EVA Pre-Procedure Instructions
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 shown to reduce pain, bruising and swelling after the EVA procedure.
2. Take one 500 mg Bromelain tablet twice per day, for 5 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. Please inform the physician performing the EVA procedure of any health problems, allergies experienced and/or medication you are currently taking. Tetracycline or Minocin should be discontinued for 10 days before and after the procedure.
5. Wear loose, comfortable clothing that can be worn over the stockings after the procedure. Please bring a warm pair of socks with you to keep your feet warm prior to the procedure. Please do not wear sandals to the procedure.
6. We have a compression stocking service onsite to ensure you are measured and fitted with the correct type and size of stockings. Accurately fitted stockings are essential to ensure success of the procedure.
7. Please read the enclosed post procedure instructions (page 10) prior to your procedure. Please bring your stockings to your follow-up appointments. Have someone accompany and drive you home after the procedure if you are having a endovenous thermal ablation procedure such as endovenous laser or endovenous radiofrequency ablation, as you will be administered a light sedative and pain medication which may cause.
Eva Post-Procedure Instructions
1. Keep support hose and Comprilan bandage on for the first 72 hours continuously. After the first 72 hours please wear the stockings from first thing in the morning (after a short 10 minute shower), until bedtime at night for another ten days. If bleeding occurs from the puncture site, apply pressure for five minutes. Remove the gauze dressing/bandages on your leg 72 hours after the endovenous ablation procedure day.
2. You can go back to work the following day. You can resume daily activities the same day of the procedure (excluding exercise). You can resume exercising the following day (no lifting weights, sit-ups or pushups for 2 weeks after the procedure). It is mandatory to walk atleast 10 minutes every hour for the first 6 hours after the procedure. We strongly encourage walking at least 30 minutes per day from the day after the procedure for two weeks. You can shower immediately after the procedure (if you wear a leg bag) but no hot baths, hot tub, Jacuzzi, sauna or tanning for 6 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. Bruising may occur the same or following day. In most cases it will be gone after 2 to 4 weeks but could remain longer. You may develop “lumpy” areas in your groin and leg which are tender and part of the normal healing process. Apply a gel pack (part of EVA kit) three times daily and Arnica Gel™ twice per day from day 3 to 5 after the procedure to reduce the bruising. From day 5 to 14 after the procedure, please apply warm compresses to the bruised and lumpy areas. 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 Decrease Pain, Bruising & Persistent Discolouration/Pigmentation:
- A. Please continue to take 5 pellets of Arnica™, 3 times per day, one 500mg Bromelain tablet twice per day for 14 days and one 500 mg Venixxa™ tablet twice daily midday and evening with meals for one month after the procedure in order to reduce pain, swelling and bruising. Also, drink atleast 2 liters of water per day to decrease discolouration/pigmentation at the sites of treatment.
- B. Elevate your leg on a couch or chair and please apply a cold gel pack for 10 minutes at a time three times daily to the bruised and painful areas from day 3 to day 5 after the procedure. Then apply a warm gelpack to the bruised/painful or lumpy areas from day 5 to 14 after the procedure. After each application of the gel pack or warm compress, apply Arnica Gel™ to the bruised areas. 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.
- C. It is essential to try to avoid sun exposure after the procedure. It is mandatory to apply a strong medical grade sunblock SPF 40 to 50 at sites of bruising or discolouration prior to any sun exposure and reapply as necessary.
The Eva Procedure
1. Please arrive AT LEAST 60 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 or 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 at least 60 minutes before your procedure to maximize effectiveness. You will also be given an oral sedative (Ativan) and pain killer (Oxycodone) if you are having a endovenous thermal ablation procedure such as endovenous laser or radiofrequency ablation to minimize discomfort during the procedure.
3. A pre-treatment photograph will be taken to act as a baseline for your medical chart. A repeat mapping venous ultrasound will be performed to ensure no change has occurred since the consult. 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) at the area to be treated to create a sterile field for treatment. 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 ablation device will be placed through the sheath under ultrasound guidance to ensure accurate position and placement.
6. Tumescent anesthetic using a special mechanical pump, will be applied around the vein, to increase the effectiveness of the ablation, and minimize your discomfort (only for endovenous laser or radiofrequency ablation). The ablation device (excluding Varithena treatments) is then activated and pulled back along the vein to be treated. For the safety of patients and staff, we utilize and fully adhere to ablation safety protocols. After the catheter is removed, a small antibiotic dressing is placed on the skin, in order to prevent infection and promote healing.
7. Branch vein sclerotherapy for your enlarged varicose veins will also be performed on the same day as the endovenous ablation using a foam Sotadecrol solution under light or ultrasound guidance. Pigmentation can occur after sclerotherapy in 2-4% of patients. The pigmentation usually resolves in 6-10 weeks with our post treatment protocols.
8. Immediately after the treatment, compression 30-40 mm Hg support stockings will be applied to the treated leg(s). We suggest you walk for five minutes after the procedure, before leaving the clinic to promote deep venous circulation.
