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Banish Embarrassing Varicose Veins with Top Treatments
at CU Dermatology – Boulder

Varicose Vein Information

Varicose veins are a very common problem, generally appearing as twisting, bulging rope-like cords on the legs, anywhere from groin to ankle. While many people have heard of varicose veins, very few truly understand their underlying cause and the potential they have for developing into a serious medical issue.

Facts about Varicose Veins

Varicose veins affect an estimated 40% of women and 25% of men. Factors leading to varicose veins include heredity, gender, pregnancy, age, and other factors. Some factors may speed up the development of this disease and make the veins worse, including prolonged standing, obesity, hormone levels, and physical trauma.

What Are Symptoms of Varicose Veins?

In addition to the visual appearance, many patients may experience one or more of the following leg symptoms:

  • Pain (an aching or cramping feeling)
  • Heaviness/Tiredness
  • Burning or tingling sensations
  • Swelling/Throbbing
  • Tender areas around the veins

If you experience symptoms and delay treatment, your symptoms may progress onward to more serious complications:

  • Inflammation (phlebitis)
  • Blood clots (e.g., DVT)
  • Ankle sores or skin ulcers
  • Bleeding

If you are experiencing any of the above, please contact Dr. Richard Levine, as treatment may be required.

How Varicose Veins Occur

Arteries carry blood from your heart out to your extremities, delivering oxygen deep into the tissue. Veins then return the ‘de-oxygenated’ blood back to your heart to be re-circulated.

To return this blood to the heart, your leg veins must work against gravity. Small, one-way valves in the veins open to allow blood to flow upward towards the heart and then close to prevent it from flowing backwards.

Varicose veins occur when the valves in superficial leg veins malfunction. When this occurs, the valve may be unable to close, allowing blood that should be moving towards the heart to flow backward (called venous reflux). Blood collects in your lower veins causing them to enlarge and become varicose.

Can Varicose Veins Be Prevented?

The underlying conditions described above usually make ‘curing’ varicose veins impossible; however, certain measures may help relieve discomfort from existing varicose veins and prevent others from arising:

  • Exercise regularly (walking is ideal)
  • Avoid standing for long periods of time
  • Avoid sitting for long periods
  • Control your weight

Since the above measures do not treat the underlying cause of the disease, varicose veins will usually enlarge and worsen over time. Legs and feet may begin to swell and sensations of pain, heaviness, burning, or tenderness may occur. If and when this happens, consult your physician immediately.

Treatment Options for Varicose Veins

Dr. Richard Levine will usually first try methods that don’t involve surgery to relieve your symptoms. These may include preventive techniques or the use of compression stockings. If your varicose veins do not respond to this conservative therapy, more active treatment may be required.

EndoVenous Laser Treatment EVLT

EVLT® – The Solution You’ve Been Looking For

EVLT® eliminates unsightly varicose veins with no hospital stay, no scarring, and no lengthy recovery or side effects. In less than an hour, you can be free from bulging, twisted varicose veins and back to enjoying your everyday activities. EVLT® is safe, fast, and effective. With EVLT® by Diomed, you can show off your legs again.

EVLT® uses targeted laser energy to seal the vein shut and help you look and feel better fast.

  • Treatment in less than an hour
  • Can be performed in our office
  • Up to 98% success rate
  • Immediate relief of symptoms
  • Return to normal activity immediately—with little or no pain
  • No general anesthesia or hospitalization
  • No scars

Here’s what to expect from the EVLT® procedure:

  • Levine uses ultrasound to map out your vein.
  • Local anesthetic is applied.
  • A thin laser fiber is inserted through a tiny entry point, usually near the knee.
  • Laser energy is delivered to seal the faulty vein.
  • Walking immediately after the procedure is encouraged. Normal daily activity can be resumed; just avoid rigorous activities such as gym workouts.
  • There may be minor soreness and bruising. Any discomfort can be treated with over-the-counter, non-aspirin pain relievers as necessary.


What does EVLT® stand for?

EndoVenous Laser Treatment

How does the procedure actually work?

A laser fiber is fired inside and along the length of your faulty, varicose vein. The laser energy damages the vein walls, shrinking them closed so that blood can no longer flow through.

Is loss of this vein a problem?

No. There are many veins in the leg and after treatment the blood in the faulty veins will be diverted to normal veins with functional valves. The resulting increase in circulation will significantly relieve symptoms and improve appearance.

What are the side-effects and complications of this procedure?

EVLT®, like all minimally invasive procedures, can potentially have some slight bruising, which commonly disappears within the first few weeks. With EVLT®, you will feel a delayed tightness (or “pulling” sensation) 4–7 days after laser treatment which is normal and expected following a successful treatment.

All surgical procedures involve some element of risk and have the potential for complications. This should be balanced against the risk of complications if your varicose veins remain untreated. Consult your physician for further information.

Am I at risk from the laser?

No, however you will be given a pair of special glasses to wear to protect your eyes, as a precaution against accidental firing of laser energy outside the body.

What are the alternatives to this treatment?

Surgery (called ‘Ligation & Stripping’) is the traditional treatment, but it can be quite painful and often has a long recovery time. It is performed in a hospital, involves general anesthesia, leaves large scars, and has a fairly high recurrence rate (on average 10–25%).

Other alternatives include ultrasound-guided sclerotherapy (injection therapy) and radio frequency electrosurgery. Injection therapy for the saphenous vein has a high recurrence rate frequently requiring retreatment and is generally limited to smaller varicose and spider veins. Radiofrequency electrosurgery is more limited in the range of patients it can treat and the treatment time is longer than EVLT®.

