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several sessions for best results, says Dr. Smeglin. While laser and radiofrequency are the most common types of venous ablation, newer techniques use chemical or mechanical energy. One of the latest techniques uses a special catheter that scrapes the inside of the vein while dispersing a sclerosing agent to close the dis- eased vessel, says Steve Elias, MD, FACS, director of the Center for Vein Disease and the Wound Care Center at Englewood (N.J.) Hospital and Medical Center. Patients like that it's relatively painless, since tumescent anesthesia is not needed, but insurers have been slow to embrace it. A laser or radiofrequency ablation system costs $30,000 to $40,000, although leasing is an option, experts say. You can also purchase cus- tomizable kits with the supplies needed for each case, like gowns, needles, ultrasound gel and tubing. Depending on the type of ablation, per-case supply costs can range from $200 to more than $600, says Dr. Smeglin. Find a quality tumescent infusion pump that features rapid administration of anesthesia, he adds, and shop for the best prices for tumescent infusion lines and compression stockings. Another choice for office-based settings is sclerotherapy, which is usually performed for cosmetic reasons and not covered by insurance. Dr. Smeglin says the procedure involves using tuberculin needles to inject a sclerosing agent into the diseased vein, irritating it and causing it to close down and be absorbed by the body. Using tuberculin needles means the procedure is relatively painless and doesn't require local anesthesia. To further reduce discomfort, he uses polidocanol or sodi- um tetradecyl sulfate injections, which are more effective, "burn" less and have superior results over their cheaper alternative, hypertonic saline. Whatever the treatment, a quality duplex ultrasound, which combines traditional ultrasound with Doppler ultrasound, is essential. Most machines cost $40,000 to $100,000. "Ultrasound is used for diagnosis, during the procedure and afterwards to make sure everything's okay," 8 6 O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | February 2015