Endovenous Treatment Options

What does endovenous mean? Endovenous is a medical term that means within or inside a vein. Endovenous treatments can be divided into two categories:

1. Thermal treatments that use laser energy or radio frequency waves to treat the vein and tumescent anesthesia to protect tissues surrounding the vein during the procedure.

2. Non-thermal, non-tumescent (NTNT) treatments, which are procedures that do not require the use of heat or tumescent anesthesia.

In this post, we’ll look at thermal endovenous treatments include endovenous laser ablation (EVLA), also called endovenous laser therapy (EVLT™) and radio frequency ablation (RFA). These are minimally invasive treatments used to address specific large varicose veins in the legs. It is considered the gold standard in treatment of named veins, such as the great and small saphenous veins. It has largely replaced previous, more invasive standards of care, such as vein stripping.

Endothermal ablation has opened the door for many patients with venous disorders to eliminate symptoms and improve their appearance with minimal time investment or pain. Endothermal ablation is an outpatient procedure performed with local anesthetic.

The procedure begins when the provider places a tiny access port directly into the problematic vein. Don’t worry, before the placement, we numb the skin with a small amount of local anesthetic. Once access is established, a very thin laser fiber is threaded into the vein up to the place “where health meets disease,” as Dr. Asbjornsen likes to say!

Patients can't feel the laser fiber because the inner walls of the veins do not have sensor receptors. Once in position, more numbing medicine is added to the outside of the vein; it should not be more uncomfortable than the first pinch when access was established.

Once the leg is numb, the heat source is turned on or "fired," sealing the vein shut from the inside out. The vein eventually is reabsorbed by the body and will no longer be visible on the surface of the leg. Blood is diverted to the many other healthy veins in the leg, and there is no ill effect from the loss of the troublesome vein. Patients can return to work the next day with very limited restrictions.

What is Tumescent Anesthesia?


The thermal endovenous treatments involve tumescent anesthesia, a technique in which a high volume of a dilute local anesthetic is infiltrated around the vein. Tumescent anesthesia serves three purposes during thermal ablation:

1. The fluid is an anesthetic, keeping the patient comfortable during the procedure.

2. It creates an insulating ring around the vein and thermal energy source. This protects all surrounding tissues, including nerves and muscles, thus stopping any type of collateral damage.

3. It causes the vein walls to collapse around the thermal fiber, maximizing contact and increasing the effectiveness of the procedure.

The tumescent fluid can be administered in many ways, but with a trained and proficient physician, the process is comfortable and painless.

To learn more about vein treatments options, contact us at the Vein Healthcare Center today to schedule an evaluation! 

3 reasons why winter is a great time for vein treatment

Diagnosing and treating varicose veins (and other forms of venous disease like spider veins and leg ulcers) is a good idea any time of year. Winter, however, is an excellent time for vein treatment. 

Here are just a few reasons why:

1. Cozy Compression

With a vein procedure such as ablation, you will be required to wear medical-grade compression stockings any time you are on your feet for the first two weeks following treatment. (After sclerotherapy, you should wear compression 7-14 days when you are on your feet.) The good news is that post-procedure compression stockings will keep you warm while you recover – and it’s much more comfortable with a winter wardrobe.

2. Less Swelling, More Comfort

Heat causes blood vessels to expand, or vasodilate, which can increase swelling and discomfort in legs that are prone to varicose veins. The cold weather naturally constricts blood vessels, which can potentially reduce post-procedure swelling and makes recovery feel easier than in the summer heat.

3. Ready for Summer 

Recovery from vein treatments take time. Patients can expect some amount of bruising, swelling, and tenderness, although post-procedure discomfort is highly variable from person to person. While some patients may experience discomfort, some may feel none at all. It takes time for legs to recover from vein treatment. If you get started in the winter months, you’ll be more ready for shorts in the summer.

If you’re concerned about your vein health and want to schedule an appointment this winter, feel free to contact us at the Vein Healthcare Center. Our goals are to learn about your condition, help you understand how your vein health affects your overall health, and provide you with treatment options. We make taking the first step simple, comfortable, and stress-free!

Meet Nicole Strout, NP!

