Yale Medical Group

Quick, painless approaches are the new solution to varicose veins

Jeffrey Indes, MD, says new methods are a revolution for patients who used to face surgery and a hospital stay

Jeffrey Indes, MD

Jeffrey Indes, MD, has been providing minimally invasive vein treatments at Yale since March, 2009.

[January 2010] Gabrielle Perrault, a nurse who is on her feet constantly caring for critically ill infants, had deep varicose veins that made her limp with pain. Both sitting and standing were agonizing for her. When she finally had a minimally invasive procedure to treat the probem, she was stunned at how quickly the pain vanished.

“The procedure itself is not really complicated, and the pain was like little mosquito bites,” she says. “The main thing was that it fixed the problem within 12 hours. The next day I could walk and my legs didn’t hurt. I wasn’t limping anymore.”

Ten years ago, varicose vein removal meant open surgery, complete with general anesthesia, large incisions and a hospital stay. Today, minimally invasive office procedures achieve the same result without the pain or inconvenience. Two procedures, endovenous laser ablation (EVLT) and radiofrequency ablation (RFA), use different forms of energy to destroy damaged tissue.

Vascular Center Physicians and staff

The Yale-New Haven Vein Center pulls together vascular surgeons, an interventional radiologist, registered vascular technologists and an administrative assistant.

“I would say that EVLT and RFA are revolutionary,” says Jeffrey Indes, MD, a Yale Medical Group vascular surgeon who began the Yale-New Haven Vein Center last March. “We’re providing treatment for venous disorders with no anesthesia, no hospitalization time and minimal recovery. There are no scars. It’s a 40-minute procedure, and many patients go back to work the next day.”

Indes is working with Bart Muhs, MD, PhD, who is also a vascular surgeon, John Aruny, MD, an interventional radiologist, and Bauer Sumpio, MD, PhD chief of vascular surgery at Yale School of Medicine. The group has performed low-risk, ultrasound-guided procedures for more than 80 patients.

The group also provides treatments for surface varicose veins, such as phlebectomy, the surgical excision of the vein or part of the vein, and sclerotherapy, a technique that injects a chemical irritant into a vein to eventually shrink it.

Diagnosing damaged veins

While the procedures sound simple, there is more to treating varicose veins than just removing the diseased veins, according to Indes. “It’s about diagnosing exactly what type of problem the patient has and in what anatomical distribution it occurs,” he says.

Obesity, prolonged standing and leg injuries can all weaken valves, as can the expanding uterus and huge increase in blood in the body during pregnancy. Perrault, who is in her late 40s, had been battling her weight and had nagging leg pain since nursing school. “I would work my 12 hours then go home and put my legs up,” she says.

Ultrasound guides procedure

Jeffrey Indes, MD

Indes and an assistant discuss a patient.

Indes begins an EVLT or RFA procedure by making a tiny nick in the skin, usually above or below the knee. He inserts a thin catheter, then pushes a fine wire through the catheter and up through the vein. An ultrasound technologist provides real-time images of the entire leg to guide Indes as he uses a fine surgical needle to inject tumescence, a special numbing solution.

“The ultrasound helps with precise placement of the tumescence, and this results in better outcomes and minimal pain,” Indes says. He uses the laser or radiofrequency device to create heat in the affected vein, causing it to shrink and disappear, and redirects the blood flow to healthy veins.

Patients go home immediately, with instructions to walk at night. Indes instructed Perrault to wear support hose and avoid hot showers for 24-48 hours.

“What it did for me was allow me to live again,” Perrault says. “I couldn’t walk, and to me that’s horrendous. I live by myself, and my life is my work.”

Treating damaged veins early

Indes suspects some patients put off seeking help for venous disease because they don’t know how easy the treatment has become. When they aren’t treated, varicose veins can develop into more severe problems, including:

  • Edema, or swelling
  • Skin changes
  • Ulceration

Long-term results for EVLT are similar to those for traditional surgery – venous disease returns in 10-13 percent of patients with both approaches, and doctors think this is due to genetic qualities, surgical technique, or other factors, Indes says. “But if the vein is truly ablated, it shouldn’t come back,” he adds. “As far as resolution of pain, or swelling, and as far as any other recurrent symptoms, I would say the minimally invasive procedure is better.”

Story by Kathy Katella 
Photographs by Robert A. Lisak

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Are you at risk?

Varicose veins and other venous disorders affect one in 22 people in the U.S. Sixty percent of American women and men suffer from some kind of vein disorder, and abnormal leg veins are a problem for 41 percent of women by age 50.

Risk factors include:

  • Working in situations that require long periods of standing, a habit that can affect blood flow
  • Overweight or obesity
  • Age, which wears down valves in the veins, causing blood to collect in the vein rather than flowing up to the heart
  • Gender: Women are at risk if they have gone through childbirth; menopause, hormone replacement therapy and birth control pills are risk factors
  • Genetics

You can prevent varicose veins by

  • Controlling your weight
  • Not crossing your legs
  • Elevating your legs whenever you can
  • Exercising regularly
  • Avoiding clothing that restricts the waist, groin or legs


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Information and appointments: 203-785-6216.


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