Office Based Procedures

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All of our five convenient office locations are fully furnished with state-of-the-art equipment and supplies. Our highly trained and specialized staff take great care to provide procedures in-office and we have a wide array of procedures we offer. Below you will find information about the most common procedures we provide. As always, you and your referring provider, will be updated every step of the way.

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Endovenous Laser Ablation (EVLT) & Radiofrequency Ablation (RFA)

In these minimally invasive office procedures, the provider inserts a tiny catheter through the skin to deliver laser energy (Endovenous Laser Ablation) or radiofrequency energy (Radiofrequency Ablation) to destroy the wall of the diseased leg vein. Both treatments result in closing the affected vein so it is no longer able to support blood flow and allows the vein to shrink and be reabsorbed by the body. Your provider will determine which modality is right for you.

Commonly Asked Questions:

Both of these procedures are less invasive than standard surgery and are performed in our office.  Many of our patients have reported “mild discomfort” and/or “minimal pain” associated with these procedures.  You will receive a local anesthetic. The procedure is under an hour and you can resume most of your daily activities immediately after treatment.

Endovenous Laser Ablation and Radiofrequency Vein Ablation usually take 45-60 minutes.

You do not need to fast prior to your procedure. We recommend eating a light meal 2 hours prior to your procedure.

Please wear loose and comfortable fitting clothing on the day of your procedure. After the procedure, the treated leg will be wrapped and may be slightly swollen, which can make it difficult to wear tight-fitting clothing or shoes.

If you were prescribed an anti-anxiety medication, you will need to arrange for a ride home.  Otherwise, you will be able to drive yourself home.

Treatment to correct venous insufficiency can range from $0 (if treatment is covered by insurance) to varying amounts depending on your particular insurance plan or if your condition is considered cosmetic.  At Seattle Vascular Surgery, most vein treatments are covered by all major medical insurances and Medicare.  Should your insurance carrier not cover your treatment or if you have a high deductible, we offer many options to make your care affordable.

You may experience some mild pain, discomfort, swelling, or bruising. These symptoms are common. You’ll be able to resume most of your daily activities immediately after your procedure but we ask you to avoid vigorous exercise for 1-2 weeks.  The treated leg will be wrapped with a compression dressing and will need to be worn for at least 2 days.  You will be given discharge instructions prior to leaving which will provide all of the necessary information for proper after care.

VenaSeal Chemical Ablation

Unlike Endovenous Laser Ablation (EVLT) or Radiofrequency Vein Ablation (RVA), which uses heat or laser energy, VenaSeal Chemical Ablation uses a glue to close the incompetent vein.  VenaSeal only requires a single needle stick, it is typically painless, recovery time is fast, and compression stockings are not needed following the procedure, making this an attractive treatment option for incompetent varicose veins.

Commonly Asked Questions:

This procedure is not usually considered painful but you may experience some mild discomfort during the procedure.  Some patients report feeling a sensation of “pulling” as the adhesive is placed in the diseased vein.

VenaSeal Chemical Ablation usually takes 30-45 minutes.

You do not need to fast prior to your procedure. We recommend eating a light meal 2 hours prior to your procedure.

Since VenaSeal Chemical Ablation does not require a compression dressing following the procedure, you may wear your desired clothing.

If you were prescribed an anti-anxiety medication, you will need to arrange for a ride home.  Otherwise, you will be able to drive yourself home.

Treatment to correct venous insufficiency can range from $0 (if treatment is covered by insurance) to varying amounts depending on your particular insurance plan or if your condition is considered cosmetic.  At Seattle Vascular Surgery, most vein treatments are covered by all major medical insurances and Medicare.  Should your insurance carrier not cover your treatment or if you have a high deductible, we offer many options to make your care affordable.

You may experience some mild pain, discomfort, swelling, or bruising.  For a small number of patients, an area of redness and/or itching may arise in the area overlying the treated vein. As this may represent a localized allergic reaction, please call our office so our provider can assess you.  You’ll be able to resume most of your daily activities immediately after your procedure but we ask you to avoid vigorous exercise.  You will be given discharge instructions which will provide all of the necessary information for proper after care.

