Varicose Vein Treatment
Treatment of varicose veins is only covered by health insurance companies if you are having symptoms. As discussed under the Vein Problems tab, almost every patient with varicose vein problems has some degree of leg heaviness, discomfort or swelling, even if they have become used to these problems over time. Before treatment of symptomatic varicose veins, most insurance companies require that the patient completes a trial of compression therapy. Typically, this means using prescription-strength stockings to see if this cures your varicose vein symptoms. If compression stockings don’t solve the problem, then the insurance company typically agrees to pay for treating the vein problem. The length of time that insurance companies require you to wear stockings varies, and some common insurance carriers requirements are listed below. This list is subject to frequent changes, so please check with your health care insurer for the latest information. If you need to see one of our specialists so you can get a prescription for compression stockings, just click on the Contact Us tab, or call 314-362-5347 (362-LEGS). If your insurance plan is not listed, please contact us to determine how long compression therapy is required before treatment of your venous reflux and varicose veins will be considered a covered medical expense.
| Insurance Company | Time of Compression Therapy Required |
| United Healthcare (UHC) | 2 weeks |
| HealthLink | 6 weeks |
| Blue Cross Blue Shield | 3 months |
| Medicare | 3 months |
| Group Health Plan (GHP) | 3 months |
| Aetna | 3 months |
| Tricare | 3 months |
| Cigna | 3 months |
When the delicate valves in the leg veins lose their proper function, the resulting venous reflux causes congestion of blood within the veins of the leg. The long saphenous vein that runs down the inside of the leg from groin to ankle, and the short saphenous vein that runs down the outside of the leg from knee to ankle, are prone to developing these broken valves causing venous reflux. Often, but not always, the blood then backs up into large branches of these veins located close to the surface of the skin, resulting in visible varicose veins. The varicose veins you see are not the long or short saphenous vein itself, but engorged tributaries that no longer can empty effectively. This backup of blood flow in the varicosities causes aching, discomfort and swelling.
Treating venous reflux and varicose veins has two components:
- Saphenous vein ablation. Saphenous vein reflux is corrected with a minimally invasive procedure known as radiofrequency ablation (RFA) or the VNUS Closure procedure (see video at top of page). This outpatient treatment is performed with the patient under mild sedation. Following the use of a local anesthetic, the doctor makes a needle puncture into the saphenous vein, and the slender radiofrequency catheter is positioned within the vein under painless ultrasound guidance. After additional anesthetic is used to surround the vein to be treated, the doctor uses the catheter to apply radiofrequency energy to the walls of the vein, sealing it off from the inside. This minimally invasive procedure has replaced the old surgical technique of saphenous vein stripping. With this new technique, patients are fully ambulatory immediately and are able to return to work within one to two days after the procedure. Typically, a stocking or supportive wrap is worn for 48 hours after the procedure.
- Micro-incision venectomy. For most patients, after RFA, the majority of varicose veins become significantly less prominent. In some patients, however, a portion of the painful or unsightly large varicose veins still remains. These residual symptomatic varicose veins are removed by micro-incision venectomy. This outpatient procedure is performed with mild-to-moderate sedation. A local anesthetic solution is placed to surround the symptomatic varicosities. The varicose veins are then extracted through a series of small (5-6 mm) incisions. The treated area of the leg is wrapped with a compressive dressing to minimize bruising. The dressing is removed in 24-48 hours. Postprocedural recovery is dependent on the number and size of varicosities that were removed. Most patients are ambulatory and able to return to work within 2-7 days after the procedure.
Spider Vein Treatment
Spider vein treatments are almost always considered to be cosmetic, and are not covered by insurance. The only exception to this is if the spider vein has had bleeding. Sometimes insurance companies will cover the cost of treating bleeding spider veins, but not the other spider veins in the legs. Your insurance company’s policy may vary, so check with them about coverage decisions. Please ask your Washington University vein specialist about the cost of treatment, and how many sessions will be required. Remember that this is only an estimate, since every patient’s response to sclerotherapy is unique. Also, be prepared for new spider veins to develop elsewhere in the future, since the process of creating new spider veins continues in your legs as you age.
Injection sclerotherapy
Telangiectasias (spider veins) and small reticular veins may be treated with the injection of FDA-approved agents such as Sotradecol® (sodium tetradecyl sulfate). These injections are done using tiny needles, and unlike older injections using concentrated saline solutions, the injection itself is painless. The Sotradecol® destroys the lining of these small veins, which are then squeezed shut so they don’t fill with clotted blood. This produces the best initial cosmetic results. Successful treatment results in the destruction and resorption of these unsightly small veins. This outpatient procedure can be done with minimal discomfort, and no sedation is required. Use of compression hose in the weeks after the procedure helps minimize pigmentation changes in the surrounding tissue. For most patients, the veins are significantly improved but often the same area will need to be treated 2-3 times to obtain the best results. While most patients experience significant cosmetic improvement, problems can occur including tattooing of the skin with brown pigment where the tiny veins were previously. Usually, this problem improves over a few months time. Very rarely, patients can experience development of multiple tiny new veins, or even ulcers at the injection site.