Your complete guide to EVLT/ EndoVenous Laser Treatment procedures! Part II

Part 2 starts on the day of surgery, if you have missed out on part one of the guide, click here: How to prepare for Endovenous Laser Treatment

Day of Procedure

You are required to be at The Vein Clinic an hour before your scheduled EndoVenous Laser Treatment so that Dr John Tan can do some marking on your legs to locate the varicose veins as well as to go through the treatment consents with you.

Marking of Veins

• You will first be directed to the ultrasound room where you will be seated on the treatment couch with your legs rested on the footstool. (In the exact same fashion you did for the ultrasound scan) Dr John Tan will use a device called the “Veinlite” to locate your bulging varicose veins, in which he will be treating with Needle Avulsion (also known as Needle Phlebectomy). Your veins will become more prominent when you are standing or sitting and less visible when you’re lying down because of the effect of gravity, hence it is important to mark out the varicose veins before surgery so that Dr John Tan can locate them and effectively administer the treatment during surgery.
• After marking your bulging varicose veins, Dr John Tan will move on to mark the deeper varicose vein/s that are to be treated with Endovenous Laser. Dr John Tan will use the ultrasound machine to locate the “leaking veins” and in the same fashion, mark the varicose vein/s that he will be treating.

Consent

• As part of the consent, Dr John Tan will be going through the treatment options as well as their pros and cons with you:
  • Local Anaesthetic: By injecting an anaesthetic agent into the skin layer of the leg, patients will be able to go through the surgery in a conscious state. Patients will only have to endure the initial needle pain for the anaesthetic, after the numbness takes over, they will not feel any more pain. Depending on how extensive the treatment will be, multiple injections might be needed.
  • Sedation: Patients who are afraid of needle pains can choose this option; they can sleep through the procedure instead. However, as safe as sedation can be, it adds risks to the procedure. Such risks include allergic reactions to the sedative medication and in very rare cases, respiratory depression – which is more common with patients who are more advanced in age. To prevent the occurrence of respiratory depression, your blood pressure, heart rate and breathing will be constantly monitored throughout the surgery.

Dr John Tan will be going through the Endovenous Laser Treatment and sedation consent in further detail with you.

After you have given your consent, your blood pressure and pulse rate will be taken. If you do not have a pair of compression stockings, the vein clinic will be measuring a pair for you. You will be briefed about post-treatment care and undergo financial counselling and billing before the procedure begins.

To be continued…

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

Related posts:

If you have varicose veins or spider veins, you may have been offered EndoVenous Laser Treatment to get rid of your varicose veins. So how does one prepare for such procedure?

Your complete guide to EVLT/ EndoVenous Laser Treatment procedures! Part I

Going for surgery in any capacity is no small issue. You’ll want to come fully prepared and make sure that nothing (as long as it is within your control) goes wrong. This guide will take you through step by step to prepare for your EndoVenous Laser Treatment procedure so that you won’t be caught in last minute jitters.

Before Procedure

After you have been offered the EndoVenous Laser Treatment for your varicose vein/s problem, your preparation will start the week before your scheduled surgery.

Medications

• If you are currently on blood thinner medications such as Aspirin or Warfarin, you should stop them 5-7 days before the surgery. This is so that the blood thinner gets cleared from the body and you won’t have to face significant bruising problems as well as other complications when Dr John Tan lasers off your varicose veins.
• If you’re on any diabetic medications, you should stop them on the day of fasting.
• For all other medications, you can continue them unless otherwise stated.

Fasting

Fasting is a very important step to take if you opt for sedation. It’s also a good precaution to take for those who opted for local anaesthesia- in case you change your mind on the last minute. This is so that your body will not have the sudden urge to throw up whatever you have eaten for breakfast while your varicose veins are being treated.

You will be advised to fast for 4-6 hours depending on your procedure:

• If you have decided to go under local anaesthesia, you can start fasting 4 hours before surgery.
• If you want to sleep through the whole procedure via IV sedation, that’ll be an extra 2 hour of fasting for you.
• If you’re undecided or unsure, just fast for 6 hours, then discuss it with Dr John Tan on the day of surgery.
• You should also stop your intake of water 4 hours before surgery.

Others

• You’re advised to wear comfortable and loose fitting clothes on the day of surgery because your leg/s will be wrapped up after the procedure.
• If you already a pair of compression stockings, please bring them along. If not, you can purchase one from the vein clinic on the day of surgery.
• Please refrain from driving because you may be given medications to relax or be under IV sedation. Alternatively, you could arrange someone to pick you up or simply take a cab home after the surgery.
• You are encouraged to take a shower before coming for the treatment because the next time you can clean your leg/s will have to be 48 hours after the surgery.

