• Aching or burning in the legs
• Pain in the legs
• Swelling of the legs or ankles
• Leg cramps or sores
• Itching of the skin around a vein
• Eczema of the skin typically in the calf region
• Open wounds such as skin ulcers around the ankle

• Heredity
• Pregnancy
• Hormonal factors
• Being overweight
• Standing or sitting for long periods of time
• Advancing age
• Injury

• Upon coming to our office you will begin by filling our own developed confidential patient venous questionnaire
• You will then undergo a personal consultation with our Medical Director Dr. Sanjoy Kundu
• He will review your venous questionnaire to focus on the most important findings and symptoms to you
• You will then undergo a focussed venous physical examination to map out all your varicose and spider veins
• Dr. Kundu will then personally perform a venous ultrasound examining your superficial and deep venous system
• A personalized treatment plan will then be presented to you with the different treatment options

The Closure procedure provides the following benefits for patients and physicians:

• Minimally Invasive Outpatient Procedure. Closure catheters are inserted into the vein via a tiny incision in the lower leg, eliminating the need for groin surgery and general anesthesia. The Closure procedure can be performed using local anesthesia in a physician’s office, as well as in an outpatient hospital setting or surgicenter.
• Clinically Proven Less Post-Operative Pain. The Closure procedure does not involve pulling the diseased vein from the thigh as with vein stripping surgery, or using 700° C laser energy which boils blood to occlude a vein as with endovenous laser (EVL). In the RECOVERY Trial, a multi-center head-to-head comparative randomized trial comparing the Closure procedure with EVL, the Closure procedure was found to have less patient pain and less patient bruising than EVL for the best patient recovery experience available from a minimally invasive vein treatment. Additionally, in other randomized comparative studies have shown that patients receiving the Closure procedure return to normal activity and work significantly faster than those receiving vein stripping.
• Excellent Clinical Outcomes. The ClosureFAST catheter, which represents the latest advancement in the Closure procedure, has been shown in a multi-center study to have a 97.4 efficacy rate at one-year. This shows that the treatment is highly effective and, as proven in the RECOVERY trial, is gentle on the patient.
• Cosmetically Appealing. Because treatment with Closure is minimally invasive and is catheter-based, it results in little to no scarring. As with any medical procedure, you are encouraged to review all safety information associated with the procedure by consulting your physician.

1. Each patient undergoes a personal physician consultation as outlined above.
2. On the day of the procedure, the patient undergoes application of local anesthetic spray and cream to the area to be treated to minimize discomfort.
3. The patient undergoes a mapping ultrasound by Dr. Kundu before the procedure to confirm the patient’s anatomy and area to be treated to decrease procedure time and note any changes from the time of the patient’s consultation.
4. Utilizing Dr. Kundu’s unique micropuncture technique, the vein to be treated is accessed and a plastic tube enclosing the radiofrequency catheter is inserted.
5. Dr. Kundu ensures correct positioning of the radiofrequency catheter using the ultrasound as a guide to ensure complete and accurate treatment.
6. We then apply tumescent anesthesia around the vein to ensure effective action of the radiofrequency energy and minimize patient discomfort.
7. After the procedure is completed, one of our knowledgeable staff will help the patient apply the medical compression stockings. Dr. Kundu will then personally review the post-procedure instructions with you.
8. The patient is then entered into our post-procedure protocol (see below) to ensure the vein treated by the radiofrequency Closure(TM) has been effectively closed and that the branch varicose veins are appropriately treated by either foam sclerotherapy or microphlebectomy.
9. Each patient is able to walk out after the procedure and return to work within two days depending on the type of occupation .

1. At The Vein Institute of Toronto™ you will undergo a comprehensive physician venous consultation including a venous history and physical exam, followed by a venous duplex ultrasound to assess for superficial venous reflux, rule out deep venous thrombosis and map out the anatomy your superficial venous system. This allows us to develop a personalized treatment plan.
2. If you decide to proceed with the procedure, please follow the pre-procedure instructions and medication protocol comprised of Arnica™ and Bromelain to minimize post-procedure discomfort and bruising to optimize the results. An EVA kit including Arnica™ tablets/gel, Bromelain tablets and gel pack may be obtained from The Vein Institute of Toronto™.
3. The EVA procedure is performed according to our own tested and proven protocol, which is taught to physicians around the world. EVA is a minimally invasive, ultrasound guided procedure involving endovenous thermal ablation of the incompetent saphenous vein. At The Vein Institute of Toronto™ utilizing our EVA protocol and unique micropuncture technique to perform the procedure has produced a 98% technical success rate and 95% clinical success rate in over 1700 procedures to date.
4. After the procedure a physician assistant will assist you to put on the required compression stockings. Please wear the Class II (30-40 mm Hg ) compression stockings for the first 72 hours and then from first thing in the morning to before bed time for another 10 days. Please follow the post-procedure instructions closely for optimal results.
5. You will be seen in follow-up after the procedure at six and twelve week appointments or as per your personal schedule and requirements. At each follow-up a venous ultrasound will be performed to confirm the treated saphenous vein is closed. Foam sclerotherapy injections (which are included as part of your procedure) will be performed for any residual branch varicose veins at your discretion. Please bring your stockings for all follow-up appointments. All post EVA follow-ups are included as part of the procedure.
6. At your 6 and 12 week follow-up appointments, you will be given the option of entering into our Leg Wellness Program to help prevent future leg veins.

