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What Are Varicose Veins?
Veins are small rubbery tubes that carry blood from your body back to your heart for fresh oxygen. When veins balloon out and become visible, they are called varicose. They range in size from small threadlike or spider veins to very large and painful bulging ropey veins.

Why Do I Have Them?
With rare exception, varicose veins, including spider veins, are caused by a weakness in the vein wall that allows the vein to dilate or balloon out. Increased pressure from a seen or unseen feeder vein will worsen the problem. For most people, this is an inherited problem, meaning that most varicose veins cannot be caused or prevented. Spider veins are often related to estrogen, and in susceptible women, will appear and worsen during the reproductive years. Pregnancy, weight gain and prolonged standing can also make large varicose veins worse. Sitting with your legs crossed will not cause spider or any other varicose veins.

Should They Be Treated?
By their nature, nearly all varicose veins will enlarge over time. Small spider veins start as a minor cosmetic problem, but many will worsen over time, slowly expanding, causing discomfort and possible bleeding. Large veins will also increase in size and can cause pain, heaviness, aching, swelling and sometimes dangerous blood clots. Skin changes can occur, beginning with brownish discoloration, leading to ulceration, bleeding and recurrent infections. Consider getting your veins fixed while most diagnostic testing and treatment options are still covered by insurance.

Do I Need These Veins?
For spider veins, the body has many alternative channels to provide needed circulation. For larger veins, Dr. Mueller relies on advanced ultrasound imaging to identify the malfunctioning veins that cause the problem and also confirm that other deep veins are available and adequate to take over the circulation function. Only the abnormal veins are removed. With his extensive experience in vascular and cardiac surgery, Dr. Mueller insures that all normal veins are preserved for possible future use in bypass surgery.

What Treatments Are Available?
Until recently, the only curative treatment for large varicose veins was surgical stripping; a painful and disfiguring process. This procedure could leave large scars with many possible complications and required at least a three week recovery period. Many large varicose veins can now be eliminated or significantly improved through the VNUS Closure procedure. This method simply seals the deep feeder vein with heat through radiofrequency ablation. Dr. Mueller also has considerable experience with lasers, but feels that the VNUS procedure is currently the best available technology. Spider veins are treated with injection sclerotherapy. Visible ropey veins are removed through miniature incisions that heal rapidly through a procedure called phlebectomy, although some will disappear by sealing only the feeder vein. Dr. Mueller still performs surgical stripping when it is the best option. Modern vascular surgery techniques offer less pain, faster recovery time and minimal scarring.

An ulcer is an open, non-healing sore that slowly worsens over time and usually results from a minor injury or infection but in many cases, an ulcer may start from no apparent cause. Most ulcers on the feet or toes will not heal because of either diabetes or lack of blood flow from blocked arteries. Ulcers located on the lower leg or ankles are typically caused by bad veins inside the leg. Usually, the skin will slowly turn into a dark brown color because of red blood cells being pushed out of circulation, which causes the skin to break down. As long as the bad veins remain, healing is prevented. Leg ulcers can also be caused by rare conditions like bone infection and skin cancer. With these special circumstances, a patient needs to contact a specialist for diagnosis and treatment.

Common treatment options require many months of healing with ineffective results. Many methods do not correct malfunctioning veins, which results in the frequent occurrence of ulcers reappearing. But with Dr. Mueller’s extensive experience as a Registered Vascular Technologist and vascular surgeon, he has the ability to eliminate problematic veins through high-resolution ultrasound scanning and minimally-invasive vascular surgery techniques. Ulcers treated require only weeks of healing compared to traditional treatment options that require months. Along with faster recovery, the treatment options provided at Garden State Vein Care offer optimal results with minimal pain

Treatment Options:

Dr. Mueller's initial evaluation includes a history, physical, photos and an ultrasound exam that will be scheduled if necessary. He will then develop an individual treatment plan that considers the severity of your problem, your overall health, insurance issues and personal expectations. The goal is to treat the varicosities in the most efficient and simplest way, causing the least pain and scarring and providing the quickest recovery time. Many treatments are performed in the office and take less than an hour. More complex procedures might require a several hour stay at the Amdur Ambulatory Center at Jersey Shore University Medical Center.

If you have any questions, concerns, or would like to schedule an appointment please contact us.

Sclerotherapy is one of several techniques available to treat varicose veins. This form of treatment is usually reserved by Dr. Mueller for spider veins that are too small to be removed surgically. Medicine is injected directly into the vein, damaging the inner lining and eventually causing the vein to seal. View Dr. Mueller’s video for more information.

The Procedure
Dr. Mueller threads the spider veins under magnification with the smallest surgical needle available and injects a medicine that will damage the inner lining of the vein causing it to eventually scar shut. The treated veins are examined at two weeks and again at two months, and reinjected as necessary during these follow up visits. The veins usually then slowly fade over several months, although some will disappear immediately. This approach keeps scarring and damage to surrounding tissues to a minimum and allows the best possible cosmetic result with minimal or no pain.

With the injection, a small amount of discomfort may be felt that will subside in a moment or two. Initially, the treated veins may look worse before they look better, and the healing process may take several months to complete. The initial treatment session is usually 20 - 30 minutes, with follow up sessions lasting 5 - 10 minutes. Large and more complex spider veins may require additional treatments for optimal results. Perfect cosmetic results are sometimes possible, but significant improvement is a more realistic goal for larger complex spider veins. Once fully treated, spider veins will not recur, but there is a possibility that new ones can appear in different places. Most patients are pleasantly surprised at the major improvement seen after a single treatment and touch up.

