Medical Management

When possible, medical management of vascular disease is utilized to control symptoms and prevent more serious damage. This may include using medications, and encouraging you to lead a healthier lifestyle through smoking cessation, exercise and proper diet. Careful management of patients with high blood pressure and diabetes is also important.

If this type of medical management is not appropriate given your condition, your physician may recommend surgery or endovascular treatment.


For patients whose vascular disease cannot be treated through medical management or endovascular procedures, surgery may be recommended. These procedures include:

Surgical Bypass

During this procedure, a graft constructed using a synthetic tube or one of your veins is surgically attached to the blood vessel above and below the blocked area. Once the blockage has been "bypassed", blood may flow normally.

Most frequently used to resolve blockages in the carotid arteries, an endarterectomy is a procedure during which the plaque inside the affected artery is carefully stripped and removed. This procedure may also include the insertion of an arterial stent or graft to aid blood flow.

Endovascular Therapy

Endovascular therapy has become an important and widely used treatment for vascular disease. At St. Vincent Healthcare, our physicians are committed to enhancing patient safety, comfort and positive outcomes through these innovative and minimally invasive procedures.

The benefits of endovascular therapies are significant. Because only small incisions are made to access the blood vessel, there is less recovery time and fewer complications than with open surgeries. There is also less discomfort to the patient following these procedures, which are frequently performed on an outpatient basis.

St. Vincent Healthcare offers a wide range of endovascular therapies to meet the needs of patients from across Montana, Wyoming and the Dakotas. These include:

  • Aortic aneurysm repair/EVAR stenting
  • Balloon angioplasty - carotid artery
  • Angioplasty - peripheral arteries
  • Arterial stenting
  • Dialysis access

Vein Ablation

Using ultrasound, doctors can detect and evaluate the deeper veins they cannot usually see or feel. The deeper veins are often the source of significant problems and go undetected. During your initial evaluation at our clinic we will conduct an ultrasound scan of the legs to determine the size, location and valve function of the veins. This mapping study will identify any faulty valves causing venous reflux in the legs. Vein Ablation, including Endovenous Laser Ablation, Radiofrequency Ablation and Sclerotherapy, are techniques we use to treat venous disease. Sclerotherapy uses range from treatment of unsightly spider veins for cosmetic reasons to abnormal varicose veins for symptomatic relief.

Endovenous Laser Ablation
EVLT is an ultrasound guided laser therapy to treat venous insufficiency. After using a local anesthetic, the physician inserts a small thin tube (catheter) into the faulty vein. Using ultrasound guidance the small catheter and a laser fiber are placed in the appropriate position in the vein. Targeted laser energy is applied to the vein via the laser fiber to seal the refluxing vein closed. The laser fiber is withdrawn at timed increments and a compression dressing is applied to the leg once the procedure is complete. Venous blood will naturally reroute back to the heart through the healthy veins in the legs. Symptoms typically resolve once the diseased veins are closed off. Laser ablation is minimally invasive, does not require general anesthesia, and can be performed as an outpatient procedure in about an hour. EVLT is effective and has an outstanding long-term success rate ranging from 93-98%. EVLT patients enjoy relief of symptoms and quick return to routine activities. Treatments are less expensive in most centers than surgical vein stripping and ligation and are commonly covered by most insurance plans.

Radiofrequency Ablation
This technique uses radiofrequency energy (instead of laser energy) to heat up the wall inside a varicose vein. Radiofrequency energy is directed through a thin tube (catheter) inserted through a small incision in the vein. It is used on large veins in the leg and can be done using local anesthesia or a mild sedative. Similar to EVLT, the vein is closed as a result of the procedure and the patient promptly has diversion of the venous blood back to the heart via the veins with competent valves. Patients enjoy relief of symptoms and quick return to routine activities. This procedure is done outpatient in our clinic.

Ultrasound Guided Foam Sclerotherapy
Ultrasound guided foam sclerotherapy is done in our office and does not require any anesthesia. During the procedure, your provider injects a foam solution under ultrasound guidance. The medication will irritate the lining of the vein causing inflammation and scarring from the inside out. Ideally, the vein will close, and be resorbed. Venous blood flow is then diverted to veins with competent valves to return to the heart. Maintaining prolonged pressure on the vein after the procedure further enhances the success of the procedure. This is achieved by wearing compression stockings or wraps for two weeks after the procedure. Patients report minimal discomfort or pain and in most cases are able to return to their normal activities the same day.

Cosmetic Sclerotherapy
We offer cosmetic sclerotherapy for treatment of spider veins and reticular veins. Patients are screened for symptomatic venous disease prior to pursuing cosmetic treatment. We offer sclerotherapy injections using Asclera (polidocanol) in a comfortable spa environment. All procedures are performed by a provider from our Vascular Surgery team. It may take several treatments, and patients must wear compression hose for 2-3 weeks after a procedure to achieve desired results. Patients can resume most normal activities after the procedure.