GUIDE TO VARICOSE VEIN TREATMENTS & WHICH WORKS BEST FOR YOU

1. GUIDE TO VARICOSE VEIN TREATMENTS & WHICH WORKS BEST FOR YOU

2. If you suffer from the effects of varicose veins, you may benefit from vein treatment. Although some people believe that varicose veins are only a cosmetic issue, this isn’t true. Varicose veins can cause a range of painful and uncomfortable symptoms, including leg swelling, cramping, and fatigue. They can also leave you vulnerable to dangerous health issues like blood clots and venous ulcers. • Unfortunately, varicose veins do not just go away on their own. However, you may not need painful surgery to get rid of unsightly, bothersome veins. Instead of dealing with daily discomfort, you may be interested to learn about a range of available minimally invasive varicose vein treatments. • At USA Vein Clinics, we offer the following outpatient procedures: • Endovenous Laser Treatment (EVLT) • Varithena Varicose Vein Treatment • ClariVein® Treatment • Ultrasound-Guided Sclerotherapy • VenaSeal Treatment™ • How do you know which one is right for you? For personalized treatment recommendations, we recommend consulting one of our leading vein specialists at USA Vein Clinics

3. Causes of Varicose Veins • Varicose veins are a sign of vein disease, also known as venous insufficiency. Venous insufficiency affects millions of adults in the United States. It is a progressive disease, meaning that symptoms tend to get worse over time. • Many of our patients want to know what causes varicose veins to develop in the first place. Your circulatory system consists of different types of blood vessels, including veins and arteries. Your arteries are responsible for transporting oxygenated blood and nutrients throughout the body, while your veins return oxygen-depleted blood to the heart for reoxygenation. • Vein disease occurs when tiny, one-way valves in the veins are damaged, often due to chronic strain. They begin to malfunction as a result, and your veins are unable to efficiently send blood back to the heart against gravity. Instead, blood may flow in the wrong direction or pool in place. Without intervention, this condition causes veins to expand and form into varicose veins. Most commonly, the legs, ankles, and feet are affected. • Genetics, lifestyle factors, and even where you work can play roles in the development of vein disease.

5. You may wish to discuss the following risk factors with your vein specialist: • Age: Although varicose veins can appear at any age, individuals over age 50 are more at risk for developing them • Sex: Women are four times more likely than men to suffer from venous conditions • Pregnancy: Many women develop varicose veins or experience worsening vein symptoms when pregnant • Weight: If you are obese or overweight, you should be aware that excess weight places undue strain on your veins and can lead to damage • Physical activity: Those who are sedentary may find themselves dealing with damaged, malfunctioning veins • Diet: What you eat (and don’t eat) can influence the health of your veins • Underlying health conditions: Certain health issues, such as diabetes and high blood pressure, can cause vein problems • Smoking: Along with contributing to a range of serious health conditions, smoking can also damage your veins • Prolonged standing or sitting: If you have a job that requires you to be on your feet a lot, you are more likely to develop symptomatic varicose veins • If you believe that you are at increased risk for varicose veins due to any of the above factors, we recommend close monitoring by a vein specialist. Although you can’t control your genes, you may be able to make lifestyle modifications that can help prevent varicose veins and control related symptoms. • To avoid additional varicose veins and the development of dangerous complications, we suggest asking your doctor for guidance on losing excess weight, exercising more, eating a well-rounded diet, quitting smoking, and managing other underlying health conditions. You may also benefit from daily or occasional use of compression socks. • If you need additional help to control your varicose vein symptoms, we recommend looking into minimally invasive, office-based varicose vein treatment.

6. When to Consider Varicose Vein Treatment • Vein disease is a progressive condition, meaning that symptoms get worse over time. For the best health outcomes, early varicose vein treatment is recommended. Along with providing necessary relief from leg pain, swelling, and other venous symptoms, vein treatment can help you avoid dangerous health conditions like blood clots and venous ulcers. • One type of blood clot that can develop is known as Deep Vein Thrombosis (DVT). DVT is considered a life-threatening condition that requires immediate, emergency treatment. Additionally, advanced vein disease can lead to the development of venous ulcers. Venous ulcers are open, non-healing wounds that leave you prone to serious skin and blood infections. • If you believe you are experiencing symptoms of DVT, please seek emergency care immediately. If you are struggling to manage open, non-healing wounds on your legs, contact your doctor as soon as possible.

7. How Varicose Vein Treatment Works • There are numerous varicose vein treatments available to you. They all have the same primary goal, which is to close off diseased veins and reroute blood flow to healthy ones. After treatment, your vein symptoms should improve over time. • It may require multiple treatments or a combination of treatments to resolve problematic varicose veins. These types of treatment decisions are based on vein size and location. We want to assure you that vein treatment is considered a low-risk procedure. If you have any questions about your treatment recommendations, we are available to answer them. • At USA Vein Clinics, we offer a range of non-surgical, outpatient varicose vein treatments. Our treatments take only 15-30 minutes, depending on how many veins are affected, and can be performed over your lunch hour. You can leave immediately afterward and return to most normal activities. Following treatment, our patients typically report improved symptoms, mobility, and quality of life.