How successful is EVLT®?

Clinical data with up to 5 years of follow-up show success rates of 98%.

How much does it cost?

EVLT®, when medically necessary (e.g., for relief of symptoms), is commonly reimbursed by most carriers (including Medicare), limiting the cost to the patient.

Varicose Vein Treatment Alternatives

The trend charts on this page compare varicose vein removal alternatives and demonstrate the clear benefits to choosing varicose vein laser treatment over alternative forms of treatment.

What Doctors Are Saying about Varicose Veins

Varicose Vein Treatment Trends Data statistics. Read more about it.

Some of the benefits include the following:

  • Up to 98% success rate without the need of hospital stay
  • Lower risk of complications
  • No scarring
  • Strong patient satisfaction
  • Fast recovery

Taken together, these factors make endovenous laser treatment the fastest growing procedure in treating varicose veins. In fact, EVLT is quickly on the path to becoming the predominant varicose vein laser treatment. But don’t take our word for it—see what doctors and market analysts are saying about EVLT in a trend comparison against other varicose vein removal options.

What Market Analysts Are Saying

Varicose Vein Treatment Trends Data Statistics. Read more about it here.

EVLT® vs. Surgery. Read more about it here.

EVLT® vs. RF. Read more about it here.


Dr. Levine uses this procedure to treat small to large veins in the legs. A sclerosing (hardening) solution is injected into the unwanted veins using very fine needles. Many veins will collapse and disappear immediately during the treatment while others will fade and disappear after several weeks.

Sclerotherapy was first developed by European doctors in the 1800s. Since then, it has been refined and perfected and now used worldwide. It is an injection treatment, is non-surgical, and minimal discomfort is experienced.

A spider vein large enough to insert a tiny needle may be treated by injecting “sclerosing solution” into it. The area is then held with pressure to keep the vein blood-free. Upon completion, the area(s) injected will be wrapped with a bandage to provide additional compression.

Patients should expect to see improvement of eighty percent or more after the first treatment and will be able to return to work immediately. Touch-up treatments, if required, are repeated six weeks later. A compression garment or dressing is usually recommended to be worn for two weeks after the treatment.


Large Vein Removal (Ambulatory Phlebectomy)

Ambulatory phlebectomy may be a readily available option for those suffering from varicose veins. This surgical, minimally invasive procedure is used to remove these bothersome veins and allows the patient for a quick return to normal activities.

Often, phlebectomy is performed in conjunction with Endovenous Laser Treatment (EVLT) to address the deeper veins. The long-term results for the two treatments are advertised as very effective. First, Dr. Levine does an ultra sound evaluation of the leg veins to evaluate the vein structures to determine the origin of the varicose vein. Local anesthesia is then used to numb the area. Small punctures about 1 millimeter are made next to the target varicose vein. A specialized hook is used to latch on to the vein which is then removed. Typically, stitches are used to close the tiny incisions which are left in for a week. To help the healing process, Dr. Levine prescribes post-operative compression stockings. Following the procedure, wearing the prescribed compression stocking to compress the area is recommended for 1 week (2 weeks for EVLT with Phlebectomy).

VascuLight Laser Treatment

VascuLight™ Laser Therapy for Face and Leg Veins

The VascuLight™ laser can treat unwanted vascular lesions like spider veins and mid-sized (reticular) veins on any part of the body, including the face and legs. The VascuLight system is equipped with two different light technologies. One for varicose veins (deeper blue veins) and one for spider veins (smaller purple or red veins).

The laser component of the VascuLight system is used to treat larger, deeper veins (reticular veins). These veins respond to the precise energy level and wavelength of light that is used. A small spot of laser light travels through the skin and is absorbed through the blood within the vein, on the basis of its color. The resulting heat coagulates or clots the blood and destroys the function of the vein. This process does not affect any of the surrounding tissues. Over time, the vein will be absorbed by the body and will disappear from sight.

The pulsating light from the laser causes the blood vessels to collapse and dissolve. Some blood vessels disappear immediately during the treatment while others fade and disappear after several weeks. Depending on the number and size of the veins, several treatments may be required for the best outcome.

Insurance Information

EVLT® Insurance Information
Most carriers (including Medicare) provide coverage for EVLT®.
Coverage for EVLT® is subject to the terms of your coverage policy. Co-payments and deductibles may be applied.

Frequently Asked Insurance Questions:

Q: Will insurance cover EVLT® for everyone?
A: No. Carriers will cover EVLT® only when medically necessary. Patients must demonstrate symptomatic venous reflux disease:

  • Pain, swelling, leg cramps, ulcers, and bleeding from varicosities
  • Presence of reflux on ultrasound scan

Q: If I have symptoms of venous reflux disease, are there any other criteria that must be satisfied before I can get coverage?
A: Most carriers require a period (3–6 months) of conservative therapy (compression, elevation of legs, possibly weight loss) before providing coverage for EVLT®.

Q: What should I do if the claim is denied?
A: You should begin by reviewing the ‘explanation of benefits’ (EOB) for a reason for the denial. If the EOB does not explain the reason for denial, you should contact the claims department and request an explanation. All insurance carriers and payers have an appeals process. Inquire into the process for appeal, including where and to whom the appeal should be sent. If further assistance is needed, you may contact us for assistance.