Micro Stab Phlebectomy

This minimally invasive office procedure involves removing the bulging/prominent varicose veins in the leg(s). In this procedure, the provider makes very small incisions through which the vein is removed. These small incisions do not require sutures and are closed with small steri-strips (adhesive tape).  This treatment is typically performed after Endovenous Laser Ablation (EVLT), Radiofrequency Vein Ablation (RVA), or VenaSeal Chemical Ablation.

Commonly Asked Questions:

Minor discomfort or pain may be felt initially when the local anesthetic is injected around the bulging veins to be treated. This usually only lasts for a few seconds. Once the numbing medicine takes effect, patients do not experience any pain but may feel pressure or a pulling sensation during the procedure.

Usually this procedure takes 30 minutes. Since Micro Stab Phlebectomy may be performed on one or both legs, time will vary based on the leg(s) to be treated and the number and size of the bulging veins on the designated leg(s). 

You do not need to fast prior to your procedure. We recommend eating a light meal 2 hours prior to your procedure.

Please wear loose and comfortable fitting clothing on the day of your procedure. After the procedure, the treated leg(s) will be wrapped and may be slightly swollen, which can make it difficult to wear tight-fitting clothing or shoes.

If you were prescribed an anti-anxiety medication, you will need to arrange for a ride home.  Otherwise, you will be able to drive yourself home.

Treatment to correct venous insufficiency can range from $0 (if treatment is covered by insurance) to varying amounts depending on your particular insurance plan or if your condition is considered cosmetic.  At Seattle Vascular Surgery, most vein treatments are covered by all major medical insurances and Medicare.  Should your insurance carrier not cover your treatment or if you have a high deductible, we offer many options to make your care affordable.

Mild to moderate pain, bruising, redness, and some swelling is expected at the incision sites post-procedure.  We recommend avoiding strenuous activity for 7 days following your procedure and encourage walking for 10-15 minutes every couple of hours.  Most patients are able to resume their normal daily activities 3-5 days following their procedure. You will be asked to keep the compression dressing on continuously for 2 days post-procedure. Since you will be asked to avoid soaking your legs in a tub or swimming for 2-3 weeks and to refrain from direct sun exposure for 3-4 months, this should be considered when scheduling if you have upcoming travel plans.  For best results, wearing compression stockings for two weeks following your procedure as well as avoiding direct sun exposure for several months is recommended.  You will be given discharge instructions prior to leaving which will provide all of the necessary information for proper after care.

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Sclerotherapy

This minimally invasive office procedure is performed to eliminate tiny varicose veins, spider veins, and reticular veins that are visible just below the skin surface. In this procedure, the provider injects a chemical solution directly into the targeted veins, causing the vein to close (or sclerose).  The vein is then reabsorbed into the tissue and eventually fades.  Treated veins tend to fade within a few weeks, although it may take up to 6-12 months for full results. Several sclerotherapy treatment sessions may be recommended. Occasionally, these veins may cause aching, burning, or night cramps. However, most patients do not have symptoms and sclerotherapy is performed cosmetically to improve the appearance of these veins.

Commonly Asked Questions:

A very small needle is used to inject the medication into the target veins.  Multiple needle sticks are made depending on the number of spider veins to be treated. This will cause minor discomfort but our patients typically report it is not painful. Over-the-counter, topical numbing cream, may be applied to the targeted areas 30 minutes prior to procedure for additional comfort.

Usually this procedure takes 30-60 minutes. Since Sclerotherapy may be performed on one or both legs, time will vary based on the leg(s) to be treated and the number and size of the spider veins on the designated leg(s). 

No, usually not.  Factors such as the area to be treated as well as the number and size of veins to be treated will determine how many veins can be targeted in one session.  There is a limit to how much of the sclerosant solution can be administered in one sitting. Additionally, multiple treatment sessions may be required to achieve desired results.

You do not need to fast prior to your procedure. We recommend eating a light meal 2 hours prior to your procedure.

This is a treatment that takes time to work. It usually takes at least 4-6 weeks post-procedure to notice a difference in the appearance of the treated veins. The treated veins may look darker and/or worse before they look better.  Sometimes, the dark discoloration will take up to 6-12 months before resolving. 

