1585 Kapiolani Blvd. Suite 1740 Honolulu, HI 96814

Vein, Spider Vein,Varicose Vein

How do I know your treatments are for me?

Our treatments are at the forefront of varicose and vein treatments. Many physicians offer sclerotherapy but our center offers comprehensive vein care that treats the underlying cause of varicose veins and eliminate them. We can treat nearly all people successfully. Some people who have venous ulcers, a history of deep venous thrombosis or other hypercoagulable states (such as lupus, Factor V Leiden deficiency, etc.), are morbidly obese, or poorly controlled diabetics may not be good candidates at this center. We will however do everything possible to help you find specialists who are more experienced at handling these difficult circumstances.

What is your success rate for treating varicose and spider veins?

With the endovenous laser ablation therapy (EVLA)-success rates are now at 98%. By using a combination of therapies in addition to EVLA we can successfully treat almost all candidates for varicose and spider veins.

How many treatments are needed?

EVLA-usually one treatment has a 98% success rate at treating the underlying cause of the varicose veins. Sclerotherapy-this varies from person to person depending on the number of and size of the veins to be treated. Typically the average person needs 2-4 treatments. Phlebectomy-by using micro-incisions to extract the vein, typically one session will eliminate the visible varicose vein.

Will my insurance cover the procedures?

Insurance will typically cover procedures such as EVLA (endovenous laser ablation therapy) and Phlebectomy so long as the below conditions are met:

Venous Ultrasound reveals that you have documented venous reflux (blood flowing in the wrong direction in your leg veins) and that your veins are causing you to have symptoms.

The other procedures-visual sclerotherapy and ultrasound-guided sclerotherapy-even though they are an essential part of the comprehensive care of veins, they are considered cosmetic and are not covered by insurance.

What is the process I can expect and what is the recovery time?

Step 1: Get a formal consultation. We will examine you and do a history and physical examination. We will educate you about venous disease as well as formulate which combination of therapies is right for you.

Step 2: Get an ultrasound done of your legs. This tells us if you have venous reflux (the flow of blood backwards in your veins that causes varicose and spider veins) and takes about 15-20 minutes per leg.

Step 3: Review ultrasound reading and set up treatments: If you have insurance, we will start the process of pre-authorization for EVLA and phlebectomy if you are a candidate. In the mean time, certain insurers require a trial of compression stockings first (it never resolves the cause). However it is a step that is required by the insurance companies-not us. Do the insurance companies have any way of knowing you actually wore the stockings? No. If you are paying cash there is no need to wait for pre-authorization and we may start treatments as soon as you like.

Step 4: Treatment day. EVLA and possible Phlebectomy procedures: These are often done on the same day (for your convenience). No need to fast the night before like surgery. We require you to bring in a pair of compression stockings (we will fit you here and order the appropriate size for you). Please adhere to this because treatment success relies upon the post-treatment plan as much as the procedure itself. If you like, before the procedure we can give a mild oral sedative so long as you have someone to drive you home. There is no down time. You may resume activities that day! We do require you to wear the stocking/leg for 24 hours and then one stocking/leg for the remaining two weeks, so a total of three weeks of stocking use after the procedures.

Visual Sclerotherapy/Ultrasound Guided Sclerotherapy: These can be done anytime. No preparation is needed. Most people need 2-4 treatments of visual sclerotherapy on average.

Step 5: Follow up visits and ultrasound: We will do a follow up ultrasound the next day as well as follow up visits after one month, after six months, and at one year. We follow you to make sure you are getting excellent results that you deserve.

What are the possible side effects?

EVLA - Most people report some "tightness" in their thighs that typically goes away after one week. Some people have a small amount of bruising at the laser entry point into the vein that typically goes away after a week or two. The complication of deep vein thrombosis almost never occurs (less than one percent of the patients) but we will follow you with ultrasound to make sure you are thoroughly screened and safe from this complication.

Phlebectomy - Most people have a small amount of bruising near the micro-incision sites, but it typically goes away quickly with compression, ice, and time.

Sclerotherapy (visual, ultrasound guided) - Some people have mild itching that only lasts a couple of days. Brown spots, or "hyperpigmentation" is a temporary problem that some people have after sclerotherapy that resolves on its own spontaneously. 70% resolve themselves at 6 months and nearly 99% resolve themselves at 12 months. Ulceration and blistering occur when sclerotherapy solution is accidentally injected into an artery. With the VeinViewer machine we employ (the only one on Hawaii) we greatly minimize the chance of this occurring. With proper care of this uncommon complication, most people heal with any problems.

