Our expertise and services
Ultrasound:

A venous ultrasound simply must be performed on any new patient to assess the state of their superficial and deep venous networks, because it is fairly common to find that a seemingly trivial problem “hides” a more complex situation, which can only be revealed by this examination. It takes about fifteen minutes, and enables a phlebologist to make a clear and precise diagnosis of the venous pathology, and then offer the patient the most appropriate treatment plan for any condition found.
Conventional sclerotherapy
This technique consists of injecting a sclerosing agent (irritant) into the varicosities, triggering an inflammatory reaction inside the vein wall. This will make the vein close, and in turn, lighten the rest of the network. This is called sclerosis.

Spider veins

Types of varicose veins
  • Spider veins (small size)
  • Reticular varisoce veins (medium size)
ADVANTAGES
  • Painless process
  • Non-invasive technique
  • Treatment performed in a medical office by a physician or phlebologist
  • No hospitalization, no time off work and immediate resumption of activities
  • Generally well tolerated by patients; infrequent side effects

SIDE EFFECTS

Side effects are rare, but occasionally in immediate post-treatment (in the following hours and days), we may see bruising and small scleroses (indurations along the treated vessels after sclerosing the vein). An allergy to sclerosing agents may occur, of course, but very rarely. There may be residual pigmentation; it spontaneously disappears in most cases. However, sometimes several months may pass. If a light intractable pigmentation persists, it can be removed with a cream or laser treatments.

***Prior to exposure to UVA/UVB rays, it is advisable to apply an SPF 30 sunscreen if there is any bruising present after the injections, and to continue to apply it until they disappear. This will minimize the risk of pigmentation.

Ultrasound-guided foam scleropathy
The principle at work here is that a foam is produced from a liquid sclerosant (either Sodium Tetradecyl Sulfate or polidocanol). This foam is then injected into the diseased vein under ultrasound guidance so it can reach the deeper veins, invisible to the human eye.

Types of varicose veins

Larger varicose veins
  • Tributaries
  • Truncular
  • Perforating
ADVANTAGES

Foam is more echogenic than the liquid, so it it more easily visible when injected.

This means that the physician can follow and “steer” the foam along the desired venous axis, thereby making it possible to strip deeper, wider-calibre veins.

SIDE EFFECTS

The foam is diluted compared to the liquid and consequently causes fewer local side effects.
Post-treatment recommendations
The client is invited and even encouraged to become mobile again as quickly as possible and walk, because every movement of the legs, especially the calves, promotes venous return, reducing the risk of complications such as phlebitis.

Wearing compression stockings is recommended after any treatment. They are an important tool to combat venous disease. They make it possible to reduce the swelling and alleviate the symptoms related to varicose veins. They also provide a means of prevention, helping to slow down the appearance of new varicose veins.

Radiofrequency or VNUS ClosureFast™
A more recent variation of endovenous laser, radiofrequency is a minimally invasive procedure for the treatment of varicose veins. The technique consists of introducing, under local anaesthesia, a small catheter into the diseased vein. Then, through the radiofrequency energy emitted by a generator, applying controlled heat to the vein wall to modify the collagen within the wall and allow the vein to close, all under ultrasound guidance. The ClosureFAST™ catheter performs the ablation of the vein in segments of 7 cm and 3 cm by applying 20-second treatment cycles.

A pioneer of radiofrequency in Quebec, Dr. Dagenais has been practicing RF since 2011 and has excellent expertise in this technology.

Types of varicose veins
  • Great saphenous
  • Small saphenous
  • Perforating
  • Main tributaries
Visible results

Pre-treatment / Post-treatment*
Effectiveness of the ClosureFAST™ catheter

The ClosureFAST™ catheter performs venous ablation in 7-centimetre segments by applying 20-second treatment cycles that cause the vein to retract and occlude. A prospective multicentre study showed a 93% occlusion rate three years after treatment.

ADVANTAGES

We do this procedure in a private office under local anesthesia in just one session.

The treatment takes about an hour, is generally well tolerated and lets patients get back to their daily activities the same day or the next.

SIDE EFFECTS

The side effects are infrequent, but occasionally, some patients may have bruising, induration and numbness along the treated vein. Rarely, thrombophlebitis may occur. In general, though, this only happens when there is a perfect storm of circumstances, which in most cases are detected as early as the initial questionnaire.

The patient must wear compression stockings for two to three weeks after surgery. This will minimize the risk of side effects while increasing comfort. Patients are seen again three weeks after surgery for a follow-up ultrasound (at no additional cost).

*Individual results may vary.
Alternative treatments
Radiofrequency or endovenous laser?

All methods of endovenous thermal ablation are not the same. With the laser technique, an optical fibre is inserted into the diseased vein under local anaesthesia, and the success of the procedure largely depends on the user. This means the user must control the handling of the withdrawal of the optical fibre. This does not occur in radiofrequency.

Results of the Radiofrequency RECOVERY clinical study

In the only study directly comparing ClosureFAST™ radiofrequency technology with the endovenous laser procedure, the ClosureFAST™ catheter was found to be statistically superior to the laser.
  • Less pain and bruising
  • Fewer complications
  • Faster improvement in the venous clinical severity score (VCSS)
Furthermore, data from a prospective multicentre study showed vein occlusion in 91.9% of cases and the absence of pain in 92.4% of cases five years after the procedure.

Surgical vein stripping

Even though vein stripping is now a widely practiced technique, it should be remembered that it includes the surgical removal of a portion of the saphenous vein.

This procedure requires a short hospital stay, followed by a period of recovery.

Many considerations should also be taken into account:
  • Very long waiting period (operation list)
  • Hospitalization and absence from work
  • Invasive technique
  • Possibility that new vessels (new veins) could form

Possible side effects:
  • Tingling, pins-and-needles sensation, etc.
  • Pain
  • Swelling, bruising
  • Thrombophlebitis
  • esensitization: if the saphenous nerve was affected
  • Possible damage to lymph ducts during stripping
Contraindications for varicose vein treatments
Absolute:
  • Major coagulation disorders (abnormal, hereditary or acquired blood factors that promote the formation of clots in the veins). Some conditions can be treated using certain methods.
  • Active cancer
  • Active deep thrombophlebitis and pulmonary embolism. These are life-threatening medical conditions that must be eradicated before considering any form of varicose vein treatment.
Relative:
  • Pregnancy and nursing: We shall decide to treat a pregnant woman if the treatment benefits outweigh the related risks during pregnancy.
  • Allergy to sclerosing agents
  • Minor clotting disorders
  • Severe migraine with aura.

When sclerotherapy is contraindicated or impossible, radiofrequency becomes the option of choice.