Dr. Mueller is the finest physician I have ever had. I have entrusted my life in his hands for over 15 years and he is the only Doc I would empower to be my medical team leader. His judgment and diagnostic & communication abilities are impeccable, as is his medical advocacy on my behalf. He actually listens, gives me full attention, and truly cares. He is always reachable immediately; I couldn’t be happier in the concierge program, which gives me extra security and confidence and I love the instant priority, no wait appointments, as well as the value, added tests that would not normally be covered.
Sclerotherapy involves chemical injections to close spider & varicose veins – (inc. liquid, foam, ultrasound guided) Sclerotherapy involves the injection, painlessly and with fine needles, of chemicals designed to irritate and close down diseased veins of any size. While this can be applied to any sized diseased veins, sclerotherapy is most useful for small to mid size veins, or severely twisting veins. Larger, straight veins are most successfuly treated with EVLA. While a variety of sclerotherapy chemicals exist, we use the only two approved by the FDA: Sotradecol® & Asclera®. Additionally, unlike many vein specialists who use cheaper Sotradecol solutions prepared by Arious pharmacies from raw ingredients (‘compounded’), we only use the much more expensive Sotradecol manufactured directly at the factory of the one company licensed by the FDA in the US (Angiodynamics, Inc.®). This is for the sake of our patient’s safety, as there are many reports of significant impurities in and safety problems with cheaper compounded Sotradecol & Asclera. We do not use Saline injections, which many facilities use because it lowers their costs. Saline is very painful upon injection, unlike Sotradecol or Asclera, and Saline has a much higher risk of causing skin breakdown if injected outside the vein”.
Please note that many offices will end sclerotherapy sessions after 15 minutes, while our sessions last much longer. Many offices have nurses or physician assistants perform your treatment, while here it is performed by Dr. Mueller himself.
Sclerotherapy is a time honored, successful technique for closing down diseased or unwanted veins, but like all techniques in medicine is not perfect. It nonetheless is more successful for treating small veins than external lasers; therefore, sclerotherapy is still considered the gold standard for treating such veins, though we offer both treatments in our vein center, as there are pros and cons to each method. Venoscope II outlining a deeper, normally invisible ‘feeder’ reticular vein. Most patients require several sclerotherapy sessions, which last approx. 30 minutes and involve the injection of approx. 10-25 veins, depending on the size. Sclerotherapy is approximately 70-80% effective in reducing or eradicating the treated veins, but cannot prevent new veins from forming, so touch-up treatments may be required periodically. Insurance does not cover sclerotherapy of spider veins but does cover treatment of varicose veins in many cases.
Our philosophy at our NYC vein care office in all our treatments is safety first, and since each patient and each vein is different, we start with the safest and lowest strength of the powerful Sotradecol or Asclera chemical (a detergent) and if needed, treatment can always be repeated on a subsequent visit with stronger strengths. Treatment sessions are typically spaced 2-4 weeks apart. Also, since vein disease is a chronic and usually progressive condition, new veins usually will develop which may require treatment in the future, such that sclerotherapy treatments often need to be repeated over time, even when initially successful.
Veinlite high-intensity halogen lamp
The same compression stocking and close follow-up regimen is used as after EVLA (usually without need for follow up ultrasound imaging). Sclerotherapy can be used as a stand-alone procedure, or as a follow-up to EVLA or phlebectomy, in order to close down smaller veins (red or blue veins; “spider veins” or “reticular veins,” respectively). Larger veins are often treated with refinements of basic liquid sclerotherapy, namely foamed sclerosant (liquid mixed with carbon dioxide gas into a frothy foam) or sclerosant injected under ultrasound imaging guidance; these techniques can improve results, with improved safety.
To further enhance safety, we make sclerosant foam with medical grade carbon dioxide (C02) gas from a tank rather than the simpler and cheaper method using room air. Numerous studies show that foam made with C02 is safer than that made with air. We also use a state of the art visualization / illumination / magnification system, the Syris v600 Visualization System®. This headlamp uses cross polarization optical filters to enhance visualization of blood vessels literally under the skin surface. The polarized filter optics are combined with magnification and potent illumination to give our vein specialists superior visualization of even the smallest veins.
Another visualization tool we use to outline deeper ‘feeder’ veins under the skin to target them for injection is Transillumination, using either the Veinlite®, by Translite LLC®, Sugar Land, TX, or the Venoscope II Transilluminator®, Venoscope LLC®, Lafayette, LA.
Veinlite outlining a normally invisible feeder vein
These powerful lights are equipped with high-intensity halogen or LED lights, respectively, which shine powerfully through the top centimeters of skin and subcutaneous tissues at an angle to the skin. They are focused on a spot deep under the skin where the focused and reflected light beams act as a point light source under the skin, which illuminates a large area.
The reflected and focused light is absorbed by hemoglobin in veins, thereby outlining them as black ribbons against surrounding tissues that transmit light back up through the skin and therefore show up as a surrounding light orange glow. The end result is a powerful contrasting effect that highlights the veins that appear dark and ‘pop’ out of the surrounding tissue when they are either poorly visible or not visible at all in regular lighting.
We also use the revolutionary VeinViewer® (Christie Medical Holdings, Inc.®, Memphis, TN) infrared vein imaging technology to visualize target veins.