As a Nurse Practitioner, Nicole Strout, NP, supports Dr. Cindy Asbjornsen, founder of the Vein Healthcare Center. Nikki joined the VHC team after providing care at an orthopedic practice in Portland. She attended nursing school as an undergraduate at Marshall University in West Virginia before receiving her Masters in Nursing from Walden University in Minnesota.

In addition to spending time with her husband, a fisherman in Alaska, and their three sons, ages 5, 3, and 9 months, Nikki enjoys the Maine outdoors – including going out on her father-in-law’s lobster boat! Read on to learn more about Nikki.

Q: How do you help patients at VHC?
A: I meet with new patients and review their medical history as well as give them a physical exam. We spend a lot of time discussing their health goals.

Q: Why is that first-visit conversation so important?
A: I work closely with Dr. Asbjornsen to determine the best treatment plan for each person, so I want to give her the most complete picture of each patient’s situation as possible. I also want every patient to feel heard, so I really tune in and listen to what their complaints are. One of the first physicians I ever worked for taught me that 90 percent of the time, the patient is going to tell me what’s wrong with them. In my experience I’ve found that that’s the best way to develop a relationship – and it streamlines their care.

Q: What is it like working with Dr. Asbjornsen?
A: She is one of the kindest, most patient physicians I’ve ever worked with. People sometimes feel that it’s hard to find someone in healthcare that you can trust and develop a good relationship with. Dr. Asbjornsen tries to do that, and so do I. So does the rest of the staff.

Q: Why are you a good fit for VHC?
A: When I was an RN, before I received my Masters in Nursing, I worked in vein treatment, so I have that background. I also like that patients with vein issues and venous insufficiency tend to be more involved in their treatment and more proactive in their approach to health. Plus, I love helping people, advising them and getting them on the right path so they can stay active.

Q: What do you like the most about vein care?
A: I think that it’s so rewarding to help people who come in with pain but can’t figure out the underlying cause. We help them figure it out, and our procedures and help with their symptoms and get them back to their baseline health and feeling so much better.

Q: What do you do when you’re not working or taking care of three young kids?
A: My sanity is running! That’s how I keep my mind functioning well.

To learn more about the team at the Vein Healthcare Center, click here. If you'd like to make an appointment to evaluate your vein health and learn about treatment options, click here.

Board certification: what it is and why it’s important

People have various motivations for seeking vein treatment, including aesthetic reasons, but it’s important to remember that treatments for spider veins or varicose veins — as minimally invasive as they may be — are still medical procedures. That’s why it’s important to be informed and to go to a provider who is certified by the American Board of Venous & Lymphatic Medicine (ABVLM).

The ABVLM, formerly the American Board of Phlebology, was established in 2007 to improve the standards of medical practitioners and the quality of patient care related to the treatment of venous disorders and all aspects of venous disease.

The ABVLM also offers a Board Certification Exam, which ensures that physicians who specialize in phlebology (vein care) have met rigorous standards of education, experience, and evaluation. In addition to passing the exam, diplomates must demonstrate their experience and continuing medical education in the field. To that end, the ABVLM has also established educational standards for teaching and training programs in phlebology.

The ABVLM and the establishment of a Board Certification Exam brings recognition to both the field of phlebology and those providers in the field who have the knowledge, skills, and experience to provide quality care to phlebology patients. While many practice in the field of phlebology in Maine, there are just six Board certified phlebologists in the state who meet this high standard.

In addition to being a Board certified vein specialist, Dr. Cindy Asbjornsen is also the only doctor in Maine to be named a Fellow by the American College of Phlebology.

If you would like to schedule an appointment with Dr. Asbjornsen, please contact us at Vein Healthcare Center. We look forward to meeting you!

How “bad” are your veins?

There are many levels of vein disease, and it is progressive. Without intervention, the severity of symptoms will increase and complications could arise that can have a serious impact on a person's overall health.

In order to have a standard way to talk about vein problems, a group of experts created a classification system known as C.E.A.P., which stands for Clinical, Etiology, Anatomy, and Pathophysiology.

