If Conservative Therapy Doesn’t Give You Enough Relief... Sometimes patients don’t find they get significant relief of their symptoms after a period of  conservative therapy.  You will meet with Dr. Vazales or James Gracy, PA-C, again once your  conservative therapy time is completed to review a recommended treatment plan. A  determination of medical necessity (usually covered by most insurance plans) versus  cosmetic (not covered by insurance plans) will be discussed with you.  Procedures -  outpatient, performed in a doctor’s office - are then often recommended. Historically,  surgical treatment required a lengthy hospital stay after a “stripping” procedure where the  veins in the leg causing the problems were removed. The recovery was often long and  painful. Today, there are several different treatment options that can be performed with little  discomfort right in the office.   We perform several different procedures for treating varicose veins in our office.  The  treatment plan prepared specifically for you is dependent on the problems you have.  The  goal of treatment is to obliterate the weak and non-functioning superficial vein. The laser  procedure is endovascular (meaning inside the vein), not superficial or on top of the skin.   Two other two procedures are micro phlebectomy, which is removal of a small segment of  vein via a tiny incision, and sclerotherapy, which consists of small injections into the vein.  A  topical numbing cream and local anesthetic are used for these three procedures.  All  procedures are performed in our office with minimal downtime.  You walk out and can do  your day-to-day activities; however, we recommend no strenuous or heavy aerobic activity  for one week.  Follow-up ultrasound tests are performed which are very important to make  sure your treatment has been successful and your symptoms have improved.  And As To Those Little Spider Veins... After completion of your treatment plan, most if not all of your large veins will disappear.  However, you may have some residual, smaller spider veins. Or you may never have had  varicose veins at all, just unsightly little spider veins.  These veins typically do not cause  symptoms but can be bothersome from a visual perspective. There are many painless cosmetic  options available to reduce, if not eliminate, superficial spider veins ranging from  sclerotherapy to superficial laser treatment.  Endovascular laser ablation  is a minimally invasive  procedure that can easily  and safely be performed in  a physician's office..   Ambulatory micro phlebectomy  is a method of interrupting or  removing a large, bulging  varicose vein; usually this  procedure follows laser closure  of the vein that feeds that  varicosity (varicose vein).  Sclerotherapy is a common  treatment used for small-  to medium-sized veins and  is easily performed in our  office with minimal to no  discomfort.              Where You Start...            OUR FREE VEIN SCREENING! We offer a free vein screening appointment to initiate our varicose vein  diagnosis and treatment process.  During this screening with one of our  highly trained clinical staff, we identify symptoms you may be  experiencing related to your varicose veins.  Symptoms include pain,  swelling, tiredness, ulceration, skin color changes, fatigue, itching, and  cramps.  We also discuss vein anatomy and venous reflux disease (blood  going the wrong way in your veins).  At your screening, you begin conservative measures such as increased  walking and exercise every day, elevating your feet, taking over-the-  counter medications like ibuprofen or Tylenol® for pain and, most  importantly, wearing compression hose prescribed by your healthcare  provider. Over-the-counter compression hose are good but prescription-  strength compression hose are more effective at alleviating symptoms.   Some insurance companies will pay for your prescription hose. Even if  they don’t, almost all insurance companies will require these  “conservative measures” for a set period of time before they will  consider paying for any surgical treatment. Most people do find their  discomfort is reduced by following conservative measures.  If we determine an ultrasound is indicated, we schedule it for you here in  our office.  Ultrasound Diagnostic Test and Consultation The venous ultrasound gives us additional information regarding your veins and helps us  decide which treatments would be the best for you.  After the ultrasound report is obtained, Dr. Vazales reviews your history, ultrasound results,  and indications for treatment (medical necessity vs cosmetic).  We will call you or mail you a  card for a consultation appointment with Dr. Vazales and/or James Gracy PA-C to review your  test results and confirm your diagnosis.  Your trial of conservative therapy will continue as required by your insurance company.