Endovenous Laser Ablation

(EVLA) is the procedure to treat the larger varicose veins in the leg.  The procedure uses laser energy to heat up and seal the inside of the vein, causing it to collapse permanently, then to be absorbed by the body. 

This treatment is done in our office using local anesthesia.  Your leg is cleansed and sterile surgical drapes are placed around your leg.  Then a tiny needle is used to numb the skin.  When the skin is numb a larger needle is inserted into the vein and then the thin laser fiber is placed inside the vein.  More local anesthetic is injected around the vein.  The laser energy travels through the fiber to the tip and heats the inside of the vein while the laser fiber is removed.  At the end of the procedure your vein has collapsed.  We put a wrap on your leg and you are able to walk out of the office and return to  normal activity the same day. 

Frequently Asked Questions for EVLA

What is Endovenous Laser Ablation (EVLA)?
It is a minimally invasive laser procedure performed in our clinic. It is a better alternative to the surgical stripping of years past. A thin laser fiber is inserted through a small catheter that is placed in the vein through a tiny opening. The laser fiber delivers heat to the vein wall, causing it to collapse and seal shut. Over time, it is absorbed by the body.

Can varicose veins return after treatment?
Current treatments for varicose veins have very high success rates. Over 90% of treated veins remained closed. Once the vein is treated, that vein will not come back. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves.

Will the procedure require any anesthesia?
We use a local anesthetic to numb the treatment area prior to the procedure, much like your dentist. If you desire, the physician may give you a mild oral sedative to relax you.

How long does the procedure last?
The actual laser portion of the procedure takes approximately 15 – 30 minutes, though patients may spend 1 – 2 hours at the clinic due to normal pre- and post-treatment preparation.

Why can’t both legs be done on the same day?
We are limited to the amount of lidocaine (numbing medicine) that is used in the procedure. If too much is used, someone could have a reaction.

What happens to the treated vein left behind in the leg?
The vein simply becomes scar tissue and will gradually be absorbed by the body. Your body, naturally, reroutes the blood through the remaining healthy veins.
What happens to the blood flow if you close off my vein?
The vein being treated is abnormal and not working properly, making other healthy veins take up the extra burden. Once the diseased vein is closed, these healthy veins can work more efficiently and will essentially improve your circulation.

What if I need the vein for bypass surgery in the future?
Enlarged diseased veins will not be used for bypass surgery. Physicians will use only healthy veins from other areas of your body.

Do I need a driver?
If ANY oral sedation is taken, we will require that a driver is present to pick you up after the procedure. If you choose to have the procedure with no oral sedation, we will still ask that you have a driver when performing the procedure(s) on your right leg due to the numbing medicine that is injected into the leg. You may have some mild numbness for an hour or two, and we will not want you to drive. If you have no one to drive you,  we will ask that you stay for a couple of hours and allow the numbing medicine to wear off prior to you driving or we will provide a taxi for you. If you choose to have the procedure with no oral sedation, and we are performing the procedure on your left leg, you may choose to drive yourself.

How quickly can I resume normal activity, (i.e. work, exercise?)
Patients are walking immediately following the procedure, and typically, resume normal activities within one day. We recommend that you stay active with a walking regimen of two 20-minute walks a day to avoid any complications. You may continue exercise classes and gym routines, as long as it is not strenuous. Don’t work through any pain (discomfort), but allow it to be your guide. You may need to take it easy for a day or two. You do not want to undo what we have done with the laser.

How long do I have to wear compression stockings?
For 10-14 days after treatment, we recommend wearing gradient compression stockings which offer the greatest amount of pressure. Compression stockings put helpful pressure on your veins. You will need to be fitted for them  at our office. You cannot wear them too much.

Are there travel restrictions?
Dr. Bowers does not want you to travel for 10 days after an EVLA if you will be seated for an extended period of time.  Otherwise, you will need to wear your compression stockings while traveling. If traveling by car, stop and walk every 90 minutes or so. If traveling by plane, walk hourly, if possible.


Sclerotherapy is the most common and effective treatment for smaller varicose and spider veins of the lower extremities. During treatment a sclerosing agent is injected into the vein with a tiny needle. The solution pushes the blood out of the vein, generating irritation to the walls of the vessel.  This causes the vein walls to collapse and stick together. As the body initiates the healing process, the vein begins to shrink and is eventually absorbed by the body, making the vein disappear.

Sclerotherapy is a technique in which a special FDA approved medication is injected into abnormal veins to produce its closure and eventual elimination. There are a number of medications available for sclerotherapy.  At Bowers Vein Institute we use Sotradecol (Sodium Tetradecyl Sulfate) and Polidocanol (Asclera). Both are FDA approved for use in vein sclerotherapy. They are very safe if used appropriately. 

Sclerotherapy Frequently Asked Questions

What results can I expect?

Improvement is noticed quickly with the smaller veins and more gradually with larger veins. Treatments are done every four to six weeks. Depending on the severity of the spider veins, two to three treatments are typically required.

Are there any side effects?

You may experience some itching and mild bruising and swelling after treatment. Most of these symptoms will resolve within a day or so after treatment. Support hose are worn for a short time following treatments. This application of pressure is important for the body’s healing process.  Wearing hose improves results and lessens side effects.

Who is a candidate?

During consultation your legs will be examined and a medical history taken. Depending on the types of veins and symptoms, a combination of different treatment modalities may be recommended.


Ambulatory phlebectomy micro-extraction is a procedure which allows for the removal of large surface varicosities through very small incisions that typically require no stitches.  It is sometimes performed in conjunction with endovenous laser ablation or another anti-reflux procedure.

Tiny skin incisions or needle punctures as small as 1 mm are used to extract veins.  A hook is inserted into a micro-incision in the leg.  A section of the vein is hooked and then removed through the incision.  After this procedure, a compression stocking is worn for 1 to 2 weeks.  This minimizes swelling and discomfort and improves proper healing.  After the vein is removed, the leg is wrapped with an ace bandage. The patient then gets up and walks around the office for a short time prior to going home.  Some patients are mildly uncomfortable and may use pain medication.   Patients may stand, walk, and most return to work on the day following surgery.  Extremely strenuous activity is limited for two weeks.  The results of the procedure have been excellent both from a cosmetic and patient satisfaction point of view.

Phlebectomy Frequently Asked Questions

What is Ambulatory Phlebectomy?

Ambulatory phlebectomy is an office procedure that removes superficial veins through small, slit-like incisions in the skin. The procedure involves four steps:

  1. Outlining or marking the veins to be treated.
  2. Injecting local anesthesia into the skin.
  3. Surgical removal of the bulging veins, segment by segment, through small incisions.
  4. Wearing compression stockings for one to two weeks.


When is Ambulatory Phlebectomy appropriate?

Ambulatory phlebectomy may be used to remove both asymptomatic and symptomatic superficial veins from the skin. Typically, treated veins are larger, bulging (raised) varicose veins, although smaller veins may also be removed. Ambulatory phlebectomy may be combined with other therapies in the treatment of venous disease.

What can I expect after having had ambulatory phlebectomy?

Bruising and swelling is normal and temporary.  You can walk immediately after your procedure  and most patients can carry on normal daily activities except for heavy exercise and lifting the next day.  You must follow the activity restrictions and wear the compression stockings as directed by your doctor to improve results and lessen the chance of adverse effects.