Frequently asked questions
HOW LONG DOES A FIRST CONSULTATION TAKE?
The first consultation usually takes 45 minutes. The exam is painless.
WHAT WILL HAPPEN DURING THE FIRST CONSULTATION?
Upon arrival you are asked to fill in a questionnaire. Thereafter, you are invited to present your problem in detail to the doctor. This is followed by a physical examination and a accurate appreciation of the leg veins by duplex ultrasound.This assessment provides information about the position and the course of your veins, their shape and size as well as the direction and intensity of the blood flow. At the end of the consultation, the doctor sums up the findings and explains treatment options, if indicated.
WHO IS TAKING CARE OF THE COST?
The cost of the examination is a taken care of by the basic insurance. With certain insurance plans such as HMO or the “family doctor model”, a letter of referral is required.
WHAT IS THE PURPOSE OF AN ULTRASOUND EXAMINATION?
For the investigation of venous disorders, ultrasound examination is focused on the impaired drainage of venous blood from the lower extremities. The assessment gives an exact picture of drainage obstacles due to clots, i.e. thrombosis, or a malfunction of the venous valves. If the venous valves are damaged, they lose the function as valves. As a consequence, the blood will flow in the wrong direction, i.e. downwards, due to gravity.
Spider veins FAQ
WHAT IS THE SIGNIFICANCE OF SPIDER VEINS FROM A MEDICAL VIEWPOINT?
Almost none. Nevertheless, many patients, not only women, perceive them as cosmetically disruptive.
WHO TAKES CARE OF THE COST OF SPIDER VEIN TREATMENT?
Due to basically benign nature of spider veins, the cost of the treatment is not covered by the health insurances. We usually charge CHF 450 for 45 minutes.
HOW PAINFUL IS THE SPIDER VEIN SCLEROTHERAPY?
Sclerotherapy of spider veins requires multiple pricks with a very fine injection needle. Most patients tolerate it without special precautions. If desired, you can apply a numbing cream before leaving home (Emla).
WHAT ARE THE CHANCES OF LASTING SUCCESS?
The vast majority of our patients show very good results. However, there are also spider veins that require multiple treatments or even prove to be resistant to therapy. However, an often heard statement that spider veins “come back anyway” is not correct. On the other hand, a genetic predisposition to develop spider veins will persist regardless of the number of treatments.
WHAT FOLLOW-UP TREATMENT DO WE RECOMMEND?
After spider vein sclerotherapy, we use bandages or stockings only exceptionally. However, treated skin areas should not be exposed to intense sunlight in the four weeks following sclerotherapy.
WHAT ARE THE RISKS?
Small hematomas are quite common, brownish discolorations of the treated skin area can occur but are rare and they usually disappear in the course of a few months.
WHAT OPTIONS ARE AVAILABLE TO REMOVE SPIDER VEINS ON THE LEGS?
Options to remove spider veins include sclerotherapy and laser treatment.
In this procedure, we inject the veins with a solution that scars and closes those veins, causing the blood to reroute through healthier veins. In a few weeks, usually a majority of the treated spider veins fade. Although the same vein may need to be injected more than once, sclerotherapy is usually effective if done correctly.
Sclerotherapy doesn’t require anesthesia and can be done in your doctor’s office. Side effects include swelling, itching and skin color changes in the treated area.
Laser treatment works by sending strong bursts of light into the vein that make the vein slowly fade and disappear. No incisions or needles are used.
The treatment is often less effective than sclerotherapy, particularly for larger veins. Side effects may include redness, bruising, itching, swelling and permanent skin tone changes.
After treatment, blood vessels fade over several months, but they may not disappear completely. Also, new spider veins can develop in the same area or elsewhere.
Thermal Ablation FAQ
HOW SUSTAINABLE IS THERMAL ABLATION?
Comparative studies have shown that the more invasive surgical approach of saphenous vein stripping has no advantage over thermal ablation, neither in the short nor in the long term. The surgical access to the groin and the subsequent healing processes tend to provoke the formation of new veins, so-called neovascularizations. The latter may lead to recurrencies and often require further treatments.
