Spider veins are discolored veins visible on the surface of the skin. Spider veins are often blue, red or purple in color and small in size. On the contrary, varicose veins are larger than spider veins and typically described as “bulging” veins. While varicose veins may appear discolored, bulging veins are usually flesh colored.

Chronic Venous Insufficiency (CVI) typically causes spider veins and varicose veins. CVI may occur in individuals suffering from an atypical circulatory system.

In a normal circulatory system, the heart pumps blood to the body. This blood is fuel – consisting of oxygen and glucose – flowing into the arterial system. Once the arteries deliver the blood to the body (via the arterial system), the veins collect the blood (via the venous system).

Unlike the arterial system, the venous system lacks a high pressure pump, and thus is described as a low pressure system. Veins utilize one way venous valves to push the blood back to the heart and lungs. When the valves begin to leak or dysfunction, as in CVI, varicose veins and spider veins may present. This results in slower blood drainage through the veins, resulting in leg pain, swelling, restlessness and prominent spider veins and varicose veins.

Over 30 Million people in the US suffer from Chronic Vein Disease (CVI), although only 1.9 Million (about 6%) seek treatment each year. Unfortunately, most patients – and sometimes doctors – are unaware that innovative, improved and effective and treatment options are now available. According to recent research, among patients who reach the age of 60, 72% of women and 43% of men will suffer from CVI.

There are several factors that can increase your risk of developing Chronic Venous Disease (CVI), including:

- Family History of CVI
- Increasing age
- Obesity
- Pregnancy
- Prolonged sitting or standing
- Prior injury or surgery
- History of blood clot in a vein

While CVI is more commonly found in women, men can be affected as well. One study estimated that by the age of 60 years, 72% of women and 43% of men will have some degree of CVI.

Patients suffering from Chronic Venous Disease (CVI) can present with a variety of leg symptoms, including:

- Pain/aching/cramping that gets worse as the day goes on
- Heaviness/fatigue
- Swelling
- Itching, with or without a rash
- Restlessness
- Prominent veins (spider or varicose)
- Darkening of the skin
- Ulcerations

If you suffer from any combination of the above signs and symptoms, and you feel that these are preventing you from living the kind of life that you want to live, you should seek treatment by a qualified vein specialist.

At Southlake Vein Care, we will collect your medical history and perform a physical examination. If we feel that your signs and symptoms are likely to be related to Chronic Venous Disease (CVI), we will perform a non-invasive duplex ultrasound study on your legs. All of that information will then be reviewed and a customized treatment plan will be developed, using a combination of the treatment modalities available to us, to address your condition.

In the past, Chronic Venous Disease (CVI) was treated with conservative measures-essentially leg elevation and compression therapy-until the patient’s condition got severe enough to warrant surgery. Vein stripping was the surgical procedure of choice. It was a painful procedure which required either regional or general anesthesia in a hospital setting, and frequently required post-operative hospitalization. There was a significant amount of post-operative discomfort, and it took a long time for patients to recover. Vein stripping procedures were often complicated by nerve injuries, and recurrence/failure rates were high.

Thankfully, much has changed in the management of CVI over since the days of conservative measures and vein stripping. At Southlake Vein Care, we are now able to treat CVI in the office setting, with minimally invasive procedures performed with local anesthesia. Once the diseased veins are identified by a non-invasive ultrasound study, we treat them by shutting them down, using a combination of the modalities that we have available to us. Eventually, the treated veins turn into scar tissue and are absorbed by the body. Once the diseased veins are shut down, the body redirects the “used” blood to other, healthy veins, and the blood is able to drain from the leg more efficiently, as it is supposed to.

During your initial visit, you will speak with the physician or physician assistant and have a physical examination. If indicated, an ultrasound study will also be performed on the day of your initial visit. This can be scheduled the same day as your visit but may not always be available.

Medical grade compression (20-30 mmHg) stockings may be prescribed.

A follow up appointment is typically scheduled based on the requirements dictated by your insurance company. Most insurance companies require a 6 week to 3 month trial of conservative measures before they will approve definitive treatment of your insufficient veins.

