On the day of the surgery, the patient will apply a topical numbing cream given to them by the VTC about two hours ahead of the appointment. The home application of the numbing cream allows the patient to avoid idly sitting in the doctor’s office for an hour or more, waiting for the anesthetic cream to become fully active. After the two hour numbing period is complete and the patient has arrived at the VTC office, Dr. Al-Misky will do a leg marking. This will provide a ‘map’ on the skin, showing on the body’s surface where the ultrasound visualization has shown where the problem vein and important ancillary veins are under the surface. Dr. Al-Misky then makes an injection of a local anesthetic under the skin, which is almost painless as the numbing cream has desensitized the tissue.

In a sterile setting, the patient is placed on the table. Another dose of local anesthesia, this time near the veins themselves, is injected under color duplex ultrasound guidance. Then the surgery begins as a minute laser fiber is inserted directly into the vein through a catheter (tiny tube) as a needle punctures the skin (no surgery scalpel needed). Pulses of laser energy are released along the course of the vein to seal it completely. Once the laser has sealed the vein, the fiber is removed and a steri-strip closes the entry point. Patients who need a Mini-Phlebectomy treatment for the smaller branches will usually have it performed at this time. When the procedure is complete, the leg is wrapped with elastic bandages.

Post instructions are reviewed with the patient, then the patient can walk out of the office and return to their normal daily routine, usually without any pain medication (about 15% of our patients take Advil or Tylenol if they feel any mild discomfort). Our office staff will usually text you that evening to make sure that you are comfortable and that everything is going according to plan.