CAN YOU ALSO TREAT TORTUOUS VEINS WITH THERMAL ABLATION?
Superficial, meandering varices are treated neither by stripping nor by thermal ablation. They are removed by so-called phlebectomies. To do this, cuts of less than 2 mm are made through the skin. They give access for a metal hook to be inserted under the skin to “fish” the varicose vein and remove it from the body. Phlebectomies are combined either with thermal ablation or with stripping of diseased saphenous veins.
Instead of phlebectomies, meandering varices can also be chemically ablated by sclerotherapy, be it in combination with thermoablation or with stripping of saphenous veins.
DOES THERMAL ABLATION ALSO WORK IN GREATLY ENLARGED SAPHENOUS VEINS?
Absolutely! We and other users have some experience with thermal treatments of saphenous veins with diameters of 20 mm and more. However, such diameters occur very rarely, perhaps in one out of a thousand patients.
CAN THERMAL ABLATION ONLY BE USED ON SELECTED PATIENTS?
Although an often-heard criticism in our part of the world, it is simply not true. This becomes obvious by the fact that not only in our practice but also in other countries, almost no more conventional venous surgery is carried out (e.g., in the USA <1%).
WHAT IS THE ROLE OF OBLITERATING SAPHENOUS VEINS WITH ADHESIVES?
An adhesive (cyanoacrylate) is injected into the vein via a catheter, which leads to its closure. This procedure is quick and almost painless, but only if varicose branches are not removed in the same session. However, most patients prefer to have done all necessery steps in one go. Furthermore, the adhesive can lead to painful phlebitis in about 15% of patients. In addition, the costs of glueing are not covered by the Swiss insurance plans in contrast to thermal ablation.
ARE THERE ANY FURTHER OPTIONS IN THE TREATMENT OF VARICOS VEINS?
Thermal ablation can also be carried out with steam, but this has hardly any advantages. Another method combines chemical sclerotherapy with a mechanical component. A rotating wire catheter damages the innermost layer of the vein wall, promoting closure. This treatment requires almost no local anesthesia. However, this only applies if varicose veins are not removed in the same session. As mentioned above, most patients prefer to have done all the necessary steps at once.
WHY IS THERMAL ABLATION NOT YET USED PREFERENTIALLY EVERYWHERE IN SWITZERLAND?
In the United States and other countries, thermal ablation has largely replaced conventional “stripping” surgery.
The American Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have declared thermoablation to be the preferred therapy for varicose veins as early as 2011.
The European Society for Vascular Surgery (ESVS) and the British National Institute for Health and Care Excellence (NICE) also recommend thermoablation as the preferred treatment.
In Switzerland, thermal ablation has been covered by basic insurance only since 2016. Therefore, not all physicians have the necessary experience to successfully carry out thermal ablation and to recommend it to their patients.
WHY CAN SOME ALTERNATIVE PROCEDURES BE PERFORMED WITHOUT LOCAL ANESTHESIA?
Forgoing local anesthesia always means avoiding phlebectomy in the same session. However, we consider same-session varicose vein removal to be an important part of a convenient and cost-effective treatment.
DO YOU RISK BURNS TO THE SKIN WITH THERMAL ABLATION?
Burns are very rare and are due to a lack of experience with the method. The decisive factor is the careful, large-scale injection of liquid or local anesthesia under the skin to protect it from heating.
WHAT IS ENDOVENOUS THERMAL ABLATION (ETA)?
ETA (endovenous thermal ablation) is a minimally invasive treatment that uses radiofrequency (RF) or laser energy to effectively treat patients suffering from varicose veins or Chronic Venous Insufficiency (CVI). We insert a catheter into a diseased vein to provide consistent and uniform heat to contract the collagen in the vein walls, causing them to collapse and close. After the vein is sealed shut, blood is then naturally redirected to healthy veins.
Several studies confirm that patients experience less bruising and pain, and fewer complications with ETA than with a conventional stripping operation.
ETA also results in little to no scarring and is invariably performed using local anesthesia in our outpatient surgical facility.
