laser Ablation requires about 5-6 needle punctures with a tiny needle to introduce local anesthetic to numb the skin and around the vein. This is not painful to the vast majority of people; most patients report this as being not uncomfortable, as the needle is very small and it numbs the area immediately with carefully administered anesthetic. After this, the area is numbed and the procedure is quite comfortable. On average my patient rated the discomfort of the procedure and recovery on a scale of 0 to 10, with 10 being most painful, and most rated it a 1. The procedure last about 45 minutes, after which normal activities may be resumed (except airplane flight or heavy lifting). It has proven to be a very comfortable and effective treatment for veins.


Q: I have large dark varicose veins in both legs. But I don’t want a procedure using needles and an incision. Which procedures do not need an incision?

A: There are several procedures to treat varicose veins that do not require incisions. After an ultrasound evaluation to determine whether a vein is refluxing in the saphenous vein/s, which often is the underlying cause of varicose veins, endovenous laser ablation or radiofrequency ablation can be done. Tiny needle punctures are the only invasive part of this procedure; there is no cutting or incision. If the vein is not refluxing and issues are confined to the varicose veins less deeply in the skin, these may be treated with sclerotherapy, which again does not require incision but just tiny needle injections.