In some extreme cases, a patient may qualify to have procedures performed without the conservative measures requirement. This would be outlined in your insurance policy criteria. Typically, patients must have some kind of ulceration or bleeding to qualify for this exemption but it can vary, based on your insurance.

“Conservative Measures” would include measures such as exercise, weight loss, leg elevation, and medical grade compression stocking use. These measures can help to decrease the symptoms associated with Chronic Venous Disease (CVI), and may also help to slow down the progression of CVI, but they will not effectively treat the underlying cause.

Despite that fact, most insurance companies require proof of 6-week to 3 months of medical grade (20-30mmHg or higher) compression stocking use. To document this, we ask that you bring a copy of your receipt for your stockings for our records, unless you purchased the stockings through our office.

If your insurance company requires a trial of conservative measures, in most cases, past compression stocking use will not be adequate. We will need to document the beginning of the trial (which is typically the day of your initial visit), the end of the trial (anywhere from 6 weeks to 3 months later), as well as the degree of relief obtained through the use of the conservative measures to determine whether or not more aggressive treatment is indicated.

Thermal Ablation:
- Radiofrequency Ablation (RFA)
- Endovenous Laser Ablation (EVLT)

VenaSeal Closure System:
- Non-tumescent, non-thermal, non-sclerosant procedure that uses a proprietary medical adhesive delivered endovenously to close the vein

Chemical Ablation:
- Ultrasound Guided Sclerotherapy (USGS)
- Polidocanol Endovenous Microfoam (PEM/Varithena)
- USGS and Injection / Cosmetic Sclerotherapy

Phlebectomy:
- Ambulatory Microphlebectomy

Most patients with spider and varicose veins have underlying venous disease. We want to provide our patients with the most optimal treatments for the best possible long-term results. Therefore, Southlake Vein Care recommends that all patients have a detailed ultrasound of their leg veins performed after their initial consultation to determine the extent of venous disease. If this ultrasound shows no underlying issues, cosmetic vein procedures may be considered.

Our goal is to follow insurance company guidelines in order to get your procedures approved. We will not schedule patients for any procedures without authorization on file from your insurance company. If you choose to go outside of your insurance and have procedures performed as a cash pay expense, you may schedule at any time but will be required to pay for all procedures in advance. Estimates are provided upon request.

Based upon the limitations set by your insurance company and the necessary process for authorizations, we may or may not be able to perform your procedures by the end of the year. Please understand that we have to schedule patients in the order that authorizations are received.

The end of the year is the most popular time for scheduling, as most patients have met most or all of their deductible. So, we recommend scheduling when you receive a call from us stating that your procedures are approved. Any delay in scheduling may result in the inability to have your treatment plan completed in the desired time frame.

We offer oral sedation in the form of Valium to our patients. Sedation is offered as a courtesy to our patients, but it is not required for the procedures.

The purpose of sedation is to make a patient less anxious during the procedure, not to eliminate discomfort during the procedure. Pain control is achieved through the use of lidocaine, a local anesthetic.

If a patient receives sedation for a procedure, that patient will need to have a driver (a friend or family member, not an Uber or Lyft driver) who will sign the patient out and assume responsibility for the safe transport of the patient.

The amount of time you need to wear the compression stockings after a procedure depends upon which procedure was performed. After most procedures, we recommend compression stocking use around the clock for the first 1-3 days, then just during the daytime for days 4-7. Compression stockings are not required after a VenaSeal procedure.

Please double check the post-op instructions given to you after your procedure.

If you can’t find the post-op instruction sheet, they can be found here.

For most patients, we recommend the use of an over the counter NSAID mediation (naproxen/”Aleve”) after procedures. Please refer to the post-operative instructions for further clarification.

Low impact exercise in the form of walking is encouraged, starting the day of the procedure.

Restrictions for 1 week after any procedure:
- No High Impact exercise (running) or activities that cause you to strain (weight lifting, yoga, pilates, golf tennis, etc.).
- No lifting over 20 lbs.

