VeinSolutions Specializes in 
Minimally Invasive Treatment of Varicose Veins

By: Paul J. Watkins
Wednesday, May 1, 2013

VeinSolutions, founded in 2003, is a division of Cardiothoracic and Vascular Surgeons, a leading surgical group serving Austin and Central Texas for more than 50 years.

The physicians at VeinSolutions are experienced, specialized surgeons dedicated to treating varicose veins and spider veins in the legs and face using state-of-the-art techniques and technologies. This focus allows them to address cosmetic and therapeutic vein problems with both aesthetic and medical considerations in mind.

Emery W. Dilling, M.D., a board-certified and fellowship-trained cardiothoracic surgeon, says the discomfort that often accompanies varicose veins comes from elevated pressure inside the veins, and if left untreated, the discomfort can become severe and lifestyle-altering.

“When the high pressures in the veins back up into the capillaries, it slows the blood flow down in the capillaries and sometimes causes them to leak, resulting in edema of the lower leg,” he explains. “It can result in poor circulation in lower leg tissues and lead to skin problems, including hyperpigmentation; lipodermatosclerosis, which is scarring of the skin and subcutaneous fat; and ulcerations, which can be severe, large and prone to infection.”

Dr. Dilling adds that, when a patient’s varicose veins have progressed to the point that he or she experiences extreme pain, the patient often seeks help from a primary care physician. This professional usually manages the patient’s varicose vein disease until conservative measures have been exhausted. Only then will the patient be referred to a specialist.

Jeffrey M. Apple, M.D., FACS, board-certified and fellowship-trained vascular surgeon, encourages primary physicians to refer patients with symptomatic varicose veins as soon as the patient presents with pain. These patients, he explains, receive maximum benefit both medically and financially when they are sent immediately to a practice that specializes in treating venous disease.

“It’s better for patients if their primary physicians simply refer them to us after their initial evaluation,” says Dr. Apple. “We can then begin a protocol starting with conservative therapy that meets insurance company requirements, as each insurance company has different inclusion criteria. If conservative therapy fails, patients don’t need to wait an extra six months to undergo a potentially lifestyle-altering procedure to relieve symptoms. Complying with these coverage rules is very complicated, but it’s essential so patients can take full advantage of their coverage, receive the very best care and achieve an optimal outcome.”

Patients are pleased to learn that VeinSolutions contracts with all major insurance carriers, including Medicare, resulting in smaller out-of-pocket expenses for patients and eliminating the need to pay out-of-network costs. VeinSolutions’ insurance coordinator is happy to assist patients by submitting insurance claims.

Minimally Invasive Options

When a combination of conservative therapies no longer provides sufficient symptom relief, Dr. Apple explains, it is time to address the physiology that causes those symptoms. At that point, removing the varicose veins is a medical necessity.

VeinSolutions offers multiple leading-edge options for surgical removal of varicose veins, and all are minimally invasive procedures performed in the comfort and privacy of the surgeons’ offices, using local anesthetic.

“Treatment consists primarily of closure, or ablation, of the saphenous vein, which contains the leaking valves and which is the primary cause of the problem,” says Dr. Dilling. “Ablation can be done using either radiofrequency energy or laser.”

“Reports suggest patients experience less postoperative discomfort with radiofrequency,” adds Dr. Apple. “We’ve been using it for about five years, and we’ve been very happy with the results, as have our patients.”

Ablation is usually followed by phlebectomy, which is removal of the visible varicose veins, or by sclerotherapy, which is injection of a medicine into the varicose veins. This medicine is toxic to varicose veins and damages them enough so they can no longer function. Dr. Apple notes that the vast majority of VeinSolutions’ patients are pleasantly surprised by the ease and comfort of modern varicose vein treatment.

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Sclerotherapy and Spider Veins

Drs. Dilling and Apple are also experts in treating spider veins, and, as with their approach to treating varicose veins, they use only the best techniques and technologies. Dr. Dilling shares an interesting fact: Sclerotherapy, the method first used a century ago to eliminate spider veins, is still considered the best method for eliminating them today.

While spider veins are almost always a cosmetic issue, Dr. Apple says some patients’ spider veins are so thinly covered with skin they experience multiple bleeding episodes.

“In such cases, the treatment of the spider veins is considered medically necessary by insurance companies, and they will pay for it,” he says.

Dr. Apple says some patients are excellent candidates for treatment with the VeinGogh Ohmic Thermolysis System. It eliminates spider veins, as well as fine telangiectasias and small angiomas, on any part of the body.

“It’s a tiny radiofrequency device that we glide over the spider veins,” he says, “and it’s very effective in eliminating them, regardless of the patient’s skin type.”

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What Physicians Should Know

“I want fellow physicians to know that varicose vein patients with symptoms of discomfort or swelling are patients whose varicose vein treatment is medically necessary and, therefore, covered by insurance,” says Dr. Dilling.

“We always deliver what we believe is the best and least invasive treatment for varicose vein patients, with each patient’s functional goal in mind,” assures Dr. Apple. “We want to get them back to their jobs and to the things they love to do — as quickly as possible. Dr. Dilling and I are very experienced in our specialty, very conservative in our treatment planning, and very thoughtful and attentive in the way we care for our patients.”

VeinSolutions is located at 1010 W. 40th St. in Austin. For more information, please call (512) 452-VEIN (8346). Learn more about the practice at For information about Cardiothoracic and Vascular Surgeons, please visit