Treatment Options


The NVI offers a range of vein treatments to meet your needs


Spider Vein Treatment

The "gold standard" treatment for spider veins is sclerotherapy. This is considered a cosmetic procedure and is usually not covered by insurance or Medicare. One of two FDA approved vein solutions are used to perform cosmetic sclerotherapy — Sotradecol® or Polydocanol®. These vein solutions are significantly safer and have a better side effect profile than the old, hypertonic saline solution. The vein solution is injected into the spider veins with a small micro needle causing the spider veins to close. The spider veins eventually disappear with time.
While sclerotherapy treatment for spider veins continues to provide the best cosmetic results, laser vein removal can occasionally be the better choice. For facial spider veins, laser vein removal is typically better.


Radiofrequency (RF) Ablation and Endovenous Laser Ablation (ELT)

Radiofrequency Ablation and Endovenous Laser Ablation are the two best modalities for treating the major superficial diseased veins in the legs. They each are very effective but may have different merits in differing clinical situations. The Nellestein Vein Institute is the only vein clinic within at least a 50-mile radius to offer both of these state-of-the-art modalities. The procedure is performed in the vein clinic and typically takes about 30 minutes. After a local anesthetic is utilized, a 1-2 millimeter puncture is made into the leg veins, usually just below the knee. A Radiofrequency Ablation or laser fiber is then inserted into the leg veins, utilizing ultrasound guidance, and placed in precisely the correct location. A very dilute anesthetic is then injected around the leg veins and indwelling fiber, creating a sleeve of anesthetic. Then an energy source is turned on in the tip of the catheter thus heating the inside of the vein and sealing it closed. The catheter is then slowly and precisely withdrawn, while heating, thus closing off the vein.

The patient is then placed in support stockings and goes home. No IV anesthetic is utilized. The patient can drive themselves to and from the appointment. Anti-inflammatory medications are typically all that are required for discomfort. The patient need not miss work and is told to wear the stockings for a few weeks afterward. These modalities are extremely effective vein solutions for the larger truncal veins. The tributary or varicose veins are better suited to microphlebectomy or ultrasound-guided foam sclerotherapy, which are often performed during the same visit at the RF/ELT. When these additional procedures are called for, the visit will typically be longer, on the order of 1-1.5 hours.



Microphlebectomy is a procedure used in varicose veins removal when veins are large and ropy. It is often used with radiofrequency or endovenous laser therapy.

The RF or laser seals off the feeding truncal vein, then the microphlebectomy removes the tributary varicose veins. This treatment for varicose veins in the legs involves removing the varicose veins through tiny puncture sites usually no larger than 1-2 millimeters in diameter. It is performed under a local anesthetic. This process is not the same as vein stripping. There are no stitches required and cosmetic results are excellent.


Ultrasound-Guided Foam Sclerotherapy

Ultrasound guided foam sclerotherapy is another important technique in the treatment of chronic venous insufficiency. Ultrasound-guided foam sclerotherapy involves treatment of veins that are too small to close with laser or radiofrequency. These refluxing, smaller varicose veins are located by ultrasound and, when visualized, they are injected with a medicine such as Sotradecol® or Polidocanol® to seal them shut. Ultrasound-guided foam sclerotherapy can also be performed at the same setting as the RF or ELT procedure. Many times however, this type of varicose veins treatment is performed a few weeks after the ELT or RF procedure.

Nellestein Vein Institute
1341 Village Drive
Saint Joseph, MO 64506
Phone: 816-323-4451
Fax: 816-897-3969
Office Hours

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