New York Vein & Laser Surgery
John Zarcone, MD, PC
state-of-the-art varicose vein & spider vein treatment
12. What is Ambulatory Phlebectomy?
Ambulatory phlebectomy involves making tiny nicks in the skin through
which the varicose veins are removed.  As a result, it does not require
stitches.  Therefore scarring is minimal, if at all, and results in a superior
cosmetic outcome.  The procedure is performed using local anesthesia
in the office.  As the name implies, you are able to walk immediately
following the procedure.  
13. What is Sclerotherapy?
Sclerotherapy may be the procedure of choice for spider veins and
smaller varicose veins.  A chemical is injected directly into the vein
causing it to close.  These veins will be absorbed by your body over 2
weeks to several months.  Oftentimes, 1 – 5 injections are required over
a course of several weeks to months.
14. Don’t I need my veins?
We all need healthy functioning veins to return blood back to the heart
and fortunately we have plenty.  These abnormal varicose veins are not
functioning properly and interfere with the normal venous return of blood
making our circulation less efficient.  Closing or removing them actually
improves circulation as blood is now diverted to normal veins with
functional valves.  Also, they are useless to be used as bypass grafts, for
example, in heart surgery.  Therefore, there is no problem in removing
these veins.    
15. Are there any side effects to these procedures?
Very minimal side effects may be experienced and will be discussed
during you initial consultation.
16. Does insurance cover these procedures?
Most insurance plans cover the treatment of venous insufficiency and
varicose veins.  However, spider veins are often considered cosmetic
and are not. You should check with your plan for coverage and benefit
determination or we will be happy to do it for you.
1. What are varicose veins?
They are twisted, enlarged, bulging rope-like veins, often dark blue in
color that are visibly unsightly near or raised above the surface of the
skin.  Varicose veins are often symptomatic and indicate the presence of
an underlying condition call venous insufficiency.
2. What is venous insufficiency?
When the one-way valves in the veins do not function properly, blood
refluxes in a retrograde fashion back down into our legs instead of
toward our heart.
3. How is venous insufficiency diagnosed?
A state of the art ultrasound is used to evaluate the veins in your legs for
reflux.
4. How do I know if I have varicose veins?
Early symptoms include: pain in the legs with a feeling of tiredness and
heaviness in the lower legs; swelling of the ankle(s) and lower leg(s);
discolored, brownish and/or thickened skin near the shin and/or ankle;
visible rope-like cords in the legs; surrounding skin may itch or burn.  
Left untreated, varicose veins can lead to severe swelling, increased
pain, permanent skin discoloration and very painful ulcerations with
possible infection of the lower leg(s).   
5. What factors can lead to varicose veins?
While they occur in men and women of all ages (approximately 80
million Americans), women tend to experience vein problems more
often.  Estrogen plays a key role therefore changes brought on by
puberty, pregnancy, menopause/hormone replacement therapy and the
use of birth control pills can lead to the development of varicose veins.
Heredity, occupation, age, history of blood clots and obesity are also very
powerful predisposing factors.
6. What are spider veins?
Red and purple blood vessels that occur in patches anywhere on the
body, but predominantly are found on the legs and face.  Spider veins
and varicose veins are not the same and one does not lead to the other.  
They may be found alone or in combination with varicose veins, however.
Spider veins are delicate thread-like veins that tend to develop in clusters.
7. Can spider veins cause symptoms?
Although spider veins do not themselves produce symptoms, the feeder
vein(s) deeper in the skin may cause much discomfort such as: dull
generalized aching, throbbing pain, night cramps, leg tiredness,
menstruation and warmer weather.
8. What factors contribute to spider veins?
Many of the same factors that cause varicose veins contribute to the
development of spider veins: hormones, heredity, occupation, obesity,
use of birth control pills, postmenopausal hormone replacement
therapy, prolonged sitting with legs crossed, prolonged standing and
history of blood clots.  Also, topical steroids, trauma or injury to the skin
and exposure to ultraviolet rays (sunburn) can predispose to the
development of spider veins.
9.  What treatments are available for varicose veins?
Lifestyle changes (weight loss, exercise, leg elevation, avoid long
periods of standing/sitting), conservative management with
compression stockings, sclerotherapy, endovenous laser therapy and
ambulatory phlebectomy.  Fortunately, vein stripping is rarely necessary.
10. What treatments are available for spider veins?
Transcutaneous laser therapy with or without sclerotherapy is the
mainstay of treatment.
11. What is Endovenous Laser Therapy (EVLT)?
EVLT is a minimally invasive procedure that is the latest advance in the
treatment of varicose veins and is rapidly becoming the “gold standard.”
Laser energy is used to seal and close a faulty vein without having to
remove it.  It offers superior results with a success rate > 95% and is
associated with minimal side effects unlike with vein stripping that is
often very painful and disfiguring.  The procedure is designed to take
less than an hour in the office using only a local anesthetic.  No
hospitalization is required.  There is no scarring and a minimal risk of
complications.  The procedure allows fast return to normal activities
(normally 1-2 days) and is covered by most insurance plans.