Griffin R. Coates, MD, FACS
Coates Vein Clinic, pllc
15920 S. Rancho Sahuarita Blvd • Suite 150 Sahuarita, AZ 85629
Phone: 520.849.VEIN (8346)
For more information fill out the form below or better yet, call and speak with a real person!
Diagnosis and Personalized Treatment Plan
After a complete review of the patient’s history and symptoms, and if indicated as medically necessary, Dr. Coates will perform a diagnostic duplex ultrasound. This examination is performed to visualize the venous anatomy and identify specific areas of venous reflux. Dr. Coates uses the high performance Terason Ultrasound—a product trusted by thousands of clinicians worldwide for superior image quality.
He teaches the patient about the venous system and ultrasound techniques as he works. Dr. Coates believes that helping the patient understand about his/her condition is an important part of medical care. After the ultrasound and arriving at a diagnosis, the doctor discusses with the patient the specific treatment options designed to best treat the patient’s venous disorder.
Dr. Coates may choose to incorporate one or more of the following into the treatment plan.
Rest, elevation, exercise
Ultrasound guided sclerotherapy/Vein Lite assisted sclerotherapy
Radiofrequency ablation (VNUS Closure/Venefit)
of venous insufficiency
Several options are available for conservative management of venous insufficiency.
These include using elevation of the legs throughout the day to assist the venous return, however, it is most effective if the legs are actually elevated above the heart and not just partially elevated on a footstool.
Using anti-inflammatory medications such as Tylenol, aspirin, or ibuprofen can also relieve some discomfort and inflammation, but may have some side effects and does not address the cause of the problem.
Wearing graduated compression socks is one of the most useful methods of relieving symptoms but it requires proper fitting and may be contraindicated in the presence of arterial disease. The stockings are designed to counteract gravitational pooling in the leg veins and are therefore tightest near the ankle and less compressive at the calf and the thigh.
There have been great improvements in the fabrics available in compression stockings and in methods to make them easy to apply. The stockings do not cure the underlying venous problem but often relieve many of the symptoms. They are most effective when worn on a regular basis throughout the day and are removed at nighttime.
Sclerotherapy (the injection of small spider veins with a chemical to sclerose, or close off the vein) is the gold standard for treating spider veins around the world. We use modern chemicals that are much less painful and safer than the saline solution that many people have heard about. We also use the smallest needles available and many patients barely feel the needle stick.
Transilluminated (Vein Lite) sclerotherapy
Often the spider veins that patients see are related to larger branches of veins that are not immediately obvious. We use a special transillumination device (Vein Lite) to help identify and treat the “feeding” reticular veins which allows a more complete and effective resolution of the spider veins.
If patients have had poor results with spider vein treatment in the past may be because these larger, less visible veins may be the underlying reflux source.
We do not use saline solutions for sclerotherapy. We use the FDA approved medications polidocanol or sotradechol which are more effective and less painful than saline.
Sclerotherapy often does not eliminate all diseased veins after just one treatment. Patients may typically require between four or six treatment sessions, scheduled a month or two apart, in order to obtain the best results. Most patients can expect a 50 to 60% improvement after completion of a course of treatments.
Sclerotherapy for spider veins is considered cosmetic and not covered by most insurance companies. Some potential complications include failure of treatment, skin discoloration, and formation of new spider veins or allergic reactions to medications. All of this will be discussed with you in detail at your evaluation.
Ultrasound guided foam sclerotherapy
In selected patients, a chemical mixed with air in order to create a foam suspension can be injected into the varicose veins in order to close them and prevent reflux. This is performed using ultrasound guidance to identify the diseased vein and guide the placement of the needle within the vein before injecting the chemical. Limitations of this technique include maintaining good pressure on the vein in order to limit movement of the chemical foam and to maintain apposition of the vein walls. Some patients develop hardening of the vein segments after the procedure and this may take several months to resolve.
It can be useful for certain patients or for recurrent tributary veins but the long-term results may not be as good as other techniques. Individual patient selection by an experienced physician is important.
Typically, compression stockings are prescribed following foam sclerotherapy treatment. The stockings should be worn continuously for a period of 48 hours after treatment, followed by a two-week period when they need only be worn during the day.