To be continued…

by Lorinda
Staff of The Vein Clinic & Surgery

Related posts:

Stockings are actually good for your veins.

While most people would relate the idea of stockings to that of a lady’s wear, stockings can be more than just a fashion accessory.

According to a study done by the America Association (2002), it is proven that surgical compression stockings can not only control the reflux resulted from the deficiency in the valves of the veins but also improve the calf muscle pump function. The study was conducted on patients who have suffered from venous insufficiency (patient who has varicose veins, spider veins, venous leg ulcers and Deep Vein Thrombosis), some of which had more advanced condition than others. At the end of the study, though some patients benefitted more in the area of controlled reflux compared to improved calf muscle pump function and vice versa, there is still overall significant improvement in the patients’ venous conditions. This goes to say that aside from seeking treatment, wearing these surgical compression stockings would be sufficient to provide support and prevent the venous conditions such as varicose veins and spider veins from deteriorating.

Even if you are not suffering from varicose veins or spider veins or other venous condition right now, wearing stockings on a daily basis would still be beneficial. They promote blood circulation and reduce the chance of “blood stagnation”; where the blood which was supposed to be pumped up to the heart gets pooled up in the veins, causing them to swell and become incompetent or dysfunctional; hence the formation of varicose veins. The stockings can also, in some cases, relieve aching, tiredness, swelling and cramps in the legs.

However, as much as stockings are beneficial to the veins, the tropical climate in Singapore does make it a hassle for many to include these compression stockings as part of their daily wear. In fact, not many would adhere to wear them even on a regular basis unless there is an absolute need to do so; for instance, the need to wear them for long plane rides.

Stockings are also prescribed in Vein Clinic for patients who just had treatment of varicose veins using Endovenous Laser Treatment or sclerotherapy.

References:
Zajkowski Paul, Proctor Mary, Wakefield Thomas, Bloom Jess, Blessing Beverlee and Greenfield Lazar (2002)
“Compression Stockings and Venous Function”
Published by Arch Surg/ American Medical Association
Retrieved on 29 December 2011 from www.archsurg.com

by Lorinda
Staff of THE VEIN CLINIC & SURGERY

Related posts:

Thrombophlebittis

What you have is called thrombophlebittis. This means that blood clot has formed inside the swollen veins (varicose veins) and this has caused inflammation to form around the area. The inflammation is often reactionary and may not mean you have bacterial infection.

Symptoms and complications of thrombophlebitis

Apart from being painful and tender, thrombophlebitis can also progress and give rise to the following problems

• Bacterial infection may set in and the area may developed into an abscess. The swelling will enlarge and you may begin to developed fever and feel unwell. At this stage the infected area will require surgical drainage
• Deep Vein thrombosis: The blood clot inside the swollen vein is by itself not dangerous. However, this clot can extend and clot may start to form inside the deep vein leading to the condition call Deep Vein Thrombosis. This is a more serious problem as the clot can dislodge and float to the lungs causing breathing distress which can be fatal in severe cases.

Treatment

You should see a doctor if you suspect that you have thrombophlebitis of your swollen leg veins. Treatment for this condition includes

• Ultrasound examination is necessary to study the extend of the clot and also to exclude the presence of Deep Vein Thrombosis. This will also provide the baseline by which future scan can be compared to study progression.
• Antibiotics may be needed if there is evidence of bacterial infection
• Compression stocking is useful for symptom relief as well as to prevent progression
• Treat the varicose veins:

You may also like to read my other posts

• Why Endovenous Laser Treatment is better than Stripping surgery for treatment of Varicose Veins
• Should I treat my varicose veins
• Does Frequent exercise cause varicose veins
• Tips on preventing Varicose Veins
• Frequent high heel cause varicose veins?
• Questions about Varicose veins and Spider Veins treatment

Do large ugly veins on your legs and hands trouble you? How do you tell whether those veins are normal or are they diseased veins? You have heard of terms like varicose veins, spider veins, reticular veins and hemangioma and you are not sure which one you have.

Let me start by saying that not every prominent vein you see on your body is diseased. Some of them may just be normal but clearly visible because you have a very thin layer of body fat.

For ease of understanding, I shall divide this blog into the following categories. Please bear in mind that this division may not be medically correct or comprehensive. Its intention is to cover commonly seen situation in a daily clinical practice.

