Varicose Veins Surgery – Witchcraft or Art? – Toil and Trouble

Varicose Veins Surgery – Witchcraft or Art? – Toil and Trouble

Double, double toil and trouble; Fire burn and cauldron bubble.

This is the well-known incantation from Shakespeare’s Macbeth. It is the line spoken by the three witches in Shakespeare’s Macbeth (Act IV, Scene I)

Witches, spirits, demons, the black arts and even unwanted veins can transcend people’s understanding.

Many people subconsciously consider laser varicose veins surgery in the same category as those black arts when varicose vein surgery is discussed.

Laser treatments of varicose veins are often thought by many to be some sort of a magic wand used to conjure up a spell or something mystical.

This article pays tribute to the Bard of Avon with some references to varicose vein surgery that he could never fathom in his wildest Midsummer Night’s Dream.

To Be or Not To Be 

If you suffer from the pain and ache of varicose veins, you wish that your veins not to be.

So why choose laser to get rid of your unwanted veins?

In the medical field, a laser generates heat. The heat can be used to cut or burn tissue.

For treating varicose veins, the burning mode is used.

A laser fiber is inserted inside your saphenous vein under local anesthesia. After the vein is numb, the laser is turned on. As the laser fiber is slowly withdrawn, the inside of the vein is burned or coagulated. That closes the vein shut.

It is subsequently absorbed by your body. The deep veins, which are already present, take over very easily. Your circulation is improved. Almost like the black magic and miracles that Shakespeare envisioned in Macbeth.

Compared to the old stripping operation, where that vein is ripped out while you are asleep in the hospital, it is a great advance.

What are Realistic Expectations? 

Stop hoping that the Laser is a Magic Wand.

Harry Potter doesn’t exist. His magic wand doesn’t exist. So how does laser really work?

The laser fiber heats the vein to 1500 degrees centigrade. That is really hot.

After a laser treatment, the vein becomes inflamed. The surrounding tissues are protected by a tube of fluid that is injected around the vein just before the laser is fired.

Sometimes the remaining surface veins are then treated with either injections of medicine called sclerotherapy.

In other cases, when the vein are very large they are removed through needle hole punctures. That is called ambulatory phlebectomy.

How is Ambulatory Phlebectomy Used in Varicose Veins Surgery?

Ambulatory phlebectomy (or phlebectomy for short) can be performed under local anesthesia either at the same time as laser or as a staged procedure.

Laser alone is usually not good enough for most varicose veins to provide a long lasting result.

Special surgical hooks are then used to extract the diseased surface veins.

Local anesthesia is all that is required. The needle-hole mini incisions result in no visible scarring.

A Man Can Die but Once. (Henry IV, Part 2)

However, what about your varicose veins? After we kill them, can they come back?

In other words, are varicose vein treatments curative?

Most honest vein specialists will tell you that the treatment of varicose veins is palliative. That means that eventually you will probably make new varicose veins since the cause is genetic. New abnormal veins often occur.

However, if experienced doctors treat all of your abnormal veins with the latest methods, your varicose veins will stay away longer.

Phlebectomy vs. Stripping – What is the Difference?

Many patients come to me with multiple scars on their legs from vein procedures that were performed elsewhere years ago. They believe that they had the stripping procedure done.

After I look at their leg with an ultrasound, I see that the saphenous vein is still intact. The previous doctor only removed the branch veins on the skin surface and left the root called the saphenous vein.

The laser is the modern standard of care to get rid of the saphenous vein.

Lately, non-thermal methods are being developed to treat saphenous vein disease.

The current problem is that there are no insurance codes available at this time to submit for these alternative procedures in order to get insurance coverage for varicose veins. It usually takes about three years for these codes for varicose vein surgery to be approved.

When that happens, even if these insurance codes are available, some insurance companies will still not cover them.

Insurance company approval for the treatment of varicose veins is in disarray. Years from now, it will be more expensive and difficult to get any insurance company to cover varicose veins at all.

If You Prick Us, Do We Not Bleed? (The Merchant of Venice)

Neglected varicose veins can bleed. Bleeding from varicose veins can be massive. It has even been reported to lead to death in a few cases.

In fact, neglected varicose veins sometimes first present with bleeding instead of aching, heaviness and tiredness.

Why wait until your enlarged bulging varicose veins inevitably enlarge and cause more problems? They will not go away. Varicose veins will definitely get larger over time.

Modern minimally invasive techniques can keep you free of veins for many years and prevent them from causing you to suffer later on in life.


Although the laser is not a magic wand, it comes close in some respects when you compare it to the stripping operation for varicose veins.

With laser, there is less toil for the doctor and less trouble for the patient. Prevent the double, double toil and trouble down the road.

Laser varicose veins surgery is a great technological advance. Laser varicose veins surgery is a great technological advance.

What light through yonder window breaks? (Romeo and Juliet)

Perhaps it is a laser’s light? A fantastic window of opportunity awaits you at our accredited vein center if you suffer from large, ropey varicose veins.

Finally, to carry this play on words to its ultimate conclusion, “Friends, Romans and countrymen and countrywomen, lend us your veins. (Happel Laser & Vein Center speaking through Julius Caesar with poetic license).

Find out if you are a candidate for the latest varicose vein surgery using laser. Call us at 724-969-0600 or contact us here.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.