"Veinwave brings instant, painless relief from tiny spider veins"

For Jeffrey Miller, MD, founder of Advanced Vein Therapies in Novi, Mich. (www.novivein.com), the search for the best way of treating spider veins has been a career-long quest. He thinks that his latest tool, Veinwave using thermocoagulation,gets him closer to the goal.

It has been estimated that 25-30 percent of women and 10-20 percent of men in the United States suffer from spider veins and telangiectasia - those unsightly clusters of red, blue or purple veins that "spider-web"across the cheeks, thighs, calves, ankles and knees.

"The first thing I read about the Veinwave was in Vein Therapy News," Dr. Miller said. "It sounded like an interesting approach, so I started communicating with the Veinwave's U.K. developers, and I decided to buy it.

"There was a pretty decent risk in buying it because I didn't have the opportunity to demo the device because it was still only available in the U.K. So, I decided to purchase it before I actually used it. I had the opportunity and pleasure of actually being trained by the inventor of the device, a U.K. surgeon named Brian Newman."

Dr. Miller was scheduled to fly to the U.K. for training when he learned that Dr. Newman was coming to Miami to meet with the U.S. distributor, Veinwave USA (VeinWaveUSA.com) of Birmingham, Ala. Arrangements were made to meet in Miami for the training.

The Principle

Sclerotherapy, although sometimes "hit and miss" in its technique, has been able to remove the darker blue veins and the thicker red veins as a good alternative to surgery in many cases, but what Dr. Newman thought was needed was a treatment to deal with the fine cosmetic veins that sclerotherapy either left behind or was unable to treat.

He sought a treatment that was more consistent than sclerotherapy and safer, less painful, and more effective than lasers. He adopted the European tried and tested principle of thermo-coagulation in developing Veinwave.

Dr. Newman devised a technique that would use the safe heat energy emitted by a uni-polar current at the tip of an ultrafine insulated needle, thereby being able to specifically target each individual vein for treatment while protecting the surrounding tissue through the insulation of the needle.

The result was what he said was the instant disappearance of the fine veins without any lasting trauma to the skin and allin relative comfort.

Dr. Miller said Veinwave is perfect for use on facial veins, and generally used in conjunction with sclerotherapy on leg veins to enable the practitioner to offer a comprehensive therapy.

Veinwave uses focused energy to heat the fine blood vessels and as soon as very high frequency microwave energy is applied to the veins they immediately disappear in a process known as thermo-coagulation, which causes the vein walls to stick together and collapse.

Dr. Newman refers to the treatment as a "walk-in walk-out" procedure. In the U.K., the process is promoted as a "lunchtime procedure," where women come in on their lunch break, have the treatment and immediately go back to work.

The Federal Drug Administration has just recently approved the use of the Veinwave in the United States, although more than 1,000 physicians worldwide have been using it as the primary tool for treating spider veins for more than eight years.

Not a Sclerotherapy Replacement

The energy is transferred to the affected area with an ultra-fine insulated needle to ensure a highly accurate application without affecting the surrounding skin and tissue. Because of this, Veinwave can even be applied to areas of the body that until now have been difficult to treat, such as the face, knees and ankles. Because the treatment does not cause aloss of pigmentation, it can also be used on any kind of skin complexion.

Dr. Miller said he relies on the Veinwave for treating the tiny spider veins, but continues to use sclerotherapy, depending on the needs of the patient.

"It is not a replacement for sclerotherapy; in fact, you can't treat the reticular veins in the leg with it nor can you treat the larger spider veins. But it's really great for the tiny veins."

Sclerotherapy provides successful treatment on the larger leg veins. However, sclerotherapy often fails to be effective on the fine veins of the knee and ankle and is rarely used on the face.

"As a combination therapy, Veinwave is the perfect compliment to sclerotherapy," Dr. Miller said.

"Over the years, we've demoed many, many lasers for spider vein treatment and most of them really hurt like heck. We haven't really found one that I've been satisfied with in terms of not causing too much pain.

"So for the most part we treated spider veins with sclerotherapy, and we still do depending on the patient's needs. But Veinwave is a very nice tool to have in the toolbox for the treatment of spider veins," he said.

"I don't think we yet have the answer for treating spider veins, and in the future I believe we will have much better ways of treating them than we do today."

