28, 6, 2020

3-Stage Approach to Vein Treatment


When visible signs of venous disease such as spider veins, varicose veins, or skin changes are present, this is usually the tip of the iceberg, and an underlying vein problem is present. An underlying vein condition (venous reflux disease) can be detected with ultrasound. A treatment plan is focused on treating the underlying vein problems first, then working outwards.

image of an Iceberg as a metaphor for the hidden dangers of vein disease

Iceberg, a metaphor for the hidden dangers of vein disease

How Is Venous Reflux Disease Treated?

Step 1: The Underlying ProblemThe first step is to treat the underlying problem, the venous reflux. The specific pattern of venous reflux was detected by ultrasound. Venous reflux usually starts in the saphenous veins. The saphenous veins are most effectively treated with vein ablation procedures. This involves placing a small catheter within the vein and using heat or a solution to produce injury and eventual closure of the vein. The most commonly used treatments for the saphenous veins are radiofrequency ablation (RFA), laser ablation, mechanico-chemical ablation (MOCA or Clarivein), and in some cases Varithena Foam. The treatment recommendation is customized, based on where reflux is present and other clinical factors.

Step 2: Varicose Veins

After the underlying saphenous vein reflux is corrected, the bulging veins (varicose veins) can be treated by injecting a foamed medication that will cause them to scar and eventually dissolve (foam sclerotherapy), or to remove them using tiny incisions. The most common method is foam sclerotherapy.  This is also known as ultrasound-guided foam sclerotherapy (UGFS).

Step 3: Spider Veins

Spider vein treatment is always considered a cosmetic procedure. If improved cosmesis is a goal of treatment, make sure to discuss this with your doctor and plan on having cosmetic treatment as the last step. Spider vein treatment is accomplished by sclerotherapy, which is an injection of a liquid medication into the spider veins. Most patients use 3 vials, and have an average of 3 treatment sessions.  Ask your provider for an estimate about how many treatment sessions/ vials are necessary to get the results you want.


3-Stage Approach to Vein Treatment2020-09-17T17:58:02-07:00

Varicose Vein Sclerotherapy Treatment: What to Expect


Ultrasound-Guided Foam Sclerotherapy

Ultrasound-guided foam sclerotherapy allows your doctor to treat backward flow (or “Venous reflux“) in superficial veins that are not visible to the naked eye but are causing symptoms including pain, swelling, and varicose veins.  Ultrasound allows us to localize the unhealthy veins, inject the medication precisely, and guide the medication towards areas of varicose veins. This minimally invasive treatment will be done in our office and does not require any anesthesia. A fine needle is placed into the vein and a sclerosant foam medication (polidocanol) is injected.  The brand names are Asclera and Varithena. The medication irritates the vein wall, which causes it to stop flowing, then eventually close down completely. The blood continues to return to the heart through other healthy veins.

Preparing for your procedure:

  • Bring your prescribed thigh-high compression stockings to every appointment. Please try on your stockings prior to your first appointment to ensure proper fit.  We do not recommend shaving your legs beforehand because the compression stockings may cause ingrown hairs.
  • On the morning of the procedure, shower and use antibacterial soap to cleanse the leg.
  • We recommend you eat a light meal before you arrive.
  • Our procedure rooms are equipped with TVs and Netflix, but you are welcome to bring a book or iPad to use during the procedure if you prefer.
  • Please notify our office if you are scheduled to have any type of medical procedure or surgery 2 weeks prior to or after your treatment.
  • If you become pregnant or are breastfeeding, please notify your La Jolla Vein Care provider as your treatment will need to be postponed.


  • If you have asthma, please bring your inhaler to your appointment.
  • If your La Jolla Vein Care provider recommended a prophylactic blood thinner (e.g. Xarelto, Eliquis, or Lovenox) or an antihistamine (e.g. Zyrtec or Claritin), please take your first dose at least two hours prior to your procedure
  • If you were prescribed a blood thinner during treatment, continue to take it until your final ultrasound 3-7 days after the last treatment unless instructed otherwise.
  • If you already take aspirin or another blood thinner, you will continue it during treatment unless instructed otherwise.

The ultrasound-guided foam sclerotherapy procedure:

The ultrasound-guided foam sclerotherapy procedure

  • You will check-in 10-15 minutes prior to your appointment, then change into disposable shorts supplied by our office.
  • We will clean your leg(s) with alcohol. We will then use ultrasound to “map” the veins to be treated.  Each vein will be accessed with a tiny needle through which the foam medication is injected.
  • You will flex the foot prior to each injection and then do calf exercises (pointing and flexing the foot) between injections.
  • After the treatment is complete, we will elevate your legs on a wedge pillow for 10-15 minutes while you continue 20 calf exercises per minute.
  • We will then help you in to your thigh-high compression stocking, then you will walk around the medical campus for 30 minutes before getting in the car.

