Total Vein Care

Endovenous Laser Therapy

Varicose veins are extremely common, occurring in 25% of women and 10% of men. Large varicose veins are often the result of blood flowing backwards through faulty valves. This reflux leads to increased pressure in the venous system and dilation of veins. The superficial venous system is most commonly affected. The great saphenous vein and the small saphenous vein are the two main veins in the superficial system. When there is reflux in either of these veins, the back pressure can cause other superficial veins to develop incompetent valves (valves that don’t close all the way) causing them to bulge. Factors that increase the chance of varicose vein formation are heredity, being overweight, pregnancy, prolonged sitting or standing, hormones and leg trauma. Varicose veins are often asymptomatic but cosmetically displeasing. Over time and without treatment varicose vein incompetency can lead to ankle swelling, skin damage and discolouration, phlebitis or inflammation, blood clots and leg ulcers.

Endovenous laser therapy, EVLT (also known as Endovenous Laser Ablation or EVLA) is a minimally invasive, outpatient procedure used to treat large varicose veins in the superficial system such as the great saphenous vein. Developed in Spain and New York in 1999 by physicians, EVLT has become an attractive alternative to traditional vein surgery for varicose veins. EVLT has a success rate of over 95-97% meaning that after 4 to 5 years the recurrence rate of varicose veins is less than 3-5%. These are superior results when compared with traditional surgical approaches. EVLT has a very low complication rate when compared with these other methods.

Endo Venous Laser Ablation is a minimally invasive option for treating saphenous vein incompetence (leaky valves). The first stage of your surgery will involve inserting a laser fiber at the level of the knee and feeding it up the greater saphenous vein (the root of your problem) under ultrasound guidance. Your leg will then be anesthetized with a local anesthetic agent. During the second stage of the treatment, the laser is removed slowly while firing. Firing of the laser inside the vein damages the inner vein wall and causes inflammation and eventually fibrosis that leads to closure of the vein. This will relieve the backflow pressure, which is causing your varicose veins. Following the procedure we will put you in a compression stocking which you will sleep in for 5 nights, and then wear for the next 14 days. Please note you are required to purchase 2 pairs of Grade II Compression stockings.

The superficial venous system is responsible for less than 5-10% of the return blood flow to the heart. The remaining superficial vessels and the deep system continue to return blood back to the heart. This procedure is very safe, mildly uncomfortable and involves minimal downtime. There will be no hospitalization, general anesthetic or stitches. The procedure itself takes 45 to 60 minutes but the total time required including before and after treatment is approximately 2 hours. You will be able to walk out of the clinic and resume normal activities the next day with the exception of prolonged standing and strenuous exercise.

The majority of individuals have uncomplicated treatments. Expected side effects include bruising, itching, burning and aching or pain in the laser treated or injected areas. Fainting or lightheadedness may occur before, during or after the procedure especially if you have a history of fainting. Bruising is increased if you take aspirin or other blood thinners. Uncommon and rare complications include loss of blood, pigment changes, blood clots, skin ulcerations, skin numbness or tingling due to nerve trauma, phlebitis (inflammation of the vein), infection, ankle swelling, telangiectasia, skin burns, scarring or allergic reaction. Eye damage can occur if protective goggles provided are not worn. The procedure may not relieve all of the symptoms of varicose veins and a small percent may show no improvement and will need re-treatment by the same or other methods. There may be risks not yet known associated with EVLT.

Smoking and being exposed to second hand smoke can lead to poor tissue healing and may increase the risk of infection and other complications.

Treatment is not recommended if you are pregnant or breastfeeding, have active infection or a recent history of a blood clot in the legs or lungs or are prone to blood clots, an unstable medical condition or are unable to ambulate. EVLT cannot treat very small or crooked veins.

Other options for treatment of varicose veins include conservative treatment with daily use of medical support hose, regular exercise, healthy eating, weight control and avoidance of prolonged standing and/or surgery such as vein stripping, ligation or phlebectomy. Radiofrequency ablation is another technology similar to EVLT. Ultrasound-guided sclerotherapy is an option for varicose veins of certain diameter. Choosing not to do anything is an option and the varicose vein disease may progress.

Conservative treatment can enhance any treatment option chosen as well as slow or prevent worsening of varicose veins and decrease the possibility of complications mentioned above but varicose veins may not be resolved by this method alone.