Advanced Vein Therapies, which is in the process of changing its name to Novi Vein Therapies, is the only provider of Veinwave in Michigan, so many patients are coming for treatment of facial veins.

"If they are coming here for facial veins, we're going to use Veinwave," Dr. Miller said. "But in terms of the legs, it is just one of the tools we do offer and its use really depends on what type of veins the patient has."

Dr. Miller's Process

Dr. Miller said Veinwave is very easy to use for a doctor with sclerotherapy skills, and takes about 15 minutes to administer. The thermo-coagulation process uses microwave heat energy and a fine-point needle to effectively locate the vein and treat it without harsh side effects of other types of treatments.

Procedurally, he uses a headset with magnifying loops and a polarized lamp so that he can actually see the veins, as tiny veins can be difficult to treat without magnification. Under magnification,he said those veins just pop right out.

"The Veinwave, which is equipped with a foot pedal, uses a very thin insulated disposable nickel needle attached to a small wand that is placed just on top of the vein. Then you look for blanching. As soon as soon as you see that blanching, you deliver a pulse of microwave energy, which causes thermo-coagulation, resulting in the vein closing down."

Veinwave uses a needle that is only 0.0075mm thick, through which a 4 MHz current passes into the vein. The heat destroys the wall and content of the capillaries. A typical treatment will use 200-250 energy pulses.

"So it is different from sclerotherapy where the needle is in the vein. With Veinwave, the needle is just on top of the vein."

Within minutes after the session, patients can resume their everyday activities without bandages or compression hose.

Risks

Because thermo-coagulation uses a selective controlled energy, which preserves the epidermis, there are no risks of burns or necrosis.

Dr. Miller says there are only two risks of the procedure: scarring and hypo-pigmentation or lightening of the skin.

"We haven't seen that yet, but we've only been using the device for a few months. However, we also are very careful to minimize those risks"

"The main thing is not to over-treat, so after you deliver a pulse of energy, be sure you are not re-treating the same area and make sure you don't get too close to the area you just treated. If you were to deliver the microwave pulse where each dot was overlapping each other, then it becomes more like a knife where you are almost cutting the skin as opposed to closing down the vein."

The needle that is used is a nickel needle, and some patients may have a severe allergy to nickel and not even know it. "We always ask our patients if they have any severe nicked allergies. Then I ask them if they have ever had their earlobe swell after wearing an earring because some inexpensive earrings are made of nickel and cause irritations. Then, because it is a microwave device, we always ask patients if they have a pacemaker or if they are pregnant."

For those patients with severe nickel allergies, doctors can use a gold needle, but Dr. Miller said he has read that there is more pain associated with the gold needle than with the nickel needle.

Other than avoiding these risks, Dr. Newman said Veinwave does not pose any risk of long-term scarring, bruises or skin discoloration.

"Unlike lasers, the Veinwave involves only slight discomfort, so there is no need for anaesthetic creams or pain medications," Dr. Newman said. "Also, the Veinwave doesn't carry a risk of long-term scarring."

Narrow Range of UseDr. Miller said the Veinwave is really designed for treating the tiniest veins in the lower extremities, and for treating any of the facial vein problems, including the veins that are seen with rosacea.

"For the rosacea patients, we pre-treat them with azelaic acid gel for four weeks before treating them," he said. "The theory behind that is that the azelaic acid gel will open up the pores. It is Dr. Newman's opinion that rosacea is caused by blockage of pores, which causes inflammation, and the inflammation is what causes the ingrowth of vessels. So, based on that theory, the azelaic acid gel is used to open up the pores so that you are getting to the underlying cause first for eventually treating the vein. The azelaic acid gel doesn't do much for the rosacea in and of itself."

Patient reaction

Dr. Miller said his patients tell him that Veinwave is very easy to tolerate and causes very little, if any, pain. Like sclerotherapy, Dr. Miller separates Veinwave treatments by at least four weeks to avoid over-treating.

"Their skin will feel rough to the touch and a little red for about a week, and then the veins start to fade."

There is no recovery process with Veinwave. Once the procedure is complete, a patient is able to leave the clinic immediately and does not have to worry about sun exposure limitations.

"What patients love about treating the legs with Veinwave is that they don't have to wear compression stockings after the treatment."

"I am really pleased with the Veinwave," Dr. Miller said. "It does a great job, and the patients appreciate the fact there's no pain associated with its use."