Medical Compression Stockings

Medical Compression Stockings

  • Wearing compression stockings is a part of your vein treatment. Your veins will not only heal faster, but compression stockings reduce the risk of complications
  • You will wear compression stockings continuously for 72 hours (3 days).  You can remove them to take a quick cool shower the day after treatment or you can shower in the stockings.
  • After the 72 hours, you will wear the stocking for an additional week during the day (for a total of 10 days after each procedure). The 10 days will start over after each treatment session.
  • For comfort, you can fold down the silicone band at the top of the stocking at night.
  • If your stockings are slipping down, try wiping down the silicone beads with rubbing alcohol to make them tacky again. We also have glue available for purchase at our office to help them stay up.
  • If you experience numbness, tingling, or discomfort on the foot, you can remove the stocking at night, then put it back on first thing in the morning.  Sometimes the stocking has to be cut to relieve pressure. Be sure to NOT cut the toe band of your stocking as this will cause the toes of your stocking to roll. Instead, cut a 1/2 to 1-inch long slit on the side and in the middle of the foot area. First, make a small cut; you can make it bigger if needed.


  • You can resume your usual activities on the day of treatment.  You can return to work the same day as long as you are able to walk and/or do calf exercises every hour.
  • Walk at least 30 minutes twice daily for 2 weeks after each treatment session.  There is no limit to how much walking you can do and inclines are okay.
  • Avoid pooling of blood in the legs by keeping the calf muscles active with heel raises, pointing/flexing the feet, and walking.  Avoid high heels.
  • When you are sitting, the more you elevate your legs the better.
  • Avoid running, spinning, other strenuous exercises, and exercise in hot environments for 2 weeks after each treatment session
  • Avoid hot tubs and leg massages for 2-3 weeks after treatment.


Travel Compression Stockings

  • Avoid long trips for the next 3 weeks.  For car rides over 1 hour, get out every 45 minutes and walk for 10 minutes.
  • On a long airplane trip, get up to walk around frequently, and flex your ankles every few minutes.
  • Wear your compression stockings during travel.

What to Expect Following Treatment

  • After treatment of dilated veins close to the skin (spider veins), it is normal for those veins to itch for a few hours.
  • Bruising at the injection sites is normal and will fade over about two weeks.  You may apply arnica or Recova cream to those areas.
  • Varicose veins may become firm and blue after treatment, then fade over a period of weeks. The skin overlying larger varicose veins may develop brown “hyperpigmentation” as the blood pigments within those veins are absorbed by the body.  This can take up to a year to fade.  Avoid exposing that skin to the sun until the pigmentation fades, so that it does not become permanent.
  • Aching and slight swelling is normal in the legs for several days after treatment, and generally improve with the following:
    • Walking 10-30 minutes is the most effective treatment.
    • Ice packs (or a bag of frozen peas or ice) over the sore veins, 15 minutes at a time, several times a day.  Protect your skin by placing a thin washcloth under the ice pack.
    • Anti-inflammatory medication such as ibuprofen (Motrin, Advil) or naproxen sodium (Aleve), taken as directed on the bottle.  If you cannot take those medications, acetaminophen (Tylenol) can be used.
    • For severe pain or pain that worsens with walking, promptly call the office.
  • Treated veins will look worse before they look better.  Initially, large veins may feel tender, firm, and/or lumpy. Please point out any lumpy and/or tender areas to the doctor.  The whole healing process may take several weeks to months.

Adverse Effects

Although rare, sclerotherapy can be accompanied by unwanted effects including trapped blood (a small amount of blood becomes trapped within the closed vein), hyperpigmentation of the skin (darkening of the skin), allergic reaction (rash, hives, or anaphylaxis), or infection.

  • Injection of the foam bubbles can be irritating to the body and cause symptoms including chest pain and headache.  We minimize this risk by giving you only a small amount of foam medication per day and by elevating your legs for 10-15 minutes after treatment.
  • Some patients develop “trapped blood” within larger varicose veins days to weeks after treatment.  This usually presents as a tender, possibly red, firm area.   It can generally be managed with ice packs and anti-inflammatory medication but we may offer needle drainage of the blood to alleviate pain and minimize the risk of hyperpigmentation.
  • Some patients develop new, tiny spider veins near areas of treated veins, which is also called “telangiectatic matting”.  This usually occurs 2-4 weeks after treatment and fades within 4-6 months but can take up to a year.  It is more common in women who take estrogen supplements.
  • There is a small risk of clot formation within the deep veins of the legs.  This risk is minimized by using ultrasound guidance throughout treatment to monitor the foam and to avoid injections near areas where the deep and superficial veins are connected through “perforating veins”.  We will ask you to do flex your foot during injections and to do calf exercises afterward to circulate the medication away from the deep veins.  Walking after treatment is also crucial to avoid the pooling of blood in the deep veins, which can predispose to blood clots.