The “C” in C.E.A.P. stands for the clinical severity rating of a patient’s veins and is the most significant in physician-to-physician communication. For patients, recognizing what C.E.A.P. classification they are in may help them to decide if and when to seek treatment.

Click on the image below:

If you recognize any symptoms from the chart above, or if you have any questions about veins at all, contact us at the Vein Healthcare Center.

Knowledge is Power

If you’ve thought about “doing something” about your varicose veins or heavy, achy legs but aren’t sure what exactly to do, here’s a suggestion: learn more vein disease and the available options for treatment. By reading this blog you’re on your way, and in this post we’re going to get more specific. After all, knowledge is power!

When researching on the Web, go to trusted sites that specialize in phlebology (the study of vein disease and vein healthcare), such as the American College of Phlebology (www.phlebology.org) and the American Venous Forum (www.veinforum.org). The Vein Healthcare Center website also provides reliable information for both patients and physicians (www.veinhealthcare.com).

If you prefer reading books to screens, then check out our previous post about vein health books.

Gathering information is important, but don’t worry yourself needlessly because of too many visits to WebMD! If you really want to understand the root of your vein problems—and possible treatments—then a visit to a Board-certified vein specialist is best.

The calf pump

Is “the calf pump” a new dance all the kids are doing? No, it has something to do with veins, of course! Namely, making sure the circulation in your legs is working properly.

As summer draws to a close, many people are returning from vacation, driving in their cars, or hopping a long flight home. In order to prevent deep vein thrombosis (known as DVT), try the foot pump, in the car or on the plane.

It’s a simple toe-tap exercise: tap your feet for a minute or two, going back and forth between heels and toes. This squeezes the deep veins in the legs and forces the blood to circulate through the leg. It also feels good after sitting for a long period of time. Do the foot pump (on each foot) every half-hour or so.

Also, don’t forget to stay hydrated, preferably with water. And try to take a brief walk in the airplane aisles (or at the rest stop) occasionally to keep the blood flowing.  

Varicose vein treatment in the summer, Part 2

In our last post we discussed some of the treatments available for venous disease, including varicose veins. Now we frankly discuss one possible drawback to seeking treatment for vein problems in the summer.

Following every vein procedure, patients must wear graduated compression stockings. The length of time that patients are prescribed compression stockings is highly variable, depending upon the patient and the procedure. It could be as short as three days for some light-assisted sclerotherapy, or as long as two weeks for endovenous laser ablations or ambulatory phlebectomies. The lighter, sheerer stockings are better tolerated during the summer months, but tend to be less durable than some of the thicker options often work in the winter.

Although some people choose to delay treatment until after summer is over, others prefer to seek treatment as soon as possible. For those who choose not to undergo a vein procedure during the summer, it is still a good time to think about vein health.

It can take several months or more for the complete resolution of veins that have undergone treatments, so people can plan for next summer by scheduling an evaluation now. Whether or not one decides to pursue intervention for varicose veins or other venous issues, here are tips for vein relief in the summer.

No matter what the season, finding a qualified vein specialist can lead to an improved quality of life and better overall health. 

Varicose vein treatment in the summer, Part 1

Mainers love their state in the summer— and so, it seems, does everyone else! Every year hundreds of people flock to Maine beaches and lakes for sailing, swimming and all manner of fun in the sun. But those with vein problems can be acutely affected in the summer, both physically and psychologically.

From a physiological perspective, most varicose veins worsen during the summer months because the heat dilates veins. Due to warmer temperatures, a “leaky” vein will leak even more, causing increased pain for people with existing vein problems.

For some people, just as bad as physical pain is the discomfort of feeling self-conscious about wearing shorts, skirts or swimsuits because of unsightly leg veins. That kind of unease shouldn’t be ignored, especially when there are treatments available.

The treatments for venous insufficiency are the same in summer as the rest of the year, though the post-procedure considerations may be different. Minimally invasive treatments include: light-assisted sclerotherapy for small veins; ultrasound-guided therapy for larger veins; and endovenous laser ablations (EVLA) for the veins in between, known as junctional veins.

After treatment, patients who have undergone any type of sclerotherapy can go out in the sun almost immediately, although wearing sunblock for six months after any vein procedure is recommended, to decrease the possibility of hyperpigmentation.

