Healthy leg veins carry blood upward against gravity, and small one-way valves keep it from falling back down. When those valves fail, blood pools in the leg. Pressure builds in the vein wall, the vein stretches and twists, and the visible rope under the skin appears. The bulge you can see is the last step in the process, not the first.
That is why treating only what is visible so often disappoints. If the underlying refluxing vein is left alone, the problem returns. Every evaluation here begins with a duplex ultrasound that maps which veins have failed and in what order, so treatment is aimed at the cause rather than the symptom.
Left untreated, venous reflux tends to progress: aching and heaviness at the end of the day, then swelling, then skin discoloration around the ankle, and in some patients a venous ulcer that will not heal. Treating the vein early is a great deal simpler than treating the skin damage that follows it.
What the procedure involves
Duplex ultrasound mapping
We image the deep and superficial systems in the standing position, where reflux actually shows itself, and identify exactly which segments have failed.
The right closure for the vein
Depending on the vein's size, depth and course, we close it with endovenous laser (EVLT), radiofrequency ablation, medical adhesive closure or foam sclerotherapy. Each is delivered through a needle puncture under local anesthesia.
Treating the branches
Once the source is closed, the visible tributaries are addressed with micro-phlebectomy or sclerotherapy, usually at a second short visit.
Walk out and keep walking
You walk immediately after treatment. Walking is part of the treatment — it keeps the deep system moving while the closed vein reabsorbs.