Sapheno-Popliteal Junction Ligations is a surgical procedure used behind the knee when the laser cannot be used.

Sapheno- Femoral Junction Ligations is a surgical procedure when the laser cannot be used.

The Murray Center is one of only twelve centers in The United States chosen to perform a revolutionary new varicose vein treatment called EndoVenous Laser Treatment or EVLT, the absolute latest technology in the treatment of varicose veins. In EVLT, a thin laser fiber is inserted into the varicose vein under ultrasound guidance through a tiny nick in the skin. This permits the permanent closure of large varicose veins and venous junctions with no scars or down time. The entire in-office procedure takes just minutes to perform and requires only local anesthesia.

If you have varicose veins or know of anyone with them, please call The Murray Center for more information or a consultation.

Ambulatory Phlembectomy

1. What is ambulatory phlebectomy?
2. Who started this and when?
3. What are A.P.’s advantages over standard stripping?
4. How long does the procedure take?
5. Will all of the varicose veins be removed at once?
6. Are bandages used to wrap the legs?
7. Will I be able to drive myself home?
8. Is it possible to shower after the procedure?
9. Will there be stitches?
10. Will bruising occur?
11. Is there pain after the procedure?
12. What is the total recovery time?
13. What is the patient satisfaction rate?
14. Could veins be removed during A.P. that I may later need if heart surgery is required in the future?
15. Will my insurance company pay for this procedure?

What is ambulatory phlebectomy?
Ambulatory phlebectomy (A.P.) is an in-office surgical procedure that removes the larger varicose veins of the legs, using local anesthesia, using minute (1-2 mm or 1/16 of an inch) incisions.

Who started this and when?
Robert Muller M.D. was a Swiss Dermatologist who began doing A.P. in the mid-fifties in Neuchatel Switzerland. It is now standard practice in most of the world to remove varicose veins by this procedure.

What are A.P.’s advantages over standard stripping?
The scars of standard strippings are eliminated. These are replaced by 1-2 millimeter virtually invisible incisions. There is no hospitalization required, no general anesthesia, greatly decreased morbidity, no down time and work can be resumed the following day.

How long does the procedure take?
The A.P. procedure can take anywhere from one to three hours depending on the severity. Usually the procedure takes approximately 1 1/2 hours.

Will all of the varicose veins be removed at once?
This depends on the extent and severity of each patient’s condition. Typically, this type of outpatient surgery is done in stages.

Are bandages used to wrap the legs?
Yes, bandages and compression stockings are used.

Will I be able to drive myself home?
Yes.

Is it possible to shower after the procedure?
The only exception to showering with a shower bag is if the varicose veins go up into the groin region.

Will there be stitches?
No stitches. The incisions are so small, steristrips will be used.

Will bruising occur?
Any bruising that occurs is usually very slight.

Is there pain after the procedure?
Less than 2% of our patients tell us they took anything for pain, and was usually only Tylenol or Ibuprofen.

What is the total recovery time?
By two weeks after the procedure the stockings are eliminated and the steristrips removed.

What is the patient satisfaction rate?
95% to 98% of all patients are extremely happy they chose A.P. over standard stripping. When standard stripping patients see A.P. results, most wish they had chosen A.P. instead of stripping.

Could veins be removed during A.P. that I may later need if heart surgery is required in the future?
The vein we are removing is a diseased vein which is already dilated and of no use in heart surgery. It cannot be put back into such a vital organ as the heart and be expected to function normally.

Will my insurance company pay for this procedure?
This will depend on the quality of your insurance program. However, with rare exceptions, this is a covered medical procedure.

An ultrasound machine is an essential instrument for a Phlebologist. You cannot practice Phlebology (the study of venous diseases without one). The other essential instrument is the Doppler. This is the Phlebologist’s stethoscope and everyone who sees any doctor should have their veins listened to first. Ultrasounds are a dynamic study, that is, you have to be able to see the direction of flow in order to properly determine what’s wrong. Anyone with any varicose vein should have an ultrasound study done first before instituting any care whatsoever.

Ultrasound Guided Injections

Venous disorders can be classified into truncal or collateral – the former involves the major veins of the legs (the Greater Saphenous and Short Saphenous) and the latter the connecting veins throughout the legs (there are about 150 in each leg). When the connecting veins become diseased the Phlebologist can either cut them to stop them from refluxing (blood going the wrong way) or using Ultrasound, guide a needle directly into the vein and insert some solution or foam which will stop the vein from refluxing. I have performed in excess of 100,000 of these without any major complications.

