The Very Latest Varicose Vein Treatments | Happel Laser & Vein Center

The Very Latest Varicose Vein Treatments | Happel Laser & Vein Center

The Three Newest Varicose Vein Treatments

Varicose Vein Technology is Changing Rapidly

Advances in technology in the field of varicose vein care are developing at an astounding rate.

Could it be too fast?

Insurance companies seem to think so.

Which of the following statements is false?

  1. The sun sets in the west.
  2. Summer follows spring.
  3. New technology is always better than old technology.

Teaser: (The answer is at the bottom of the page in the conclusion).

Varicose vein centers have sprung up throughout the country at an exponential rate.

Vein centers have to stay competitive by offering the latest and greatest treatments.

There are minimally invasive and established varicose vein procedures that already work extremely well. They are already covered by insurance companies.

In the rush to offer the latest in vogue device, time-tested procedures are sometimes glossed over.

Some people only want the latest, “sexiest”, and the most high-tech gizmo.

The three latest FDA approved treatments for varicose veins are so new that there are no insurance codes for some of them yet. Some have just been approved.

Insurance codes should be available for all of these latest developments soon.

Insurance companies can still reject paying for them even though codes exist.

Let’s look at these three latest FDA approved vein therapies in more detail.

Varicose Vein Treatment #1  Mechanico-Chemical Ablation (MOCA) or Clarivein

Of the three new vein treatments, this is the “oldest”.

A small industry sponsored study started the ball rolling for this option in 2012. More in depth studies and follow-ups were performed by Bishawi and Boersma in 2013.

This therapy is a combination of a mechanical scraping of a wire that rotates inside the targeted vein at 3500 revolutions while a chemical is injected into the vein. The combination of the mechanical aspect is believed to make the injected medicine more effective.

Advantages of MOCA are that only one injection of numbing medicine or local anesthetic is required to introduce the catheter into the saphenous vein.

In addition, numbing medicine called tumescent anesthesia is not required to surround the targeted saphenous vein like with laser or radiofrequency. It is fast and usually takes about twenty minutes to perform.

Clinical trials have been performed comparing MOCA with older, insurance accepted technologies like radiofrequency ablation. The results are promising.

Recent data from Great Britain in their National Institute for Health and Excellence guidelines supports the use of MOCA as of May 2016. They find that MOCA is a “successful and accepted treatment for varicose veins”.

Stockings are recommended for two weeks after the procedure. There is an insurance code for the procedure. It is not covered by all insurance companies.

Varicose Vein Treatment #2  Varithena Foam

Varithena foam is injected directly into the targeted vein to eliminate that vein. Of the three newest vein treatments, Varithena foam has been studied the longest. Rigorous trials have been ongoing for well over a decade.

Data proving its efficacy has been established. It uses a chemical called polidocanol.

This compound is mixed with a proprietary combination of safe gases to create a foam.

No numbing solution is required around the vein. The injection of the foam using ultrasound guidance takes about ten minutes.

Stockings are recommended for two weeks after the procedure. The failure rate is higher than older laser and radiofrequency technologies but it can often be repeated.

Now. How. It. Works.

That foam is injected into the vein. The vein is sealed. It is eventually absorbed by the body. Theoretically.

The question of whether or not it is more effective than the traditional and much less expensive foam made in the doctor’s office has yet to be answered.

The recurrence rate after the treatment is higher than with present methods of varicose vein treatment. One criticism is that the medicine is not strong enough to completely get rid of varicose veins.

That results in the veins opening up. More treatments are required. That is disappointing. Some doctors are switching to using it for only recurrent varicose veins.

The company that makes this product is also disappointed with its commercial lack of success. BTG Plc, the company that makes Varithena foam, spent a lot of money bringing this product to market. It has not caught on with vein experts like the previous two treatments discussed.

Varicose Vein Treatment #3 Varicose Vein Glue or Venaclose Closure System

Venaseal glue is the very latest craze in the vein world. Like MOCA, only one numbing injection is required to introduce the catheter into the vein.

Medical cyanoacrylate glue is injected into the vein with an instument that looks like a gun similar in appearance to the MOCA device. It takes about twenty minutes to perform.

The glue causes the vein to become irritated. It seals immediately. The irritation can cause an inflammatory process which is felt in about twenty per cent of patients. This requires anti-inflammatory medications like Ibuprofen or Motrin. Usually an antihistamine is also prescribed.

Glue should be thought of as an implantable device. The adhesive can be present for over five to ten years or more after the procedure.

The biggest advantage of the glue procedure is that heavy compression support stockings are not required either before or after the procedure. You can go to the gym and work out the same day!

If you’ve ever had a varicose vein procedure, how awesome is that?

Wearing hot and uncomfortable support stockings is usually the biggest complaint that patients have with any of the other varicose vein treatments.

One world’s most experienced vein specialist with this technique in the United States is Kathleen Gibson MD. She has treated about two hundred patients with this new glue.

Dr. Gibson states that after three months, about half of the patients treated with this glue method will need more vein treatments to clean up the surface veins that you see on the skin. Usually these surface varicose veins will get smaller after the glue procedure but will not disappear.

Currently this treatment is not covered at this time. It costs about $3,500 per saphenous vein treated. An insurance code to bill for this is expected sometime next year.

Long term results are not available at this time since this treatment is so new.


The latest three methods of treating varicose veins were designed and are FDA approved to treat saphenous veins.

The saphenous veins can be viewed by some authorities as the root of the problem. No numbing of the saphenous veins (also called tumescent anesthesia) is required with any of these new vein procedures.

These alternatives look promising.

Usually either injections of the varicose veins on the skin surface called sclerotherapy or a procedure called phlebectomy are required to complete the treatment with all of the three new options.

Can’t have everything.

Many insurance companies state that they are still investigational. Eventually, insurance billing codes will be available for all three of these methods in the next couple of years.

Unfun fact: At the present time, if you want one of these latest treatments, getting insurance approval is often difficult or impossible. With Clarivein, a CPT billing code through the AMA has just been obtained. The billing code will be effective starting January 1, 2017. With Varithena, some insurance companies are covering it if it is being billed under the miscellaneous code.

With these treatments, even though there are fewer injections, they are not needle or injection free. There is no magic wand. They are not pain free as some advertise. That is disingenuous and misleading.

As tantalizing as many of these newest treatments sound, the long-term results still are not yet available. Don’t test the water with both feet.

Until those billing codes are all available and accepted by insurance companies, the traditional near perfect forms of varicose vein treatment work extremely well and are associated with little discomfort.

For more information to find the best treatment for your veins, call us at 724-969-0600 or click here to discover more.

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.