Eva Follow-Up Appointment Protocol
WHAT SHOULD I DO BEFORE MY FOLLOW-UP APPOINTMENT?
1. Do not shave your legs or apply cream for one day prior to and on the day of your follow-up appointments. No tanning within two weeks of the treatment date. 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.
WHAT SHOULD I DO AFTER MY SCLEROTHERAPY TREATMENT?
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 decrease Pain, Bruising & Persistent Discolouration/Pigmentation:
- A. Please take 5 pellets of Arnica™, 3 times per day, one 500mg Bromelain tablet twice per day for 11 days and one 500 mg Venixxa™ tablet twice daily, midday and evening with meals for one month after the procedure in order to reduce pain, swelling and bruising. Also, drink atleast 2 liters of water per day to promote healing, reduce bruising and prevent discolouration or pigmentation.
- B. Elevate your leg on a couch or chair and please apply gel pack for 10 minutes at a time three times daily to the bruised and painful areas from day 3 to day 7 after the procedure. Then apply a warm compress to the bruised/painful or lumpy areas from day 7 to 14 after the procedure. After each application of the gel pack or warm compress, apply Arnica Gel™ to the bruised areas.
- C. 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.
- D. It is critical to avoid sun exposure after sclerotherapy. It is mandatory to apply a strong sunblock SPF 40 to 50 at sites of bruising, discolouration or pigmentation if there prior to any sun exposure and reapply as necessary.
3. You can resume normal daily activities excluding exercise following sclerotherapy. You can resume exercising in 2 days. You can shower in the morning but no weight lifting, sit-ups, push-ups, hot baths, hot tub, sauna and jacuzzi for 6 weeks after sclerotherapy.
4. Bruising, local swelling, areas of bumpiness, lumps and some tenderness are normal after treatment, but please feel free to call the office if you have any questions or concerns. If you have pain or leg swelling involving the entire leg or calf, call our office immediately.
5. You will not notice an immediate improvement. Clearance of varicose veins and discolouration usually occurs over a 4-18 week period and in some instances may take longer.
Leg Spider and Small Vein Therapy
Leg Spider & Small Vein Therapy Pre-Procedure
Most varicose veins are not a serious medical issue. However, left untreated, varicose veins can sometimes lead to complications, such as bleeding from varicose veins, blood clots, open sores, and infection, which may arise from skin problems due to fluid buildup. Untreated, varicose veins tend to get worse over time and can lead to serious problems, such as chronic venous insufficiency.
Leg Spider & Small Vein Therapy Post-Procedure
Surface Laser Procedure:
We utilize the Revolutionary Syris 300 T patented subsurface technology, which allows us to see approximately 1 mm below the skin’s surface. This also allows us to have a more complete patient assessment and treatment, with reduced procedure times and improved outcomes.
Through a hand piece that is extremely small and lightweight. The 5 Hertz system allows patients to be treated quickly and efficiently. The laser can be set to pulse or continuous mode. Spot sizes are easily interchangeable and come in 0.5, 1.0 and 1.5 mm sizes. Our D940 Flexipulse Laser has the smallest focal spot available. This allows precise treatment of fine spider vein networks. At The Vein Institute of Toronto™, the sole function of the D940 FlexiPulse Laser™ is the treatment of spider veins. We do not believe in multi-functional lasers, which are not tailored to one specific application. By injuring the veins with the laser first, the vein vasoconstricts and less sclerosant is required. The benefit of the “Double Injury” method over sclerotherapy alone is a quicker resolution and a significant decrease in the risk of staining or bruising. Staining appears as brownish discoloration on the skin.
Although discomfort with surface laser treatments is minimal, we utilize a Zimmer Cryo Cool 6™ air cooling device to increase the patient’s comfort. The Zimmer Cryo Cool 6™ air cooler is designed both for comfort and safety. Cooling the skin during a laser treatment protects the outer layer of the skin (epidermis) from potential damage while making the treatments more comfortable for the patient. Because cooling the skin protects it from damage, the laser power can be increased to more effective levels, making each treatment maximally beneficial and minimizing the number of treatments. We are the first clinic in Canada to utilize a Zimmer Cryo Cool 6™ for surface laser spider vein treatments.
Small Vein Therapy
What Should I Do Before My Treatment?
What Should I Do After My Treatment?
Post-op Compression Stockings
Regardless of procedure to treat your leg spider veins, you will have to wear compression stockings for several hours after the procedure — or overnight, for larger veins. You want the vein wall to scar down and stick so no blood gets into it and the vein is no longer visible.
Book An OHIP Covered
The Vein Institute
217 Davenport Road,
HOURS OF OPERATION
Monday: 9:00 am - 5:00 pm
Tuesday: 9:00 am - 5:00 pm
Wednesday: 7:00 am - 5:00 pm
Thursday: 9:00 am - 5:00 pm