1. Take 5 pellets of Arnica™, 3 times per day, for 5 days prior to the procedure. Place pellets under the tongue and allow them to dissolve in your mouth. Arnica™ is a homeopathic medicine which has been proven to reduce pain, bruising and swelling after the EVA procedure.
2. Take one 500 mg Bromelain tablet twice per day, for 3 days prior to the procedure. DO NOT TAKE Bromelain, if you have a Sulfa allergy.
3. Your normal medications may be taken on the morning of your procedure along with a light breakfast. You may eat and drink normally before the procedure-however please avoid alcohol and caffeine containing products.
4. Do not take blood thinners for 1 week prior to the procedure. Please check with the physician who prescribed your medication to verify that you may discontinue this medication for this period of time. Please inform the physician performing the EVA procedure of any health problems, allergies and/or medication you are currently taking. Tetracycline or Minocin should be discontinued 10 days before and after the procedure.
5. Wear loose, comfortable clothing that can be worn over the stockings and bandages after the procedure. Please bring a warm pair of socks with you to keep your feet warm prior to the procedure.
6. We have a compression stocking service onsite to ensure you are measured and fitted with the correct type of stockings. Accurately fitted stockings are essential to ensure success of the procedure.
7. Please read the enclosed post procedure instructions prior to your procedure. Please bring your stockings to your follow-up appointments. Have someone to accompany and drive you home after the procedure.

1. Please arrive AT LEAST 30 MINUTES before your procedure time, to allow for proper preparation before the procedure. On arrival, you will be asked to change into a procedure gown and remove your trousers and shorts leaving your undergarments and socks on.
2. A local anesthetic cream will be applied to the area to be treated. This should be applied atleast 30 minutes before your procedure, for maximal effectiveness. You will also be given a oral sedative (Ativan) and pain killer (Oxycodone) at your option.
3. A pre-treatment photograph will be taken for to act a s a baseline for your chart. A repeat mapping venous ultrasound will be performed. A tourniquet will be applied to your leg, in a standing position.
4. You will then lie down on the treatment table and a cleaning solution will be applied on the leg(s). Sterile drapes will be placed around the treatment area (All materials used are sterile and disposed after single use).
5. Local anesthetic (“freezing”) will be injected at the vein entry site. A needle is placed through the skin using ultrasound guidance into the vein to be treated. At The Vein Institute of Toronto™ we utilize a unique micropuncture technique to maximize success and minimize your discomfort. A guidewire will be placed through the needle into the vein. You may feel mild discomfort as the wire is being positioned. A vascular sheath (tube) will be placed over the guidewire and positioned at the junction of the superficial and deep venous system using ultrasound guidance. The radiofrequency catheter will be placed through the sheath to the correct position.
6. Branch vein sclerotherapy for your enlarged varicose veins will be performed with foam Sotadecrol solution under light or ultrasound guidance.
7. Tumescent anesthetic using a special mechanical pump, will be applied around the vein, to increase the effectiveness of the radiofrequncy ablation, and minimize your discomfort. The radiofrequency catheter is then activated and pulled back along the vein, utilizing the radiofrequency heat energy to close the incompetent saphenous vein. The radiofrequency catheter is activated for a period of 2-5 minutes. After the radiofrequency catheter is removed, a small antibiotic dressing is placed on the skin, to prevent infection and promote healing.
8. Immediately after the treatment, your dressing and support stockings, will be applied on your leg(s), to the treated area. We suggest you walk for five minutes after the procedure, before leaving the clinic to promote venous circulation.

