At Society Hill Vein Center, our physicians specialize in the comprehensive evaluation and treatment of varicose and spider veins. They are certified by the American Board of Surgery in Vascular Surgery for:
- Duplex Ultrasound vein mapping
- Radiofrequency and laser vein ablation
- Ambulatory phlebectomy
- Other Veinous Procedures
Matthew J. Dougherty, MD
Medical Degree: Harvard Medical School, 1984
Residency: Massachusetts General Hospital, 1990
Fellowship: May Clinic, 1992
Keith D. Calligaro, MD
Medical Degree: University of Medicine and Dentistry of New Jersey, 1982
Residency: University of Health Sciences in Chicago, 1987
Fellowship: Montefiore Medical Center, 1989
Is vericose vein treatment covered by insurance?
Health insurance usually covers procedures considered “medically necessary”. While many insurers will cover the cost of some treatment for symptomatic veins that fail to respond to compression therapy, most will not cover treatments which are primarily cosmetic. At Society Hill Vein Center, saphenous veins have usually been covered, while office-based procedures such as ambulatory phlebectomy and sclerotherapy generally are not. The physicians and staff at Society Hill Vein Center will assist you in ascertaining in advance as to what to expect in coverage and costs.
How do I schedule an evaluation?
Society Hill Vein Center is located at 7th and Spruce streets, in association with Pennsylvania Vascular Associates. To schedule an appointment, please call 215-829-6625.
700 Spruce Street, Suite #101
Philadelphia, PA 19106
What are varicose veins and spider veins?
While arteries carry blood from the heart to the tissue capillaries, veins are the blood vessels that return blood to the heart. In the legs, the deep veins are the main route for venous return, but superficial veins are present as well. The superficial veins are redundant and are sometimes harvested for use for bypass surgery. Veins have valves oriented such that as leg muscles contract, blood only flows toward the heart. These valves can become incompetent, causing blood to pool at high pressure in the superficial veins (“reflux”), stretching them and causing further valve incompetence.
The cause of failure of the valves may be hereditary. Hormonal influences contribute – vein disorders are more common in females and particularly associated with pregnancy.
Varicose veins and spider veins arise as prominent veins just beneath the skin. While varicose veins can produce bulging deformity with standing, spider veins typically appear as blue or purple streaks or nests. Both are manifestations of the same problem – congested venous blood in dilated veins caused by non-functioning venous valves. Approximately half of adult Americans are affected by varicose and spider veins.
Are varicose veins serious?
In many people, varicose and spider veins cause no symptoms. Pain, throbbing, and heaviness frequently accompany varicose veins, and these complaints are typically exacerbated by standing. Serious complications such as phlebitis (blood clots) are less common. Occasional patients develop thinning or inflammation of the skin overlying large varicose veins. However, the most common complaint is the unsightly appearance of the abnormal veins.
How are varicose veins and spider veins diagnosed?
Patients usually notice the protruding veins or discoloration even before symptoms occur. As board-certified vascular surgeons, the physicians at Society Hill Vein Center are very experienced in evaluating abnormal veins. The Registered Vascular Technologists in our ISCAVL-accredited vascular laboratory utilize color-duplex ultrasound to provide a precise map of the venous system, with particular attention to identifying the location and extent of venous reflux, which usually guides treatment options.
How are varicose veins and spider veins treated?
Stockings. As standing and having the legs in a dependent position increases the pressure in the leg veins, leg elevation will often relieve symptoms. To counteract the high pressure gradient in the standing position, elastic support hose can be quite effective. These stockings keep the veins collapsed and prevent reflux, and may help prevent progression of varicose veins.
Vein Stripping. the traditional treatment for reflux from the greater saphenous vein (the most common cause of large varicose veins) has been surgical removal. Under general or spinal anesthesia, incisions are made at the groin and below the knee and a wire is passed through the vein. A “bullet” is attached to the end of the wire and pulled back, tearing the vein from its branches and subcutaneous tissue. Bleeding into the space from which the vein was removed is minimized by compression, but significant bruising and swelling are common. This generally resolves in 6 weeks. Ace wrapping or support stockings are needed for 2 to 6 weeks.
Ambulatory phlebectomy. This office-based procedure is appropriate for secondary varicosities that persist after treating saphenous reflux, or for varicosities not contiguous with a major refluxing vein. Using a dilute anesthetic solution, small (-3mm) stab incisions are made over the bulging veins, and specialized hooks and clamps tease the veins out. The small incisions do not require suturing and heal with minimal scarring. Moderate bruising and discomfort is typical, and compression therapy is used for several weeks.
Radiofrequency ablation and EVLT (endovenous laser therapy). These newer minimally invasive procedures are an alternative to saphenous vein stripping. Rather than removing the vein, a catheter is placed into the vein under local anesthesia with ultrasound guidance. A dilute anesthetic solution is injected around the vein, which is then treated with radiofrequency or laser energy to heat-damage the inner vein lining. This causes the vein to contract and close, eliminating reflux. The procedure typically takes 30 to 40 minutes, requires no surgical incisions, and causes significantly less pain or bruising than vein stripping. compression stockings are used for about 2 weeks, and patients can usually resume normal activities within 48 hours. As with vein stripping, symptoms from secondary veins are usually relieved. Additional treatment with ambulatory phlebectomy or sclerotherapy may improve cosmetic results.
Sclerotherapy. This office-based modality is optimal for veins too small for phlebectomy, such as spider veins and reticular veins. No anesthesia is needed. A solution containing an agent irritating to the vein lining is injected under magnification. The inflammatory response incites a localized phlebitis within the tiny veins, causing them to close.
The small amounts of clotted blood may leave brownish pigment in the area, which typically resolves over a few months. Sometimes this material is drained with a small needles to accelerate healing. Several treatment sessions are usually needed for optimal cosmetic results.