What is Phlebology and who can practice it?

Phlebology is a field of medicine that pertains to advanced vein care. Currently many types of physicians including vascular surgeons and interventional radiologists have pioneered it. Drs. Chung is a Board Certified Emergency Physician and because of his background in Emergency Medicine, inserting catheters into veins (the hardest part of any of the vein treatments) is a routine procedure, perhaps more than almost any other specialty. Drs. Chung is an active member of the American College of Phlebology. Dr. Chung is also a Diplomate of the American Board of Phlebology.

Vein FAQ

What's the difference between arteries and veins?

Most people with varicose and spider veins are self-diagnosing. To better understand what is going on to cause varicose and spider veins we must know what the difference between arteries and veins are. Both are designed to carry blood in only one direction-like cars on a freeway. The difference is quite simple. Arteries carry blood away from the heart and bring it to the extremities. Veins do the opposite. Veins carry blood back to the heart from the extremities. In the legs they must do so against gravity. How are they able to bring blood back against gravity from the legs to the heart? They do so with the help of one-way valves in the veins. They allow blood to travel up but not back down towards the feet.

What are varicose and spider veins?

Varicose veins and spider veins appear when those valves fail and allow blood to flow in the wrong direction back toward the feet. This blood flow in the veins toward the feet is called venous reflux, or reflux for short. The chronic pressure of blood flowing back toward the feet causes blood to pool in the veins and produce damage to the vein valves, which eventually leads to visible vein bulging, and their appearance depending on size & depth of location produces what we call varicose and spider veins.

What are the symptoms of varicose veins?

The visual appearance of purplish, knotted veins is what most people note first. In addition to being unsightly, many people experience one or more of the following:
Pain (aching or cramping feeling), Heaviness/Tiredness, Burning or tingling sensations, Swelling/Throbbing Tender areas around the veins

What can happen if varicose veins go untreated?

The symptoms typically will progress over time and you may form more varicose and spider veins. In addition you may form one of the below complications as well:

  • Inflammation of the veins (phlebitis)
  • Blood clots (e.g., deep venous thrombosis a.k.a. DVT)
  • Ankle sores or skin ulcers
  • Bleeding
Why do I have varicose and spider veins?

Varicose veins are a very common problem. They affect 40% of women and 25% of males. Forty percent of people of Japanese descent have varicose veins. There are many risk factors that predispose one to having varicose and spider veins.

Gender - Women have a higher incidence of varicose vein disease due in part to female hormones and their effect on the vein walls.

Pregnancy - Blood volume increases during pregnancy and hormonal effects contribute to vein enlargement.

Age - The tissues of our vein walls lose elasticity as we age causing the valve system to fail.

Prolonged standing - Occupations that involve standing for a long period of time causes increased volume and pressure of blood in the lower limbs due to the effects of gravity. Your veins must overcome gravity to bring blood back to your heart and prolonged standing makes it harder to do so.

Hormone levels - Treatments like birth control pills and post-menopausal hormone replacement may cause the same hormonal effect as pregnancy.

Physical Trauma - Injury to the lower limbs can damage underlying blood vessels and add to the problem.

What is the difference between the superficial and deep veins?

There are two sets of veins in your legs called the superficial and deep veins. Superficial veins are the ones that are responsible for the formation of varicose veins. One vein in particular-the great saphenous vein (GSV)-is the most often malfunctioning vein that is the cause of varicose and spider veins. This is the vein targeted for closure by our endovenous laser ablation technique.

The deep veins are the veins that carry most of the blood from the legs back to the heart. Under normal circumstances they carry 80% of the blood in the legs back to the heart. They are capable of carrying 100% of the blood back to the heart. They usually are not the cause of varicose veins.

What are perforator veins?

Perforator veins are the tiny veins that connect the superficial and deep veins.

Why do we need to get rid of them?

Unfortunately-having a connection between the superficial and deep veins allows the blood to escape from the veins that never cause trouble (deep veins) into the veins that can cause varicose veins (superficial veins). This allows more blood to pool in the legs and cause varicose and spider veins. Closing the perforator veins provides an extra measure of security from forming varicose and spider veins.