Patients can usually swim twenty-four hours after any vein treatment. Generally, there will be some bruising at the site of the procedure, but the bruises are fairly small. There are also many affordable self-tanners and cosmetics that effectively cover up bruises— short-term options that are generally preferred over a bulging varicose vein.

How to prepare for an EVLA

In a previous post we described the outpatient procedure called EVLA, or endovenous laser ablation. Now we’ll discuss what to do to prepare for an EVLA appointment. Being fully prepared for your appointment and following recommendations for care before your appointment will help ensure successful, comfortable treatment.

Most vein specialists offer patients pre-operative instructions. Read— and heed— all of the guidelines as part of preparing for the appointment. Common EVLA preparations include:

1. Compression stockings should be purchased and worn prior to your appointment to be sure they are comfortable. You should bring them with you the day of the procedure, as you will use them immediately following treatment and during the following two weeks.

2. Refrain from shaving your legs the morning of the procedure. This will reduce the risk of razor burn irritation from the sterilizing wash.

2. Take all regular medications the day of the procedure.

3. You will be prescribed a muscle relaxer to help keep the muscles in your leg loose, and a pain medicine. Take both medications 1 hour before the procedure or as directed by your physician.

4. Fasting is not required— eat a normal breakfast or lunch.

5. Prepare to bring or wear high-cut underwear that you are willing to have stained by iodine solution. You will likely want a second pair to change into after the procedure is over.

6. Bring an iPod or headset if you'd like to listen to music during the procedure.

It’s important to remember that while endovenous laser ablation (EVLA) is the gold standard for venous care, you and your vein doctor, together, may decide on a different course. Call the Vein Healthcare Center to schedule an educational visit and learn about what options may be right for you.

What is EVLA?

EVLA stands for endovenous laser ablation. For years, patients suffering from varicose veins and other effects of venous reflux had few options for treatment, among them vein stripping or ligation. Now, EVLA is considered the gold standard. 

During the outpatient procedure, the physician uses imaging guidance to thread a small laser fiber into the vein at the failure location. Laser energy is then applied to the inside of the vein, “irritating” the vein wall and essentially sealing the vein closed. The vein eventually disappears and is no longer visible on the surface of the leg. Blood is diverted to the many other healthy veins in the leg, and there are no ill effects from the loss of the troublesome vein. 

An appointment for EVLA therapy takes approximately two hours. The procedure itself usually takes about forty minutes. A local anesthetic is used, although for most patients, the laser causes no pain. You should tell your doctor if any pain does occur, so that more local anesthesia can be administered.

You may resume most normal activities immediately after the procedure, and most patients can return to work the next day. Note that many physicians require you to have someone drive you home, so be prepared to have someone accompany you to your appointment, or to meet you after your procedure is completed.

If you would like to learn more about EVLA and whether you are a good candidate for the procedure, call Dr. Cindy Asbjornsen at the Vein Healthcare Center. 

Happy veins, happy hearts

During the month of February, Americans tend to think a little more about their hearts, especially about what they can do to keep their arteries healthy. But arteries are just half of the story. 

Veins also need to be healthy to do their work optimally. (For a brief review of the circulatory system, check out our last post.)

While vein treatments today are outpatient procedures, minimally invasive and virtually pain-free, there ARE things one can do before seeing a doctor. 

Here are 3 ways to alleviate venous discomfort and help prevent the progression of symptoms:

• Walk. Walking causes the rhythmic contraction of calf muscles and helps promote blood flow to the heart. Walk at least 30 minutes every day– all at once, or in shorter increments.

• Elevate. Elevating your legs above your heart as often as possible– for as long as 30 minutes, or as briefly as three minutes. The best time is after you have been standing, or after a hot shower.

• Don’t smoke. Smoking and exposure to second-hand smoke constricts veins and affects overall circulation.

• Sit properly. Focus on good posture and avoid crossing your legs, or sitting in ways that can compress veins for prolonged periods.

Happy Valentine’s Day, and as always, feel free to give us a call at the Vein Healthcare Center with any vein-related questions you may have.