WHAT IS CHRONIC VENOUS INSUFFICIENCY (CVI)?
CVI is a progressive medical condition in which the valves in veins that carry blood from the legs to the heart no longer function, causing blood to pool in the legs and veins to swell. This incorrect blood flow (or reflux) causes veins to expand, lose form and protrude from beneath the skin. Common symptoms include pain, leg swelling, leg heaviness, and fatigue as well as skin changes and ulcers in more severe cases.
Varicose veins are often thick, bulging veins that can protrude well beyond the skin’s surface. Often misunderstood as a cosmetic issue, varicose veins can progress to CVI, which is a more serious condition.
HOW IS AN ETA PROCEDURE DIFFERENT FROM VEIN STRIPPING?
Vein stripping is a surgical procedure, where the surgeon makes an incision in your groin and ties off the vein, after which a “stripper” tool is threaded through the leg vein to pull it out through a second incision just above the calf.
The ETA Procedure is minimally invasive. In contrast to vein stripping, the vein remains in place and is closed using a special catheter inserted through a small incision below the knee or near the ankle.
Vein stripping is usually performed in an operating room under a general anesthetic, while the ETA procedure is performed on an outpatient basis, typically using local anesthesia.
HOW IS ETA USING THE CLOSUREFAST - VENEFIT PROCEDURE DIFFERENT FROM LASER ABLATION?
The Venefit procedure utilizes radiofrequency energy to provide consistent and controlled heat to contract the collagen in the vein walls, causing them to gently collapse and seal. Once a leg vein is closed, blood flow is redirected to healthy veins.
Laser ablation, on the other hand, uses laser heat to collapse and seal the affected vein. The laser targets the blood in the vein, which causes the blood to boil. The results of ETA using the newest laser technology are similar to those of ETA using radiofrequency.
HOW LONG DOES THE PROCEDURE TAKE?
The ETA procedure takes about 45-90 minutes, depending on the number and magnitude of the findings.
IS ETA PAINFUL?
Most patients report feeling little if any, pain during the ETA procedure. We will give you a local or regional anesthetic to numb the treatment area.
DOES IT REQUIRE ANESTHESIA?
The ETA procedure can be performed under local, regional, or general anesthesia. We perform it invariably using local anesthesia in our outpatient surgical facility.
HOW QUICKLY AFTER TREATMENT CAN I RETURN TO NORMAL ACTIVITIES?
Most patients experience a quicker return to normal activities than after conventional stripping surgery. For a few days, we recommend a regular walking regimen.
HOW SOON AFTER TREATMENT WILL MY SYMPTOMS IMPROVE?
Most patients report a noticeable improvement in their symptoms within one to two weeks following the procedure.
IS THERE ANY SCARRING, BRUISING OR SWELLING AFTER AN ETA PROCEDURE?
Patients report minimal to no scarring, bruising, or swelling following the procedure.
PATIENTS REPORT MINIMAL TO NO SCARRING, BRUISING OR SWELLING FOLLOWING THE PROCEDURE.
As with any medical intervention, potential risks and complications exist. They can include paresthesia (numbness or tingling), phlebitis, hematoma and – extremely rarely – infection thrombosis, pulmonary embolism or skin burn.
IS AGE AN IMPORTANT CONSIDERATION FOR AN ETA PROCEDURE?
The most important step in determining whether or not an ETA procedure is appropriate for you is a complete ultrasound examination. Age alone is not a factor in determining whether or not the procedure is appropriate for you. However, ETA lends itself particularly well for old patients because of the avoidance of spinal or general anesthesia and of a hospital stay.
WHAT HAPPENS TO THE TREATED VEIN LEFT BEHIND IN THE LEG?
The vein simply becomes fibrous tissue after treatment. Over time, the vein will gradually be completely absorbed into the surrounding tissue.
IS THE ETA PROCEDURE COVERED BY MY INSURANCE?
Many insurance companies pay for ETA procedures in part or in full if patients have complimentary insurance. We unfortunately don’t expect full coverage in short-term by basic insurance.