We caught up last week with Dr. Andrew Kwak of Lumen Laser Center in Bryn Mawr, Pennsylvania. He was kind enough to spend some time with us on the phone to share his perspective on some of the questions people with varicose veins often ask. Thanks, Dr. Kwak, for sharing with our readers here on the www.vein-treatment.com blog:

What’s this new laser treatment for varicose veins, how was it discovered, and how does it work?

Varicose veins have been a problem for centuries. The only answer to this common medical problem until recently was a surgical “stripping” procedure. About 6 to 7 years ago a laser procedure was invented in which a laser fiber is inserted and closes off the problem vein instead. It’s called Endovenous Laser Ablation (EVLA) or Endovenous Laser Treatment (EVLT), and it has higher overall success rates with better outcomes for patients, lower recurrence rates, and faster recovery times. It was invented by an interventional radiologist named Dr. Robert Min at Cornell. Since then, thousands of these procedures have been done throughout the world, producing very good data that support its safety and effectiveness.

What are the main reasons a person with varicose veins should speak to a qualified vein specialist?

The fact is that the EVLA procedure, from a technical aspect, can be learned and performed by a whole spectrum of physicians, and they may do it well.  But you really want to find someone who is a vascular specialist who‘s been working specifically in the vein arena for a long time and who also has the requisite technical skills.  Unlike regular surgery, you must have a specialized skill set for this procedure.  With traditional surgery you watch your hands as they cut and stitch.  With this you are looking at a computer screen to guide you most of the time—it’s like surgery by Nintendo.  For some physicians, learning this new skill set can be challenging.

Many people with varicose veins hate the way these veins look.  How do you help?

Even though varicose veins are considered a purely cosmetic problem by many people—unfortunately, including many doctors who don’t really know—the truth is that varicose veins typically develop when there’s some malfunction internally in the leg from a bad vein. By closing the problem vein that’s not working, you divert blood to healthy veins that work and you accomplish many things.  You look better on the outside and your leg will work and feel better—you are basically fixing a plumbing problem.  It will also help halt the progression of vein disease so that you won’t be as likely to develop more serious problems, such as skin ulcers or blood clots.

What do you recommend if a person has large varicose veins but they don’t hurt?

A lot of times people come in with large varicose veins and swear they don’t hurt. Most people think of “pain” as a sharp, stabbing sensation. Vein problems develop over years and decades, with slow onset. It’s not the kind of pain that’s shooting, but it’s more a heaviness or weighted feeling that’s hard to put a finger on. They are very likely living with leg fatigue that they consider normal, but once the problem is fixed, they realize how a good leg is supposed to feel.

What about people over 60 getting varicose veins treated?

If you’re over 60, you usually want to think twice about open surgeries because they usually involve risk and significant recovery time which is more difficult as you get older. When stripping was the only option, this issue was certainly a consideration. But EVLA has changed this. The procedure is minimally invasive with no general anesthesia needed, and you get back on your feet again right away. It’s in fact very good for people over 60 because it does not necessitate downtime. After age 60 you’re actually more likely to develop problems from the veins because your activity is lower. By getting treatment you’ll be lowering your risk of developing further problems such as phlebitis or blood clots, especially if you are hospitalized for some reason.

What kind of background should a vein doctor have?

There are many types of doctors that are involved in the treatment of veins. These doctors as a group are called phlebologists, although they may be vascular surgeons, interventional radiologists, dermatologists, or internists. As long as the physician is experienced in the treatment of veins, I think that you will be fine. My background is interventional radiology. Our field developed the field of image guided surgery, basically harnessing tools like ultrasound to guide our procedures. EVLA is a perfect example of how minimally invasive, image guided surgery has improved the quality of people’s lives without the need for cutting.

What major cities do you serve?

In addition to Bryn Mawr, we serve Philadelphia and the Main Line area (western suburbs of Philadelphia) although I do have patients also traveling to me from the Tri-State area including Delaware and Southern New Jersey.

What’s the best way to find the right certified vein doctor in Pennsylvania?

Look for expertise in EVLA; ask how many of these procedures they have performed. Do they really specialize in this type of work? Phlebology requires a doctor to dedicate a lot of time to these types of problems.

Which Pennsylvania hospital are you affiliated with? The Hospital of the University of Pennsylvania.

What should people expect during recovery from EVLA and how long should they plan to be out of work after receiving it?

Most people don’t have to take any time off from work—they go back to work the next day. You might feel mild discomfort and a slight pulling sensation for 3 to 4 days after the procedure, but it doesn’t usually limit activity, and you can take over-the-counter ibuprofen if needed.

Does sclerotherapy really get rid of spider veins?

Yes, it does. It’s very effective, but people must realize spider veins are a chronic problem. Procedures like sclerotherapy and external laser should be considered pruning—those weeds will come back to some extent eventually and will require re-treatment.

What advice do you give women who develop varicose veins during their pregnancies?

For the woman who’s had a lot of difficulty with varicose veins during pregnancy, I’d recommend getting them treated even if you are considering future pregnancies. There’s no reason to live through that type of discomfort. The chances of a subsequent pregnancy reversing repairs are pretty low. I recommend you take care of it before your next one. Perhaps for someone who has not had much discomfort and only a tiny increase with each pregnancy, it may make sense to wait until you are done with your pregnancies as vein problems do tend to worsen with each successive pregnancy.

Barbara Payne
Vein-Treatment.com Blogging Team