Activities allowed during the first week after a procedure:
- Walking
- Elliptical machine (low resistance)
- Exercise bike (low resistance)

You can swim after 1 week in your own pool and 2 weeks in a public pool.

Sun exposure is not recommended without heavy sunscreen. The sun can cause darkening of the skin on areas that are bruised or discolored after procedures.

You must wait at least two weeks before extensive travel. We also recommend a 3-month post-operative healing period before taking long trips, but if you do travel during that period, you will need to follow certain precautions. Wear your compression stocking, stay well hydrated (avoiding caffeinated beverages), and ambulate often. Stop at least once each hr if traveling by car to walk for 5-10 minutes. If flying, the same precautions apply, and you can either walk around the cabin or flex and relax your calf muscles regularly during the flight. This encourages blood flow out of the leg and lowers risks of blood clots. Flights over 3 hours are not recommended for 1st month following thermal ablations.

There is a common misconception that the treatment of venous disease is considered purely cosmetic, and therefore not covered by health insurance. While that is true for the treatment of spider and reticular veins (the small, blue/purple veins close to the surface of the skin), those treatments are only a small component of the treatment of venous disease. Patients who have spider and reticular veins typically have more significant underlying venous problems which are causing those surface veins to become more noticeable. Fortunately, most insurance plans do cover the procedures that treat those underlying problems.

There are many reasons why insurance companies may deny some/all of your recommended treatments. These decisions are made by the insurance companies using the medical policies that each insurance company have established for the treatment of Chronic Venous Insufficiency.

While the policies that the various insurance companies use are similar in many ways, they can be quite different in terms of requirements that need to be met, treatment options that are covered, etc. Also, these policies can change without warning, which can lead to some confusion and frustration. We do our best to stay up to date and monitor for any policy changes in order to make the process go as smoothly as possible.

The treatment plans that we recommend for our patients are customized for that patient. When drawing up a patient’s treatment plan we not only look at the presenting signs and symptoms and ultrasound findings, but we also take into consideration what their insurance plan will cover, with thoughts of getting the best results for the patient at the most reasonable cost to the patient.

Insurance companies usually send authorization/denial letters to patients to explain these decisions. We encourage you to read through your letter, which should tell you exactly why some/all of your procedures were denied. Please feel free to reach out to our office with any questions.

Although it is strongly recommended that you complete all recommended treatments outlined by your physician, you may choose to not complete some non-covered procedures, based on your insurance authorizations/denials. We encourage you to carefully read the documents mailed to you by your insurance company regarding your approved/denied procedures. Should you have any questions regarding omitting any treatments, you should address these issues at your pre-operative appointment.

If you have any questions regarding your authorizations/denials and potential fees for services, please contact our insurance department by phone Monday thru Thursday 8:00am-5:00pm or contact us via web form.

We have tried numerous times in the past to perform peer-to-peer reviews and appeals on decisions concerning medical policy guidelines and medical necessity. Sometimes we are able to successfully explain why the recommended treatments are medically necessary, but this is not always the case. If, based on our experience, we feel that there is a good chance of success, we will perform a peer to peer review.

We encourage you, as a patient and consumer, to call your insurance company and inquire as to why these things were denied and let them know that your condition is “affecting your quality of life”. Sometimes by filing your own appeal, you can get them to change their decision.

If the insurance change happens during the required period of conservative measures use, you would not have to restart the conservative measures trial. The length of the conservative measures trial may be shorter or longer, depending upon the medical policy of your new insurance carrier.

As an example, if you previously had BCBS TX, which requires a 6 week conservative measures trial, and switched to Cigna, which has a 3 month conservative measures requirement, we would have to move your insurance required follow up to a date 6 weeks later than originally planned.

If the insurance change happens during the treatment plan, we ask that you please inform us about this change in coverage immediately, as the new insurance company is under no obligation to cover procedures that were approved by a different insurance company. In that event, all future procedures would need to be cancelled and we would need to submit your information to your new insurance company for authorization. Failure to notify us will likely result in a denial of the claims and you will be responsible for the cost of the denied procedures.