1. Keep support hose and Comprilan bandage on for the first 72 hours continuously. After that please wear the stockings and Comprilan bandage from the first thing in the morning (ideally, take a quick 5 min shower and then put them on before doing the rest of your morning routine), until bedtime at night for another ten days. If bleeding occurs from the puncture site, apply pressure for five minutes. Remove the gauze dressing on your leg 72 hours following the procedure.
2. You can resume day to day activities today (excluding exercise). You can resume exercising in two days (no weights, sit-ups or pushups for 2 weeks after the procedure). We strongly encourage walking atleast 30 minutes per day from the day of the procedure for two weeks. You can shower after 72 hours but no hot baths, hot tub, jacuzzi or sauna for 2 weeks after the procedure.
3. Bruising, localized swelling, some tenderness, tightness and pain are normal along the inner thigh or behind the calf after treatment, but please feel free to call the office if you have any questions or concerns. Bruising may occur the same or following day. In most cases it will be gone after 2 weeks but could remain longer. You may develop “lumpy” areas in your groin which are tender and part of the normal healing process. Applying a gel pack (part of ERFA kit) three times daily and Arnica Gel™ twice per day for two weeks helps reduce the bruising. Redness, tenderness and swelling around the point of entry may remain longer than 2 weeks. If you have pain and leg swelling involving the entire leg or calf, please call our office immediately.
4. To Prevent Pain, Bruising & Persistent Discolouration
   1. Please continue to take 5 pellets of Arnica™, 3 times per day and one 500mg Bromelain tablet twice per day for 11 days after the procedure to reduce pain, swelling and bruising. Also, Drink atleast 2 liters of water per day to promote healing, reduce bruising and prevent discolouration.
   2. Elevate your leg on a couch or stool and please apply gel pack three times daily, 10 minutes at a time to the bruised and painful areas. After each application of the gel pack apply Arnica Gel™ to the bruised areas.
   3. Please purchase generic Ibuprofen tablets (not Advil™) and take 600 mg three times daily orally for seven days after the procedure date. Ibuprofen may be purchased at any pharmacy.
   4. It is preferable to avoid sun exposure after the procedure. It is mandatory to apply a strong sunblock SPF 40 to 50 (available here) at sites of bruising or discolouration if there is any sun exposure.

1. Do not shave your legs or apply cream for one day prior to and the day of your follow-up appointments. No tanning within two weeks of the treatment date. Do not take aspirin or blood thinners 3 days prior to procedure. Do not take Tetracycline or Minocin 10 days before or after sclerotherapy. Eat a snack one hour prior to your treatment. Bring shorts to wear during the procedure and slacks to wear out of the office. Sclerotherapy will only be performed if necessary.

1. Keep stockings on continuously for the first 72 hours. Only take off stockings to go to the washroom or for showers. After the first 72 hours wear your stockings from morning to night for another 7 days (ideally, take a quick 5 min shower and then put them on before doing the rest of your morning routine). Compression stockings help decrease bruising at the sclerotherapy sites.
2. To Prevent Pain, Bruising & Persistent Discolouration
   1. Please continue to take 5 pellets of Arnica™, 3 times per day and one 500mg Bromelain tablet twice per day for 11 days after the procedure to reduce pain, swelling and bruising. Also, Drink atleast 2 liters of water per day to promote healing, reduce bruising and prevent discolouration.
   2. Elevate your leg on a couch or stool and apply a gel pack three times daily, 10 minutes at a time to the bruised and painful areas. After each application of the gel pack, apply the Arnica Gel™ on the bruised areas.
   3. Please purchase generic Ibuprofen tablets (not Advil™) and take 600 mg three times daily orally for seven days after the procedure date. Ibuprofen may be purchased at any pharmacy.
   4. It is preferable to avoid sun exposure after the procedure. It is mandatory to apply a strong sunblock SPF 40 to 50 (available here) at sites of bruising or discolouration if there is any sun exposure.
   5. Apply Creamy Cleanser for sensitive skin twice per day to site of varicose veins and rinse off. Apply Complex Cu3 Intensive Tissue Repair Crème 3-5 times per day, to treated areas. If itchy then apply greater than five times per day. If any irritation occurs discontinue use and call office.
3. You can resume normal daily activities excluding exercise today. You can resume exercising in 2 days. You can shower in the morning but no hot baths, hot tub, sauna and jacuzzi for 2 weeks after sclerotherapy.
4. Bruising, local swelling and some tenderness are normal after treatment, but please feel free to call the office if you have any questions or concerns.
5. You will not notice an immediate improvement. Clearance of varicose veins and discolouration usually occurs over a 2-10 week period and in some cases may take up to 12 weeks.

1. Q. How much and where can the bruising occur after the procedure?
   
   A. The bruising can be quite marked (black and blue) for two weeks along the inner thigh for Great Saphenous Vein Treatments and on the posterior calf for the Small Saphenous Vein Treatments. This is normal.

2. Q. Where does the pain occur and what does it feel like?
   
   A. The initial pain immediately after the procedure will be like a aching pain along the inner thigh for Greater Saphenous Vein Treatments and on the posterior calf and behind the knee for Lesser Saphenous Vein Treatments.
   
   B. After the first week you will experience a tightening inside the leg along the inner thigh for Greater Saphenous Vein Treatments and on the posterior calf and behind the knee for Lesser Saphenous Vein Treatments. All of the above are normal.
   
   C. You may also experience a transient numbness or loss of sensation in the treated area which is also normal.

1. Q. What is used for sclerotherapy?
   
   A. We use a foam solution comprised of Sotadecrol, which has been used for over 30 years.

2. Q. What will I experience after sclerotherapy?
   
   A. You will feel tender hard lumpy areas after sclerotherapy for up to four weeks which is a sign of normal healing, and will usually produce a good response.

Call 416-929-0834 for a Complimentary Physician Consultation