Follow-up Ultrasounds and Clinic Appointments

Follow-up Varicose Vein Ultrasounds and Clinic Appointments

We will schedule an ultrasound 2-7 days after your final treatment to make sure veins are responding appropriately.  We will do the formal ultrasound of your superficial veins for backward flow (or “reflux”) at one month.  At that point, we will re-evaluate your symptoms and anatomy and decide if additional treatment is indicated.  Be sure to come to all of your scheduled follow-up appointments to ensure that your veins are healing properly.

It is important to come to all follow-up appointments so your provider may follow your progress and address any adverse effects promptly.

Varicose Vein Sclerotherapy Treatment: What to Expect2021-11-13T13:29:56-08:00

1, 4, 2020

Benefits of Online MD Consultations for Varicose Veins


Connect with a vein expert from the convenience of your own home.

Benefits of Telehealth for Varicose Vein Patients

Many of us have found ourselves at home with time to think about health concerns, we have not had time to address.

one of our 10 exam rooms at la jolla vein care clinic

Common questions our patients are asking via online / telehealth consultations are:

  1. Should I be concerned about my leg pain?
  2. What is causing my leg pain?
  3. I have lumpy veins, are these varicose veins?
  4. I have bluish-colored spots on my legs, what are these?
  5. What are the treatment options for varicose veins?
  6. Why are my legs always so fatigued?
  7. Do my varicose veins pose a health problem?
  8. Should I be concerned about varicose veins?
  9. Are these veins normal?
  10. What are these ugly leg veins?

Now is the time to ask all the questions you have ever had about your legs and vein condition.

Although we cannot see you in person, by taking a thorough history and listening to your concerns, and if you like you can send a picture of your legs by text, we can discuss your symptoms and help determine the cause of your symptoms. Because we specialize in venous disease, a lot of information can be obtained from your pictures, such as the pattern of vein disease we see on your legs is often correlated to underlying vein disease. As a result, we can come up with a preliminary treatment plan, which will then be confirmed by an ultrasound examination at our state-of-the-art diagnosis and vein treatment center, after April 30th, 2020.

Here’s a summary of the benefits of online consultation for varicose veins:

  1. Discuss your concerns with the doctor
  2. If vein treatment is desired, a preliminary treatment plan will be made, based on the appearance/pattern of veins on your legs. An ultrasound will later be required.
  3. Learn treatment options for your condition
  4. Start conservative management today- The doctor will discuss things you can do to help your legs feel better today. Insurance also requires 3 months of documented conservative management. Start your conservative management today, so you can start treatment in 3 months from now!

Telehealth Consultations are covered by most insurance types. Schedule your telehealth consultation today with Dr. Sarah Lucas:

858-550-0330 or email anna@lajollaveincare.com.

Benefits of Online MD Consultations for Varicose Veins2021-11-04T13:54:13-07:00

5, 4, 2018

Varithena Varicose Vein Treatment

image of varithena foam

varithena foam

At La Jolla Vein Care, we are the experts in using foam sclerotherapy to treat varicose veins: we have performed thousands of successful treatments over a decade. We are pleased to offer Varithena foam.  Varithena is the only FDA-approved foam treatment used to treat varicose veins caused by problems with the greater saphenous vein and other related veins in the leg’s greater saphenous vein system.   Varithena is not thermal ablation and does not require multiple injections to numb the treatment site as with tumescent anesthesia. The administration of Varithena is minimally invasive: There are no incisions, sedation, or general anesthesia required. Patients can even go back to doing some activities the very same day as treatment, and the entire procedure should take less than an hour. Varithena® is a name brand of foam, that comes in a pre-made canister. Varithena® treats a wide range of varicose veins in the GSV system, including:

o   Tortuous (twisted) veins

o   Veins above and below the knee

o   Veins with small, medium, and large diameters

o   Veins previously treated with other methods.

Varithena Varicose Vein Treatment2020-12-19T04:24:50-08:00

5, 8, 2012

Olympic Athlete Struggles With Varicose Veins

Olympic athlete Summer Sanders

Olympic athlete Summer Sanders

Patients sometimes tell us that they feel isolated or alone as a result of their varicose veins. The fact is, however, that they are not alone- one in four Americans have some form of vein disorder. Olympic athletes get varicose veins too! Olympic swimmer and gold-medalist, Summer Sanders shares her story of suffering with varicose veins. “As a life-long athlete and Olympic swimmer, I never thought a condition like varicose veins or chronic venous insufficiency (CVI) would affect me. It soon hit me that, even though I was active, I was starting to get my mother’s legs.
It’s important for people to realize that varicose veins and CVI can happen to anyone and they are more than just a cosmetic issue. But you don’t have to live with the uncomfortable and painful symptoms. There are minimally-invasive treatments available that are covered by many insurance plans.
It’s time to Rethink Varicose Veins. I’m glad that I did.” Watch Summer’s story at youtube https://youtu.be/my5b_R1JEFc

Olympic Athlete Struggles With Varicose Veins2021-11-03T22:28:14-07:00

7, 11, 2011

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