Dr. Christiane Werneck
VENOUS DISEASES
Care by Professionals You Can Trust
VARICOSE VEINS
Varicose veins are a very common condition. They are bulging veins in the legs and can cause aching and fatigue, ankle swelling, blood clots, sores or bleeding. They are caused by defective valves preventing normal return of blood in the veins back to the heart against gravity. Appropriate diagnosis with throughout clinical assessment along with venous ultrasound of the legs are essential for determining best treatment.
The initial treatment starts with compression support hose or stockings which can relieve the discomfort and prevent complications. Further treatments such as traditional stripping, venous ablation with laser, sclerotherapy (injections) are some of the options available. Even though not all options are currently covered by OHIP, the initial assessment will determine which one is more appropriate for you.
STOCKINGS
Support hose or stockings are medically graduated socks specifically designed for the treatment of venous insufficiency, most commonly varicose veins, and also chronic leg swelling. When sized appropriately, it works fast and effectively compressing the veins and preventing the pulling of blood down at the legs. Some conditions may preclude you from wearing them such as severe arthritis, Diabetes and PAD. In those cases, external wrapping and pumps can be used. Stocking with pressure above 20mmHg  requires medical prescription and you need to be measured for them. The knee-high stockings is appropriate for most patients. To learn more or ask questions, simply reach out.
TREATMENT OPTIONS
Going beyond Stockings
Treatment for Varicose Veins are important and starts with stockings. However when the relief is not adequate further treatment may be required to relief symptoms and prevent complications. Different treatments can provide more durable results. However varicose veins have a tendency to recur over time. Staying fit and wearing stockings help better prevent.
NON SURGICAL OPTIONS
This is indicated for smaller veins (spider veins), often very superficial. Most commonly done for cosmetic reasons.
SCLEROTHERAPY
Also known as injections, consists in injecting a chemical in the superficial varicose veins causing shrinking of the vein (spam) and clot. Often it requires multiple sessions. Over time, the veins may disappear. It is ideal for spider veins.
FOAM SCLEROTHERAPY
This form of sclerotherapy is normally used for larger and or deeper veins not easily seen at the skin. It is done under ultrasound guidance  and the chemical is injected as micro-bubbles instead of liquid form to improve results.
LASER THERAPY
The use of Laser for treatment of spider veins has been described but it is not very popular. It can very uncomfortable and the results may vary.
SURGICAL OPTIONS
Different options of treatment designed to treat small and large varicose veins. They have similar results. Less invasive options may provide a faster recovery with much lower risks of complications. Currently, Stripping is the only option covered by OHIP for those patients with "complicated disease", based on their criteria. The initial assessment will determine your condition and your coverage.
STRIPPING
Traditional treatment
Traditional treatment which involves removal of the main superficial vein through small surgical incisions at the groin and knee. Multiple small incisions are made to remove smaller veins. It requires general anesthesia and some recovery time. Ideally, only one leg is done at the time considering potential bleeding, risk of infection, increased pain and time of major anesthetic . When both legs need treatment it is recommended at least few weeks in between treatments to allow good recovery and reduce the risks of complications.
THERMAL ENDOVENOUS ABLATION
RFA or EVLT
Catheter based procedure that causes the blockage of the main superficial vein in your leg by using heat generated by the catheter. In order to avoid any discomfort local freezing is injected along the vein which can cause some discomfort. It is very precise since it is guided by ultrasound. This technology is quite safe and well established for more than 25 years. It allows fast recovery and has lower risks compared to traditional stripping. It is consider the gold standard in the treatment of varicose veins.
VENASEALâ„¢
The latest Innovation
Most recent form of treatment where a special polymer (adhesive) is injected inside the main superficial vein and large veins. The medical adhesive was specific designed for this form of treatment, but similar polymer has been used for brain aneurysms and cardiac surgery for years. The procedure is also ultrasound guided to ensure precision and safety. It provides similar results to the laser treatment. It also has with fast recovery and very low procedural risks.
MICROPHLEBECTOMY
Great Cosmetic Results
Microphlebectomy is another surgical option to deal with varicose veins that might be resistant to sclerotherapy or vein that remained after other treatments such as EVLT. It carries much less risks than traditional surgery and minimal recovery is involved. It has excellent cosmetic results and is also done at the office setting under local anesthetic.