Please wear loose and comfortable fitting clothing on the day of your procedure. After the procedure, the treated leg will be wrapped and may be slightly swollen, which can make it difficult to wear tight-fitting clothing or shoes.

If you were prescribed an anti-anxiety medication, you will need to arrange for a ride home.  Otherwise, you will be able to drive yourself home.

Treatment to correct venous insufficiency can range from $0 (if treatment is covered by insurance) to varying amounts depending on your particular insurance plan or if your condition is considered cosmetic.  While at Seattle Vascular Surgery, most vein treatments are covered by all major medical insurances and Medicare, Sclerotherapy tends to be considered cosmetic by many insurance carriers.  Should your insurance carrier not cover your treatment or if you have a high deductible, we offer many options to make your care affordable.

Mild bruising at the injection site or darkening of the treated veins is common. Vein discoloration may resolve very slowly but surrounding bruising will typically resolve within 1-2 weeks. Most patients are able to resume most of their normal daily activities immediately following their procedure. For best results, wearing compression stockings and avoiding direct sun exposure for two weeks following your procedure is recommended.  You will be given discharge instructions prior to leaving which will provide all of the necessary information for proper after care.

Yes, new spider veins may develop post-treatment.  If they do recur, you may choose to undergo additional treatments.

Fistuloplasty

In this minimally invasive office procedure, the provider injects contrast material into the dialysis access circuit to assess for narrowing in the AV fistula or graft and to re-open the fistula or graft if necessary. If left untreated, hemodialysis will become increasingly ineffective and eventually the AV fistula or graft will completely occlude and become nonfunctional. While the exact reason is unknown, the vast majority of patients with a fistula or graft will eventually develop significant narrowing, or occlusion, of their dialysis access.  We, at Seattle Vascular Surgery, try to extend the longevity of the fistula or graft by keeping a close eye on the dialysis access via ultrasound and performing fistuloplasty procedures when necessary.

Commonly Asked Questions:

Mild pain and/or discomfort is to be expected during the procedure. Your provider will inject a local anesthetic to provide you additional comfort. Many patients describe feeling some pressure or discomfort during treatment.

Usually this procedure takes 30-45 minutes.

You do not need to fast prior to your procedure. We recommend eating a light meal 2 hours prior to your procedure.

You will be provided a gown to cover the top half of your body. As such, you are encouraged to wear your desired clothing.

If you were prescribed an anti-anxiety medication, you will need to arrange for a ride home.  Otherwise, you will be able to drive yourself home.

Yes.

It is uncommon to experience much discomfort or pain following a fistuloplasty. You will be given discharge instructions prior to leaving which will provide all of the necessary information for proper after care.

Tunneled Catheter Removal

Once our provider has determined the patient no longer requires their hemodialysis catheter, the provider will remove it in a short office procedure. 

Commonly Asked Questions:

There may be momentary discomfort or pain when your provider injects a local anesthetic (numbing) around the catheter.  After the numbing medication takes effect, you will not experience any pain but may feel some pressure, tugging, or a pulling sensation during the procedure.

Usually this procedure takes 20-30 minutes.  After the catheter is removed, you will be observed for 10-15 minutes for any bleeding from the removal site.

You do not need to fast prior to your procedure. We recommend eating a light meal 2 hours prior to your procedure.

You will be provided a gown to cover the top half of your body. As such, you are encouraged to wear your desired clothing.

If you were prescribed an anti-anxiety medication, you will need to arrange for a ride home.  Otherwise, you will be able to drive yourself home.

No, the entry point of the catheter will be left open and usually heals from the inside-out.  You can expect mild scarring, at the site, as it heals.  Sometimes, an incision will be made to remove the catheter.  In this case, a suture will be placed to close the incision after the catheter removal.

Occasionally, minor discomfort, pain, or bruising may be experienced after the procedure. These should resolve within 2-3 days following the procedure. You will have a clear dressing on the incision site after the catheter is removed. Please keep this on for 24 hours. You will be given discharge instructions prior to leaving which will provide all of the necessary information for proper after care.

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