• Prominent and swollen but normal veins
• Varicose veins
  • Spider veins
  • Reticular veins
  • Varicose veins
• Congenital (in born) abnormal veins
  • Hemangioma

Prominent but normal veins

The best example of this is prominent veins on the back of the hand. They are often seen in people who use their hand muscle a lot. The muscle activity increases blood circulation thus causing the veins to enlarge.

When present on the leg, it can sometime be difficult to differentiate them from varicose veins. They are often straight and evenly prominent unlike varicose veins that are tortuous and bulges unevenly .

These veins do not cause you harm and can be left alone. However, if you really hate the appearance, your doctor can remove them quite easily by doing Foam Sclerotherapy for you. This is a procedure where a chemical is converted into foam and injected into the vein to close it.

Varicose veins

These refer to veins that are abnormally swollen due to valve defect. They can be divided into 3 types according to size

1. Spider Veins

These veins are < 1mm in diameter and they appear purplish or reddish in colour. They are often present on the outer aspect of the thigh and back of the knee. As the name implies, they appear in clusters and often looked like spider webs.

2. Reticular Veins

These veins measures 1-3mm in diameter and they often appear together and near the spider veins. They are actually the feeder for the spider veins. They appear bluish or greenish in color and they are flat and don’t bulge from the surface.

3. Varicose Veins

These veins measures >3mm in diameter and they looked like snakes under the skin of the leg. They are very tortuous and bulges unevenly along it s path. Their color is dependent on the depth from the skin. The one near to the surface often appear blusih or greenish, but the deeper one appeared to be completely covered by the skin.

Hemangioma

These are veins that are not formed properly and they are present since birth. They can be found in any parts of the body, including the face, hand, buttock and leg. They vary in size and can range from a 1-2cm to large size covering the whole of a face or thigh or buttock.

You may like to read my other posts

• Why Endovenous Laser Treatment is better than Stripping surgery for treatment of Varicose Veins
• Should I treat my varicose veins
• Does Frequent exercise cause varicose veins
• Tips on preventing Varicose Veins
• Frequent high heel cause varicose veins?
• Questions about Varicose veins and Spider Veins treatment

1.What is vericose vein (typo from source)? Please explain.

Varicose veins are abnormally swollen or enlarged blood vessels in the leg caused by the weakening in the vein’s wall. Apart from being cosmetically unpleasant, varicose veins in their advance stages can be harmful to a patient’s health, because they may be associated with the development of one or more of the following conditions: inflamed tender vein, blood clot in the vein, and skin ulcers.

The reason varicose veins developed is not fully understood. The basic problem appeared to be that of damaged valves. Normally, the veins transport blood from the leg to the heart. In order for this to be possible, it has one-way valves to allow blood to travel in only one direction. In varicose vein, these valves have failed. Without the proper valve function, the blood tends to flow down (leaky), giving rise to blood pooling in the leg, thus causing the vein to bulge.

People who have varicose veins often have an inherited weakness of this valve. They may also give history of prolonged standing at work or multiple pregnancies, situations that will cause significant stress on the veins in the leg. These ultimately cause the veins to stretch and the valves to fail.

SYMPTOMS OF VARICOSE VEINS

These can be grouped into

* Asymptomatic-some patients has no symptoms at all apart from the veins being unsightly. They are usually very active physically and their active leg muscles compensate for the weakness of the vein function.

* Mild symptoms-aching and cramps in the leg, itchiness near the area of the veins and swollen ankle. All these are worse with prolonged standing.

* Severe symptoms and complications –leg ulcers, bleeding and thrombophlebitis

2.High heels is sometimes accused to be the culprit of this condition. Is it true? Is there other cause?

High heels can contribute to the formation of varicose veins but they are usually not the only factors.  The 3 main factors are inherited weakness of the veins, pregnancies and prolonged standing

a. Inherited weakness of the veins-patients whose parents have varicose veins may have inherited sets of veins. These get damaged when subjected to stressess like pregnancies and prolonged standing.

b. Pregnancies stressess the veins in many ways. Pregnancy causes an elevation of many hormones. Estrogen relaxes the smooth muscle and collagen fibres in general, which may contribute to the vein wall expanding. In addition, the amount of blood in the systems increases by up to 40% thus exerting additional stress on the leg veins. The large uterus in the pelvis can also impede return flow of blood in the veins thus causing congestion in the leg veins.

c. Prolonged standing. This explained why people who stands a lot at work have a tendencies to get varicose veins. Like hawkers

3.Who can get varicose vein? Does age worsen this condition?