Surgery (stripping or ligation) is the “gold standard” for the treatment of saphenous vein reflux and is fully covered by provincial health care. A general or spinal anesthetic is needed, there is at least one incision at the knee and the groin which can cause scarring, at least one week of time off is required, there may be long wait periods for the procedure, the recurrence rate is approximately 25% at 3 years, surgical treatment of the small saphenous vein and repeat surgery have a higher recurrence rate and a higher chance of complications, major complication rates approach 1% (example: blood clot), minor complication rates approach 15% (infection, bleeding, numbness, tingling)

Ultrasound-guided sclerotherapy can be done in an outpatient office, requires no anesthetic, has no surgical scar, little “down” time, can treat veins that are difficult to treat with surgery such as smaller veins, has a lower complication rate than surgery and is associated with minimal discomfort. U/S-guided sclerotherapy may also be an option for treatment of the larger superficial veins (the great saphenous vein) when they are too tortuous or too small to treat with EVLT. U/S-guided sclerotherapy (USGS) in larger veins has a recurrence rate of up to 30% at 2 to 3 years, has a small risk of medication allergy of 3 in 1000 for a skin reaction and less than 1 in 10 000 to 1 in 50 000 may have a major allergic reaction. There is the risk of blood clot formation in the deep veins, as with surgery, of less than 1/1000 to 1/10 000. This is usually preventable with daily exercise. There is a very rare potential risk of skin or muscle damage if the medication is injected outside the vein or into an artery. There may be other risks associated with USGS. There is a fee for ultrasound-guided sclerotherapy.

It is important to know that varicose veins and spider veins are chronic and recurrent conditions. The variety of treatments available will not offer a cure, but rather a control of the condition. It is unlikely that laser-ablated veins will recur but other veins present may require further treatment.


Prior to the procedure you should:

· have an initial consult with Dr Meathrel or Dr Sangers and at which time an ultrasound of your leg(s) may be arranged. A follow-up appointment will be made to review the results and further discuss the options for treatment.

· apply a generous layer of anesthetic cream in a 6-inch wide band from the groin to the knee of the leg being treated. This will be equivalent to a 30g tube. Cover the cream with saran wrap.

· be given some sedating medication, lorazepam 0.5mg, to take 2 hour prior to the procedure. You may take a second pill 30 minutes later unless you are feeling very groggy. You should also have an anti-inflammatory to take after the procedure (naprosyn 500mg twice a day x 7days with food).

· arrange for transportation to and from the appointment. Because of the mildly sedating medication given 1hour before your procedure, you should not drive that day.

· notify at consultation or treatment if your medical situation.


During the procedure you may/will/should:

· wear protective eyewear during the laser treatment.

· feel discomfort from the freezing needles and perhaps some pressure as anesthetic fluid is injected around the treatment vein.

· not feel pain from the laser but may note a feeling of heat as it is being activated.


After the procedure you:

· should go immediately for a 20-minute walk.

· may return to your normal daily activities on the day following treatment, with the exception of prolonged standing and strenuous exercise such as weight lifting and jogging.

· may experience moderate bruising and some lumpiness and soreness in the treated area at 24hrs after the procedure and up until 7 days after the procedure. These and other local side effects will generally disappear within 1 to 2 weeks.

· may gradually resume exercise routines according to how your leg(s) feel.

· should walk 30 minutes per day for the next 2 weeks. (

· should avoid hot tubs and extended hot baths.

· should take ibuprofen 400 to 600 mg (2 to 3 regular strength tablets) 3 times per day or another anti-inflammatory as prescribed for 7 days.

· should keep your bandage on for 3 days and wear the support stockings for 7 days and 7 nights unless the doctor has given alternate advice.

· should remove the stocking if you are experiencing numbness, tingling, cramping or pain in your foot or calf.

· should call the clinic if you are experiencing leg swelling or pain (that is not relieved by anti-inflammatory medication), fever, chills, discharge or redness at the entry site of the catheter (the nick in the skin covered with a small piece of tape).

· should strictly avoid long automobile or plane trips for 4 weeks.

· should not drive or operate hazardous equipment until the next day due to the effects of the sedation medication, lorazepam (Ativan).

· should inform the clinic in the event of any unexpected admission to hospital within 10 days of the procedure.

· should follow-up at the clinic between 1 week and 1 month. An ultrasound may be performed at that time to confirm successful treatment. Most patients will need sclerotherapy for remaining superficial varicosities. Annual follow-up may be required.

· should contact the clinic at anytime if you have questions. We are here to help you and would like your experience to be a pleasant one.


NdYAG Laser Vein Removal

Spider veins are unsightly little red, blue or purple veins usually found on the face or legs. They can occur singly, in clusters or in combination with larger dilated veins called varicose veins. Cherry angiomas are benign tumors made from blood vessels. Spider veins or cherry angiomas are cosmetically displeasing but rarely cause medical problems. Other types of vascular lesions may also be treated with the NdYAG laser.

