Vein Center Of Orange County
250 E Yale Loop, Suite D, Irvine, California 92604, Phone: (949) 551-8855
Hours of Operation: Monday - Friday 9:30AM to 4:30PM
Ultrasound-guided Sclerotherapy (UGS) & Endovenous Laser Ablation (EVLA)
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| 1. | Kanter A, Thibault PK. Saphenofemoral incompetence treated by ultrasound-guided sclerotherapy. Dermatol Surg 1996;22:648-52. |
| 2. | Kanter A. Clinical determinants of ultrasound-guided sclerotherapy outcome, Part I: The effects of age, gender, and vein size. Dermatol Surg 1998;24:131-135. |
| 3. | Kanter A. Clinical determinants of ultrasound-guided sclerotherapy outcome. Part II: In search of the ideal injectate volume. Dermatol Surg 1998:24:136-140. |
| 4. | Kanter A, Gardner M, Isaacs M. Identification of arteriovenous anastomoses by duplex ultrasound: implications for the treatment of varicose veins. Dermatol Surg 1995;21:885-9. |
| 5. | Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Inter Radiol 2003;14:991-996. |
| 6. | Almeida JI, Raines JK. Radiofrequency ablation and laser abalation in the treatment of varicose veins. Ann Vasc Surg 2006;20:547-552 |
Note that the skin surface is located at the top of the ultrasound image, with deeper tissues underneath. The needle tip will appear as a fine white line entering from the above right, and will advance slowly through the vein's top wall until it enters the vein's channel, or lumen. As the injection is done, you will observe the solution (white particles) to disperse within the vein.
The number of injections (performed in a single session) depends on the individual response observed on the ultrasound video monitor, and averages 3 or 4.
Video
In essence, UGS and EVLA are safe and highly effective out-patient procedures using endovenous laser and/or injections to eliminate the deeper diseased veins hidden from view that have traditionally required surgical removal. Here is a brief explanation of these important advances in the treatment of varicose veins.
For a long time, sclerotherapy was thought to be effective only for spider veins and small varicose veins that remain after surgery. But since 1990, the use of duplex ultrasound (DUS) has enabled the precise anatomic location of abnormal "saphenous" veins and their tributaries, so that injections of powerful sclerosing agents directly into these veins can be accurately delivered for effective and durable results.1-4 DUS thus serves both to provide a diagnostic functional assessment with anatomic mapping, and to guide the actual injection process. The patient benefits by avoiding Xray contrast studies (venography), and at the same time achieves ablation of the affected saphenous veins without the disadvantages of surgery (higher risks and costs, recuperation time, and scars).
DUS is the key to the success of this procedure. First, it locates the diseased "saphenous" vein(s) hidden from view that cause the more obvious bulging surface
varicosities. Next, it guides both the placement and number of injections according to individual response. More recently, DUS guides the placement and deployment of an endovenous laser fiber often combined with sclerotherapy.5-6 Later, follow-up DUS examinations confirm success and guide additional treatment when necessary.
Expertise in operating and interpreting DUS is critical for accurate and effective treatment of venous disease. For that reason most physicians send their patients to a specialized ultrasound imaging center for mapping upon which treatment decisions are based. However, there is a clear advantage in having the same expert who performs the diagnostic mapping also perform the treatment.
At VCOC, Dr. Alan Kanter does exactly that in one location. On top of two decades’ experience as a phlebologist using DUS to guide thousands of treatments,1-4 Dr. Kanter has also earned the RVT (Registered Vascular Technician) credential documenting a high standard of expertise as it applies to ultrasound imaging and interpretation for venous disease. He is one of only a few physicians with this additional formal training, which means he is highly qualified to follow his patients from beginning to end.
The success of surgery and duplex-guided treatment depends on accurate control of all reflux points. Both methods share a similar high success rate when performed by experienced practitioners who accurately target the diseased veins using DUS. However, published studies show that most patients prefer duplex-guided treatment if given the choice, especially since recent studies show EVLA has the highest success rate of all.5-6
No treatment method can prevent new varicose veins from developing as a result of the natural progression of this chronic condition. However, UGS and ELVA offer less traumatic, less costly alternatives to gain and maintain control. Treatment in the earlier stages helps avert expensive and morbid complications including leg ulcers, stasis dermatitis, phlebitis, and venous thromboembolism while relieving chronic symptoms.
It is important to note that recent international consensus groups and the medical literature agree UGS and EVLA should be performed only by highly experienced specialists. I am happy to have contributed to the developments of UGS.1-4 By scrolling further down on this page, you may view a very brief video of an actual ultrasound-guided injection.
Alan Kanter, M.D., R.V.T., F.A.C.Ph.
Founder & Medical Director, VCOC
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