Historically humans have struggled with this venous disease as far back as thousands of years.

Documents recovered from 1,500 BC from ancient Egyptians show images of varicose veins on a depicted character’s legs. Many other ancient cultures, such as the Greek, also have historical evidence of varicose veins disease and their struggle to treat this condition. One of the oldest discoveries was wrapping the leg with cloth soaked in herbal medication. It seems like in ancient times it was discovered that the pressure from wrapping an extremity will help with skin ulcers caused by venous disease.

Varicose vein disease to this day is one of the most common problems involving the lower limbs in the Western world – no matter if you live in Los Angeles, Long Beach, or the other side of the country. Close to 25% of the adult population is struggling with viscose vein disease. Overall, around 30% of women and 20% of men have varicose vein disease in the United States. Close to 2% of the entire US population are suffering from venous stasis skin ulcers.

The treatment of varicose veins and varicose vein-related complications can be very complicated if not cared for properly. About 35% of venous stasis ulcers have underlying multifactorial causes such as venous insufficiency, prolonged ambulation, post-thrombotic syndrome, inheritance, or even arterial insufficiency. Varicose veins are associated with skin changes such as hyperpigmentation, inflammation, and ulcers. Other problems related to varicose veins are limb heaviness, pain, lower leg swelling, and bleeding into the skin. But what is most commonly cited as the main cause for starting vein treatment in Los Angeles and Long Beach is that varicose veins have a very undesirable cosmetic appearance, forcing patients to hide their legs to avoid public humiliation. Historically, treatment of varicose veins has been very challenging. Many proposed non-invasive medical therapies, such as compression stockings, leg elevation, and some herbal remedies with very little success. However, surgical procedures have become the backbone of approaching varicose veins with excellent results. The most prevalent invasive method of treating varicose veins is removal via small incisions of the varicose veins. Over time, with technological advancements and a greater understanding of varicose vein disease, there has been an exciting surge in lesser invasive non-surgical approaches to treat varicose vein disease and venous insufficiency in general.

Sclerotherapy is one solution that offers chemical injection of these veins with sclerosing agents, such as hypertonic saline, or detergents, such as Sotradecol, is the primary treatment for undesired veins. This is indeed the most common method to treat smaller varicose veins such as reticular veins or spider veins, which are small varicose veins forming within the dermis and epidermis layers. Both reticular and spider angiomas tend to form over the thighs, particularly in premenopausal women. During the menstrual cycle, the surge in progesterone can cause these veins to engorge and become more painful.

The cosmetic outcome after sclerotherapy is also advantageous for patients of our Los Angeles clinic. Suppose the varicose veins are associated with significant superficial vein reflux disease. In that case, the varicose vein's treatment should consist of either surgical removal or endovenous ablation of the diseased superficial vein.

The most commercially available non-surgical methods are endovenous radiofrequency ablation (EVRFA), endovenous laser treatment (EVLT), mechanochemical ablation (MOCA), or chemical foam ablation. With EVRFA or EVLT techniques, heat is generated to intentionally burn the vein's inner wall, triggering clotting formation within the diseased vein's lumen. Since the generated heat within the vein can be transferred to the adjacent structure(s) such as the nerve and cause injury, a large volume of saline mixed with numbing medication (lidocaine, sodium bicarbonate with epinephrine) is injected around the vein with multiple needle punctures connected to an injector pump, slows down the transfer of heat to the adjacent structures and also numbs the vein for patients' comfort. The patient undergoing venous ablation with EVRFA or EVLT are painful with moderate to severe discomfort with requires moderate sedation to tolerate the procedure. Since there is epinephrine in the injected solution, patients may feel their heart is racing shortly after the procedure.

Sometimes, the volume injected can reach as much as one liter, creating edema and forcing patients to take several days off from their daily routines.

From Dr. Taheri's personal experience of performing these procedures and caring for his patient in our Los Angeles clinic afterward, he finds that heat ablation is the most painful non-surgical method to treat veins, with the most extended downtime, of all non-invasive methods, unlike commercially advertised by many manufacturers or large practices.

However, MOCA is a much less invasive method, requiring only one skin puncture with a tiny size sheath. The commercially available devices essentially constitute a wire within a plastic cover connected to a motor in one end and an angled non-traumatic tip.

The device is introduced into the vein. Upon physician's command, it starts to rotate with high RPM within the lumen of the vein. The tip of the wire agitates the vein's lumen; simultaneously, there is a catheter around the wire that injects the sclerosant into the vein. The combination of mechanical trauma mixed with the sclerosants' detergent property triggers the clotting cascade within the vein's blood. The treatment goal is to create a blood clot in the entire treated segment of the vein.

The clot will harden and prevents any flow within the vein; hence there will be no reflux into the varicose veins. The varicose vein will either collapse immediately or fill up with blood clots and scar over time. This process may take up to three to six months to completely take effect. However, patients can see immediate results as early as two to three weeks after the procedure is done. Since no heat is used, there will be no need to inject the leg with saline fluid, and patients can walk without feeling any difference in their legs. Most patients resume their daily activities soon after the procedure. The last method is to simply access the vein with an Intravenous (IV) line and inject a mixture of sclerosant foam (mixed with CO2), into the vein, under ultrasound guidance.

Once again, this is almost the same concept as MOCA, except that the inner vein is not mechanically agitated. Only the chemical sclerosing agents are used in the form of CO2 foam to increase their contact with the vein's inner lumen. The most common complication of venous ablation therapy is local inflammation and tender. The less common complication of venous ablation is DVT which can occur in up to 3% of patients. If DVT is diagnosed after the venous ablation, the patient will be treated with anticoagulation medication for at least six months.

At Aurses Healthcare's office, We provide a comprehensive screening using the latest ultrasound technology.
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