Spider veins less than 3mm in diameter can be treated with laser. UCosmetic uses the Harmony XL Nd:YAG 1064nm laser for spider vein and vascular lesion treatment. This laser can treat spider veins that sclerotherapy may not be able to treat.The Harmony Nd:YAG laser penetrates the skin to the depth of the spider vein and raises the temperature of the blood vessel causing it to clot. The treated vessel gradually shrinks and disappears. Most individuals require 4 to 6 visits 4 to 6 weeks apart. Each session is approximately 15min long. Laser light is pulsed over the spider vein and feels like a strong rubber band snap. Cooling is applied before, during and after the treatment to decrease discomfort. It is expected to see a decrease in number and/or colour of treated vessels after a treatment series is completed. Although good results are expected, with the focus on improvement rather than perfection, every person is unique and it is impossible to guarantee.

The majority of individuals have uncomplicated treatments. Expected side effects include redness and swelling which can last for a few days and possibly, discolouration or bruising that can last for a few months. Blisters may form. Bruising is increased if you take aspirin or other blood thinners. Rare complications include permanent pigment changes, burns and scarring. The risk of all side effects increases with treatment of facial veins because this is a more sensitive area. Eye damage can occur if protective goggles provided are not worn. Many of these side effects are worsened by sun exposure.

Smoking or second hand smoke exposure can lead to poor tissue healing and may increase the risk of infection and other complications.

The Harmony NdYAG laser cannot be used on veins near or on a tattoo or near the eye. Treatment is not recommended if you are pregnant or breastfeeding, have active infection or a tattoo at the site, if you have a sunburn in the treatment area or plan to have UV exposure in the immediate future, have a light sensitive disorder such as porphyria or light-triggered seizures. Certain medications such as thiazides (for high blood pressure), certain antibiotics (such as tetracyclines, fluoroquinolones, griseofulvin or sulphonamides), sulfonylureas (used to treat diabetes), phenothiazines (used to treat certain emotional problems or induce sleep), Accutane, Gold therapy, St John’s Wort and Ginkgo Biloba may increase your risk of side effects because of increased sensitivity to light.

Other options for treating spider veins are sclerotherapy if the spider veins are large enough. Other vascular lesions may be treated by surgical removal, AFT Photorejuvenation, camouflage make-up or not doing the procedure is an option. Facial spider veins may also be treated with high quality skincare products such as RevaléSkin and Obagi.

The Harmony NdYAG laser can only treat existing spider veins and vascular lesions. It does not prevent new ones from forming. When multiple varicose veins or tortuous varicose veins are present this is an indication of a problem with the whole superficial vein system and this would require another type of treatment offered by U Cosmetic.

Prior to the procedure you should:

· not shave your legs the day before or the day of your procedure.

· avoid sun exposure and tanning bed for 3 to 6 weeks before treatment.

· expect test patch treatments may be done prior to a full treatment to evaluate skin responsiveness if you have skin risks.

· notify at consultation or at your treatment appointment if you have a social or important event in the near future.

· notify at consultation or treatment if your medical situation changes.


During the procedure you may/will:

· feel discomfort like a sharp rubber band snap. If the treatment is very painful then let your technician know immediately.

· Appear pink, red or swollen in the areas treated or form a blister


After treatment you should/may:

· apply ice packs or cool compresses immediately following the procedure (for 20 minute periods, 2-3 times minimum) to decrease redness, swelling, bruising, discolouration and tenderness. This usually subsides within a few hours to a few days. Bruising and discolouration may last at a site from 2 weeks to 2 months or more.

· avoid sun exposure to the treated area but if unavoidable use a good quality sunscreen with an SPF of 15 to 30.

· resume normal day-to-day activities today and exercising in 3 to 5 days.

· shower with tepid water. Avoid exposure to hot water in baths, hot tub, or sauna for 1 week.

· apply Fucidin H cream if you blister after your procedure. This can be purchased at U Cosmetic or a prescription may be written. To prevent scarring and for optimal cosmetic result, do not pick, scratch or disturb blisters or healing wounds in anyway.

· notice an improvement immediately. This may be temporary as the vein spasms from the treatment. Improvement usually occurs over a 2-week period and in some cases may take up to 8 weeks or more after repeated treatments. The spider veins may initially turn darker red after treatment. This is part of the normal healing response.

· Contact the clinic at anytime if you have questions. We are here to help you and would like your experience to be a pleasant one.