During this two-week period, patients should avoid strenuous exercise and ensure that treated areas are not exposed to the sun.
Normally, patients notice improvement in symptoms and appearance anywhere from three weeks to three months following foam sclerotherapy treatment.
With foam and liquid sclerotherapy, multiple treatments may be necessary for optimum results. Liquid sclerotherapy treatments are usually spaced six weeks apart and foam sclerotherapy sessions may be repeated in as little as one week.
Sclerotherapy (injections) versus Laser treatment for spider veins
Many patients with spider veins inquire about laser treatments. A laser is simply a focused, powerful beam of light that is designed to be fired through the skin and heat the blood within the vein. It tends to be more painful, less effective and more expensive than injecting the veins with a chemical (sclerotherapy). It can also sometimes cause permanent white spots on the skin. Therefore, for many reasons we do NOT use laser treatments.
Lasers may work in a small number of patients but they often fail because of the presence of larger (reticular) veins under the skin which feed into the smaller spider veins near the surface. These veins are easy to see with special devices that shine a light through the skin to create a shadow that will identify the larger reticular vein .It is much easier to treat these reticular veins with injections of a chemical and therefore have better long-term results.
Originally developed in Europe and now commonly performed in the United States, ambulatory microphlebectomy is the surgical removal of surface varicose veins. This procedure is minimally invasive, uses local anesthesia, and is done in the doctor’s office. Using specially designed instruments, the abnormal vein is removed through tiny punctures in the skin. These mini punctures do not require stitches to close and the discomfort is minimal. After the vein is removed by phlebectomy a bandage and/or compression stocking is worn for a short period of time. The patient is able to walk out and return to normal activities with 24 hours.
(formerly known as VNUS Closure/Venefit)
Radiofrequency ablation of the saphenous vein
The Venefit procedure, previously known as the VNUS closure procedure, utilizes radiofrequency energy to heat and contract the collagen in the vein wall which causes the vein to collapse and seal shut. It involves using local anesthesia to temporarily place a very thin catheter inside the diseased saphenous vein. Once the catheter is in place, additional local anesthesia is placed around the vein using ultrasound guidance. Patient sometimes experience a sensation of fullness in the leg but not pain. The catheter is removed after heating the wall of the vein. A small Band-Aid is placed over the 2 millimeter incision.
The Benefits of Radiofrequency Endovenous Thermal Ablation Therapy
There are many benefits to radiofrequency endovenous thermal ablation when compared to other forms of serious venous disease treatments, such as endovenous laser ablation or vein stripping.
Venefit Targeted Endovenous Therapy is a minor outpatient procedure that requires only a small incision for each vein that is to be ablated.
When compared to endovenous laser ablation, radiofrequency endovenous thermal ablation is associated with significantly lower rates of pain, bruising, and complications.
Vein stripping, which is a much more invasive procedure than either radiofrequency or laser ablation, and requires incisions in the groin and calf through which a tool is inserted and the diseased vein pulled out of the leg. As a result, the likelihood of pain and bruising is much higher.
Advances in technology have revolutionized vein care, making vein stripping rarely necessary. If a vein stripping has been recommended for you, please call Dr. Coates for a second opinion by a true vein specialist.
Endovenous treatment typically takes about 30 or 45 minutes. If additional procedures are performed at the same time it may take up to an hour and a half. After the procedure, compression dressings and a support stocking are applied. The compression bandages are removed after two days and the support stockings are worn for two weeks. Most patients can go back to normal activities the day after the procedure although impact exercises and long distance travel are limited for 1-2 weeks.
Speedy Recovery and Better Results
Patients treated with radiofrequency endovenous thermal ablation recover faster than patients treated with laser ablation or vein stripping. In fact, most patients are able to resume normal activities within a day or two after the procedure, though patients may be asked to avoid strenuous activities for a few weeks.
Studies show that patients also experience quality of life improvements up to four times faster than patients treated with laser ablation.
Most patients report a significant improvement in their symptoms (pain, swelling, heaviness) within a few days to a week or so after the procedure.
In our experience, 95% of the veins treated with radiofrequency remain closed at five years. Occasionally, small branch veins may develop and these can usually be treated with either injections or microphlebectomy.