Sclerotherapy

1. What is sclerotherapy?
2. How safe is sclerotherapy?
3. Can the sclerotherapy solutions cause an allergic reaction?
4. Are there any other side effects that may occur?
5. Who should not receive sclerotherapy?
6. What to avoid before sclerotherapy?
7. Are there any medicines I shouldn’t take prior to sclerotherapy?
8. Are compression stockings really beneficial?
9. How soon after the injections will the veins disappear?
10. How may sessions will it take?
11. Once the veins have been treated can they come back?

Varicose veins are an extremely common disorder affecting about one half of the population. Although most venous disease sufferers are women, men are also afflicted. For these people, everyday life is often disrupted by leg cramps, swelling, itching and burning in the legs. The exact cause of varicosities is unknown, but some of the risk factors are heredity, pregnancy, menopause, obesity, prolonged standing or sitting, estrogen, birth control pills, tight girdles, trauma and aging.

What is sclerotherapy?
Sclerotherapy is a non-surgical procedure that involves injecting a medication into a diseased dilated vein or spider vein. This causes a reaction within the wall of the vein allowing it to close and route the blood back to the heart. The unsightly veins disappear.

How safe is sclerotherapy?
Sclerotherapy is extremely safe. There are many different types of solutions that may be injected and each one carries its own risk. Because of the different vein sizes, pigmentation of the skin and veins’ location, different solutions and concentrations are frequently employed on an individual basis. Feel free to ask Dr. Murray what types and concentrations he would recommend in your individual case.

Can the sclerotherapy solutions cause an allergic reaction?
Despite a detailed history and exam, there is always the possibility of an allergic reaction. This, however, is extremely rare. This rare complication may range from slight tingling sensations to hives and even an anaphylactoid reaction. Extremely rare cases of deep vein thrombosis and pulmonary embolus have been reported in the medical literature.

Are there any other side effects that may occur?
There are two other RARE complications that may arise from sclerotherapy. In some patients there are superficial A-V malformations (arterial-venous abnormality) and if one of these are injected, a small ulcer may appear on the skin. Secondly, a small amount of sclerosing solution may spill into the subcutaneous tissue. Both of these may leave a small scar on the skin.

Who should not receive sclerotherapy?
People who have connective tissue diseases such as Lupus, Discoid Lupus, P.S.S. – Progressive Systemic Sclerosis, CREST and Rheumatoid and Psoriatic Arthritis, and Hemophiliacs.

What to avoid before sclerotherapy?
– Do not apply oil or lotion on your legs 24 hours prior to treatment.

– Do not shave or wax your legs 24 hours prior to treatment.

Are there any medicines I shouldn’t take prior to sclerotherapy?
Avoid the use of aspirin or other anticoagulant for one week prior to treatment. If you are currently taking iron supplements this may add to skin staining risk.

After sclerotherapy recommendations:
– Exercise for 30 minutes after treatment by walking, biking or using exercise equipment involving leg motion.

– Wear compression stockings or special bandages continuously for 48 hours after treatment.

– Wear compression stockings for a few weeks after treatment.

– Wear compression or support stockings as often as possible.

– Continue a normal routine as usual after your treatment, simply emphasize your exercise (walking, swimming, aerobics).

– Do not sunbathe for two weeks after treatment.

– Avoid training with free weights for two weeks after treatment.

– Avoid hot baths and whirlpools.

– Avoid constrictive girdles.

Are compression stockings really beneficial?
ALL of the literature published to date reports improvement with compression stockings worn after sclerotherapy. For your convenience, the stockings are available at The Murray Center. The stockings are very thin, come in seven different colors and are very aesthetic.

How soon after the injections will the veins disappear?
Different sized veins disappear at different rates, but usually we ask you to wait 3-6 weeks before evaluating the results. There is, however, disappearance up to 12 weeks from the time of the injection.

How may sessions will it take?
This question has to be answered on an individual basis. However, we do offer three levels of services depending on your severity – full sessions, limited sessions, and mini sessions.

Once the veins have been treated can they come back?
No, once treated those veins are gone forever. However, new veins may develop in the future.