As above. Varicose veins get more common and more severe as a person ages as the additional years mean more stress on the veins anad more damaged valves

4.Can varicose vein endanger you health in general?

Varicose veins is not merely a cosmetic problem. At a later stages, varicose veins can cause thickening and eczematous changes in the skin around the ankle area. Left untreated, the patient can developed large ulcers that is very difficult to treat.

Other complications of varicose veins includes profuse bleeding, infection and thrombosis of the veins. Patient with varicose veins are also at risk of developing Deep Vein Throbosis, a potentially life threatening conditions.

5.What can we do to prevent varicose vein?

This may not always be possible; however some simple measures and changes in our lifestyle can potentially delay the onset of varicose veins.

* Regular exercise will improve circulation and strengthen the veins. Focus on exercises that work your legs, like walking or running.

* Watch your weight. Obesity can put a lot of pressure on the legs and is known to cause spider veins.

* Do not cross your legs when sitting.

* Elevate your legs when resting or sleeping. To achieve this, the ankle should be place above the level of the heart. Try sleeping with 2 pillows under the feet, or lean on a couch and elevate the leg while watching TV

* Try not to sit or stand for long periods of time. When you have to sit for a long time, get up and take a walk every now and then. If you must stand for a long time, shift your weight from one leg to the other or do tip toeing exercises to improve circulation in the leg.

* Wear elastic support stockings as much as you can.

* Avoid wearing tight clothing and high heel shoes. They can constrict your waist and legs and impede circulation.

* Eat a well balanced diet with sufficient fibers and cut down on salt intake.

6.If you already have varicose veins, is there any treatment that you can go through?Is it invasive?

For the last 40 years, the only treatment available for varicose veins is an invasive surgery called stripping of varicose veins. Under general anesthesia, a few large incisions are made in the leg and the disease veins are completely stripped off. Post surgery, the patient ususally have to rest in the hospital for a few days. The pain is intense and patient usually cannot walk for a few days.  Patients are left with very unsightly scars. Furthermore, many studies have shown that about 25-30% of the varicose veins recurred after this surgery.

It is not surprising that it is extremely unpopular and most patients prefer to leave theis varicose veins than to go through this surgery.

Since 2002, THE VEIN CLINIC, Singapore has been treating varicose veins using an advance technique called ENDOVENOUS LASER TREATMENT. Endovenous Laser is a minimally invasive, clinically proven alternative to surgical vein stripping that effectively and safely treats varicose veins by using a laser fiber to deliver energy inside the vein, directly into the vein wall. The precise laser energy achieves optimal therapeutic effect while limiting collateral damage.

The procedure is performed under local anesthesia. A tiny laser fiber is first inserted into the diseased vein through a tiny opening in the skin. Laser energy is then delivered through the fiber, which causes the vein to close as the fiber is gradually removed.

With over 70,000 procedures performed worldwide, and over 60 clinical articles documenting its efficacy out to five years, EVLT is the proven alternative. Dr. John Tan has personally performed more than a thousand cases of Endovenous Laser Treatment with 99% success and no major side effect or complications.

Benefits of EVLT include:

1. Treatment in less than an hour

2. Can be performed in the doctor’s office

3. Up to 98% success rate

4. Immediate relief of symptoms

5. Minimal post procedure pain

6. Immediate return to activity

7. NO general anesthesia or hospitalization

8. NO scar

7.Where can you get this EVLT treatment?

THE VEIN CLINIC Singapore

290 Orchard Road,

#12-01 Paragon

Paragon

Singapore (238859)

Tel: (65) 9889 0288

Fax: (65) 6238 8566

www.theveinclinic.com.sg

email drjohntan@gmail.com

8.How long will the treatment last? Is it save?

about 30 minutes. Dr. John Tan has performed more than a thousand cases with no significant complications.

9.I’ve read about EVLT in your clinic, what are the benefits of this treatment?

as above

10.What are the consumer’s opinion about this treatment?

This technique has completely revolutionise the way we treat varicose veins. Patients are also more receptive to treatment because they know the treatment is safe and leave no scars.

My patients are very happy with the procedure. They come to the clinic at 9am in the morning, have the vein treated with virtually no pain and walk out of my clinic on their own about 2 hours later. THey are even more thrilled with the beautiful legs they get after the treatment. The needle marks are so small they healed without leaving any scars. With all the varicose veins gone and no visible scars, they can confidently go out in skirts again.

