Minimally Invasive Procedures for Chronic Venous Insufficiency

If you’re diagnosed with chronic venous insufficiency, NYU Langone’s world-renowned team of vascular surgeons at the Vein Center can manage your symptoms using minimally invasive procedures. The goal is to minimize pain and disability and help you lead an active life.

There are many different kinds of minimally invasive procedures for chronic venous insufficiency. Your doctor makes his or her recommendation based on your individual diagnosis and health. After any of these procedures, your doctor may recommend that you wear compression stockings or bandages to promote healing and help prevent blood clots.

Thermal Ablation

At NYU Langone, vein specialists apply heat to destroy damaged veins in a procedure called thermal ablation. There are several methods. In each procedure, the specialist uses ultrasound imaging to guide a catheter, which is a thin, hollow tube, into the veins.

Radiofrequency Occlusion

Also known as Venefit, radiofrequency occlusion is when heat from electrical energy is used to destroy the vein wall. 

In this procedure, a hollow tube called a catheter that has electrodes at its tip is inserted through a small incision below the knee. It heats the walls of the damaged vein in 20-second bursts. This causes the vein to shrink and collapse. Your body eventually absorbs the vein, and blood is naturally rerouted to healthy veins. 

Radiofrequency occlusion is performed using local anesthesia in the doctor’s office and typically takes less than an hour. You can go home the day of the procedure and return to your usual activities right away.

This procedure typically causes less bruising and tenderness than surgical treatments. 

Endovenous Laser Treatment

Endovenous laser treatment is also called VenaCure.

During this procedure, an NYU Langone vein specialist makes a small puncture and inserts a catheter into the damaged vein in the leg. A laser fiber is then inserted into the catheter with a guiding tube. It heats the damaged vein, causing it to shrink and collapse. The body absorbs the vein and blood is rerouted to healthy veins.

You wear protective glasses during this procedure to protect your eyes from the laser. Endovenous laser treatment requires local anesthesia and takes less than an hour. You can go home about 30 minutes after it’s completed.

Nonthermal Ablation

In nonthermal ablation techniques, chemicals are used to cause a damaged vein to collapse and disappear. 

Injectable Foam

Your doctor may recommend a procedure in which a chemical foam, called Varithena®, is injected into the vein.

For this procedure, the vein specialist administers a local anesthetic and then inserts a catheter into the leg. Using ultrasound images to guide the catheter, the doctor injects a small amount of the foam through the catheter into the vein.

This causes the affected leg vein to collapse. Blood is then redirected to healthy veins.

This procedure takes less than an hour. You can go home the same day and resume your usual activities. Your doctor may recommend avoiding heavy exercise for up to one week after the procedure. 

Mechanico-Chemical Ablation

Mechanico-chemical ablation, also called ClariVein®, typically requires fewer injections of local anesthesia than thermal procedures.

In this procedure, the vein specialist uses ultrasound to guide a catheter into the affected vein. Next, a liquid chemical is delivered to the vein while a small, rotating metal wire helps to destroy the vein. Blood is rerouted to healthy veins. 

This procedure takes less time than other minimally invasive procedures, and you can go home the same day. 

Medical Adhesive

A medical adhesive may be used to close a damaged vein, sealing it shut, in a procedure that is also called VenaSeal®.

Your NYU Langone vein specialist inserts a catheter and then uses ultrasound guidance to advance the catheter. The doctor then delivers several precisely measured injections of the medical adhesive into the vein and presses on the vein using his or her hand. This helps the vein walls adhere, closing them off. Blood is rerouted to healthy veins nearby.

The procedure takes less than an hour, and you can go home the same day.

Phlebectomy

During phlebectomy, damaged veins are removed through small punctures in the skin that don’t typically require stitches. 

Your doctor injects a local anesthetic into the skin over the vein and then makes a tiny puncture. A thin metal hook in then inserted to pull the affected vein out of the body. 

The procedure takes between 30 minutes and one hour, and you can return to your usual activities the same day.

Sclerotherapy

In this procedure, a liquid or foam solution is injected into the affected vein. This irritates the vein, causing it to swell shut. The body reabsorbs the vein, and blood is naturally rerouted to healthy veins.

Generally, you can resume your regular activities afterward. Side effects include bruising or skin pigmentation problems, which usually disappear in weeks to months. You may need several sclerotherapy sessions to achieve the best results.

Lysis Therapy

NYU Langone vascular surgeons sometimes use lysis therapy to eliminate clots from leg veins.

In this procedure, a catheter is inserted into an incision in the upper leg and advanced to the clot. Next, your doctor injects medications that help to break up the clot. This type of medication is frequently infused through an IV while you stay in the hospital overnight. 

Sometimes, a tiny metal tool is inserted through the catheter to help destroy the clot. This may be done at the same time the medication is given or 24 to 72 hours after treatment with the medication.

Stents

Some damaged veins in the lower pelvis and upper legs can be treated with a stent, which is a small mesh tube.

During this procedure, which is performed using local anesthesia and sedation, your doctor makes a tiny incision in the groin and advances a catheter to the narrowed leg vein. A tiny balloon at the end of the catheter is inflated to stretch and widen the vein.

The doctor then inserts a stent into the vein through the catheter and expands it to hold the vein open. It remains in the vein and acts as “scaffolding,” allowing for proper blood flow.

You can go home after the procedure and return to your usual activities.

Compression Therapy

Your doctor may prescribe compression garments, multilayer bandages, or a compression pump, which is an automatic external pump that’s connected to padded, inflatable stockings that stimulate blood flow.

These therapies can help improve blood flow and reduce swelling, heaviness, achiness, itching, and fatigue in the legs. They can also help the legs to heal after minimally invasive procedures that destroy damaged veins.

Wound Care

For people with skin ulcers, which are painful sores that can be caused by chronic venous insufficiency, our specialists provide wound care. This involves cleaning wounds and preparing dressings that help prevent infection and promote healing.

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