8. Varicose Vein Treatment Options • Below, we discuss five state-of-the-art varicose vein treatments available at USA Vein Clinics. All of our treatments are FDA-approved, and performed at our IAC accredited facilities. To determine which treatment is best for you, schedule a consultation with one of our leading vein specialists. They provide personalized treatment recommendations and steps for staying healthy after treatment. • ENDOVENOUS LASER TREATMENT (EVLT) • If you have chronic venous insufficiency, Endovenous Laser Treatment (EVLT) can help. EVLT, also known as endovenous laser ablation, is often referred to as the gold standard of varicose vein treatment. • As discussed previously, all of our vein treatments, including EVLT, aim to close off diseased veins. Once a diseased vein is treated, your healthy, surrounding veins take over the important role of circulating blood back towards the heart. • During the EVLT procedure: • Your vein specialist will numb your leg with local anesthesia • They will insert a very thin laser fiber (less than one millimeter) into the diseased vein while using real-time ultrasound guidance • Next, they will apply laser energy to heat up and close the malfunctioning vein • Finally, the laser fiber will be removed

9. Endovenous Laser Treatment recovery requires little, if any, downtime. During the first several days after treatment, you will be encouraged to walk as much as possible. This helps boost circulation, prevent blood clots, and reduce swelling. You may also be asked to wear compression socks for a set amount of time. • Some patients experience temporary discomfort after treatment. This can include tenderness, tightening, swelling, burning, and redness. You may also notice bruising along the treated vein, which should resolve within one to two weeks. Post-procedure discomfort, if any, can usually be managed with an over-the-counter pain reliever, such as ibuprofen or acetaminophen. However, you should avoid taking aspirin-based products. • If you are interested in state-of-the-art vein treatment, be sure to ask a vein specialist whether treatment by endovenous laser for varicose veins is right for you.

11. VARITHENA VEIN TREATMENT • Varithena varicose vein treatment is another potential option to treat your varicose veins and alleviate painful or uncomfortable symptoms. Similar to EVLT, Varithena Vein Treatment works by closing malfunctioning veins and redirecting blood flow to healthy ones. Over time, your varicose vein symptoms should improve. • During Varithena treatment: • Your vein specialist uses a specialized device that generates a microfoam called Varithena foam • Varithena foam comes in a canister already measured to the perfect dosage • This foam is injected into the affected vein using real-time ultrasound guidance • After the injection, the foam fills and collapses the impacted vein • To discover whether Varithena foam treatment is right for you, we suggest contacting a vein specialist. We want you to know that our experts at USA Vein Clinics are highly skilled and experienced at performing this safe and effective office-based treatment.

12. ULTRASOUND-GUIDED SCLEROTHERAPY • Similar to Endovenous Laser Treatment and Varithena Vein Treatment, Ultrasound-Guided Sclerotherapy (UGS) is a type of ultrasound treatment for varicose veins. • During UGS ultrasound vein treatment: • A vein specialist uses live ultrasound guidance to inject a sclerosant solution into the affected vein • This solution causes the targeted vein’s blood to thicken while purposely irritating the vein’s walls • As a result, the diseased vein collapses and becomes sealed off • Blood flow is then diverted to healthy, surrounding veins • Over time, the treated vein is naturally absorbed into the body, so there is no need to remove it • Discover whether you are a good candidate for this treatment by consulting with one of our vein specialists.

13. CLARIVEIN® TREATMENT • What is ClariVein®? ClariVein®, also referred to as mechanochemical ablation, is yet another type of minimally invasive treatment for varicose veins. However, ClariVein® is somewhat unusual in that it simultaneously uses mechanical and chemical methods to collapse and seal off diseased veins. The specialized ClariVein® catheter has a rotating fiber tip at one end. • During ClariVein® treatment: • Your vein specialist makes a very small incision, typically on the upper thigh • Then, using real-time ultrasound guidance, they insert the ClariVein® catheter into the diseased vein • When the catheter reaches the affected vein, the fiber at the end of it begins to rotate • As the fiber rotates, it removes the lining of the vein while also delivering a medical solution • The rotation may last for several minutes and cause a light humming sensation in the region being treated • This should not cause any significant pain or discomfort • ClariVein® treatment is non-surgical like all our treatments, so ClariVein® recovery usually goes very smoothly. Since the treatment does not use thermal energy, the potential for nerve damage is also minimized. You may experience mild discomfort, tenderness, and skin discoloration. You should be aware that some individuals develop small spider veins afterward, which can be treated with Visual Sclerotherapy. • To learn more about how ClariVein® can alleviate symptomatic varicose veins, we suggest consulting one of our highly skilled vein treatment specialists

14. VENASEAL™ TREATMENT • What is VenaSeal™? The VenaSeal™ Closure System is our newest minimally invasive varicose vein treatment. Performed as an outpatient procedure, VenaSeal™ is known for a very comfortable patient experience. • During this short procedure, the targeted vein is accessed via a single needle stick. There is no need to provide tumescent anesthetic, or local anesthesia, over a large region of the leg. Although you may experience some minor discomfort, you should not have any significant pain. • To perform VenaSeal™ treatment: • Your vein specialist will use ultrasound imaging to map the veins in your legs • Using real-time imaging, they will insert a small catheter into the diseased vein • Then, VenaSeal™ medical adhesive is applied to the vein through the catheter • Next, your provider will apply external pressure to help seal the vein • Finally, the catheter is removed • You can go home with just a bandage to cover the entry point • When it comes to VenaSeal™ aftercare and recovery, you can return to most normal activities immediately. You may experience tenderness around your treated veins along with some slight discoloration. Unlike most other forms of vein treatment, there is no need to wear compression socks afterward. • To learn more about the VenaSeal™ Closure System for varicose veins, schedule an appointment with USA Vein Clinics.

15. Varicose Vein Treatment at USA Vein Clinics • To avoid unnecessary pain and serious health problems due to varicose veins, we encourage you to schedule a consultation with one of our expert vein specialists as soon as possible. We perform varicose vein treatment at 90+ clinic locations nationwide. For your convenience, we also offer telemedicine options. • At USA Vein Clinics, we look forward to helping you take back control of your vein health.

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