You may like to read my other posts

• Why Endovenous Laser Treatment is better than Stripping surgery for treatment of Varicose Veins
• Should I treat my varicose veins
• Does Frequent exercise cause varicose veins
• Tips on preventing Varicose Veins
• Frequent high heel cause varicose veins?

So it is natural that most patients, when confronted with the advice of varicose vein treatment, will asked
‘don’t I need that vein?’

A vein will become varicose or dilated when the valves along the veins are defective and are not closing properly. This will mean that flow of blood in that vein will be downward instead of upwards to the heart. This will result in pooling of blood in the leg leading to swollen veins.

We have a lot of veins in our legs. When one vein is varicose and defective, blood gets redirected and flow though the good veins. So closing or removing the diseased vein does not impair the ability of our leg veins to transfer blood to the heart. Conversely, by closing the varicosed vein we stopped the downward leak of blood thus reduces pooling of blood in the leg.

It is a medical paradox of sort. After the treatment, you are one vein short but your circulation actually become better.

By Dr. John Tan
On iPhone 4

You may like to read my other posts

• Why Endovenous Laser Treatment is better than Stripping surgery for treatment of Varicose Veins
• Should I treat my varicose veins
• Does Frequent exercise cause varicose veins
• Tips on preventing Varicose Veins
• Frequent high heel cause varicose veins?

However I personally think that wearing too much high heels can make your varicose veins worse.

When you are wearing heels >4 cm high, your use much less calf muscle when you are walking. Since calf muscle pumping is responsible for emptying and pushing blood in the leg to the heart, wearing high heels will lead to more pooling of blood in the calf. This will distend the veins in the leg and thus lead to valve dysfunction and ultimately give rise to varicose veins.

Therefore I always advice my patient who has varicose veins to wear heels < 4 cm high in their daily life. But I tell them it’s is ok to go ahead and wear their Jimmy Choo’s heels for that special occasion where they need to look their best.

Dr. John Tan

You may like to read my other posts

• Why Endovenous Laser Treatment is better than Stripping surgery for treatment of Varicose Veins
• Should I treat my varicose veins
• Does Frequent exercise cause varicose veins
• Tips on preventing Varicose Veins
• Don’t I need those veins?

The answer is no. On the contrary, walking and running is actually better for the health of your veins. The reason is that during walking and running, our calf muscles are actively pumping blood back to the heart. This will reduce pooling of blood in the leg and therefore reduced the distention of vein, thus prolonging the life span of your veins.

So if you ever need to stand or sit for prolong period of time, try to get up and walk around for 5 minutes at half hourly interval. If this is not possible, try to at least flex and point your feet repeatedly to activate your calf muscles.

Dr. John Tan

Read my other posts

• Why Endovenous Laser Treatment is better than Stripping surgery for treatment of Varicose Veins
• Should I treat my varicose veins
• Frequent high heel cause varicose veins?
• Tips on preventing Varicose Veins
• Don’t I need those veins?

1. Don’t stand or sit for prolonged period of time. If you are sitting for a long time, try to get up and walk for 5 minutes after half an hour interval. If you are standing, then do regular tip toe movements to pump your calf muscles. These actions will reduce the pooling of blood in calf veins and therefore reducing the stress and damage to your valves.
2. Wear support stocking in situations where the veins are under a lot of tensions
   1. During pregnancies
   2. If your work requires you to sit or stand for prolonged period of time
   3. When taking long haul flights. This is especially so if you are sitting in the economy class where the cramp environment prevents you from moving your calf muscles.
   4. If you already suffer from varicose veins or spider veins, support stocking not only relieve aches and pain in the leg, it also reduce the stress on the good veins and thus preventing new varicose veins from forming
3. Try not to cross your leg when sitting. This is a controversial area and not every doctors believe that this action has any role in the formation of varicose veins. My personal view is that crossing the legs do impede the venous blood return and therefore may add additional stress on your veins. It is not scientifically proven, but hey, what do you loose by not crossing your legs.
4. Don’t wear heels that are more than 3-4 cm high.
5. Avoid tight clothing which is tight and constrictive on the upper legs.
6. Exercise regularly. This will reduce pooling of blood in the calf.

Read my other posts

• Why Endovenous Laser Treatment is better than Stripping surgery for treatment of Varicose Veins
• Should I treat my varicose veins
• Does Frequent exercise cause varicose veins
• Frequent high heel cause varicose veins?
• Don’t I need those veins?