Since sclerotherapy involves destroying unwanted tissue, complications cannot be completely avoided. Allergic reactions, brownish skin discoloration, skin ulceration, bluish matting and treatment failures can occur. From Dr. Mueller's personal experience with treating thousands of spider veins, these problems have never been seen or rarely encountered.

Phlebectomy (phlebo = vein, ectomy = removal) is a surgical procedure that refers to complete removal of a visible varicose vein through a series of miniature incisions. Having removed thousands of veins with his personal version of this technique, Dr. Mueller is convinced that this procedure leads to quicker healing, less pain and a better cosmetic result than other techniques commonly used by other vein specialists. Most of the results seen in the photo gallery were obtained, at least in part, by phlebectomy. Although sealing unseen feeder veins will cause the visible varicose veins to shrink, by adding a phlebectomy, the veins will immediately be gone forever.

The Procedure
The vein to be removed is first studied with ultrasound so that any feeding source can be treated, either as a staged procedure or at the same time. The visible vein is outlined with a skin marker, using ultrasound and special lighting techniques to carefully mark deeper parts of the vein that will also be removed. The vein is then freed from the skin and fat through a series of 1/8" cuts and removed with a surgical instrument resembling a tiny sharp crochet hook. The cuts are then closed usually with small surgical tapes only. Depending on the size and length of the vein to be removed, this procedure is done either in the office with local anesthesia or at Jersey Shore University Medical Center's outpatient surgery center. This procedure is possible because even the largest varicose veins, when the blood is milked out, will collapse like a deflated balloon and can be slid out through the tiny cuts. The entire procedure is done under magnification.

Pain Management
Surprisingly, there is little pain during and after the procedure. A tugging sensation may be felt when the vein is actually removed. Most patients report little pain during healing, and the minor discomfort is usually relieved with ibuprofen. All patients are offered stronger prescription pain medicine to use if necessary.

Most of the healing process is completed in two to three weeks, although the final cosmetic appearance, like any surgical procedure, may take several months. Most patients experience immediate improvement in their preoperative symptoms and appearance of the leg, since the troublesome vein is now gone forever.

Phlebectomy is a surgical procedure, and with any surgical procedure, risks include bleeding, infection, swelling, allergic reactions to local anesthetics, discoloration and numbness. In Dr. Mueller's personal experience, these occurrences are quite rare and usually temporary or have never been seen. The treated veins will not recur but this or any other procedure cannot completely prevent development of new varicose veins from new sources.

Endo (inside) venous (vein) ablation (destruction) is a newer technique that replaces the surgical stripping of a nonvisible feeder vein. The vein's inner lining is treated with heat that causes the vein to clot and then seal shut. With its feeder vein gone, the surface varicose veins will then shrink and sometimes even disappear.

The Procedure
Controlled heat is delivered to the inner vein wall by direct contact with a 3" long miniature heating coil. This coil is mounted on the end of a thin plastic tube that slid into the vein through a tiny incision. The precise location is confirmed by ultrasound, and the vein is numbed with a local anesthetic. Radiofrequency energy provides the heat source. This type of ablation is called the VNUS Closure procedure, named after the manufacturer of the system. A laser can also be used as the heat source, but Dr. Mueller feels that the current VNUS system has more advantages.

Following the procedure, mild discomfort in the area of the treated vein can occur, but significant pain is quite unusual. Patients sometimes report a pulling like sensation in their inner thigh for a short time. Prescription pain medicine is prescribed, but for most patients, ibuprofen is all that is necessary. Dr. Mueller checks the treated vein with ultrasound in a few days and again in a few weeks. Many patients return to work in a day or two, but all should refrain from running or vigorous activity for three weeks. A support hose is worn during the day for two weeks, and daily walking for twenty to thirty minutes is recommended. The varicose veins will begin shrinking immediately and will continue to improve for several months. Varicose veins not originating from the sealed feeder vein will need to be treated with other techniques.

Endovenous ablation is an invasive destructive procedure, and like all surgical procedures, carries a risk of bleeding, infection, allergic reactions to medicines, abnormal blood clots and damage to neighboring tissue. Although these risks have been reported, in Dr. Mueller's extensive personal experience, they are quite rare or have never been seen.

Ligation and stripping of the saphenous vein has been the surgical treatment standard for many years mostly because it was the only treatment available that offered a possibility of a cure. The saphenous vein was pulled out through an incision in the groin and at the ankle.

Why does ligation and stripping have a bad reputation?
This operation was designed before the invention of ultrasound, and wrongly assumed that all varicose veins came from one deep feeder vein, the saphenous vein. Without preoperative ultrasound mapping, large incisions were sometimes necessary to find the vein, which was then removed in its entirety rather than only the abnormal section. The visible varicose veins were then removed through cuts an inch or longer. The consequences were disfiguring with sometimes painful scars and recurrent varicose veins as other feeding sources were never identified and eliminated. These results were quite frustrating both for patients and surgeons, and the bad reputation was well deserved.

Why does Dr. Mueller still perform ligation and stripping?
Saphenous veins that are significantly enlarged, located close to the skin or have an unusual anatomic course may be better treated with surgical removal than endovenous ablation. All of Dr. Mueller's treatment recommendations are individualized to provide all patients with the best possible result with the least pain and quickest recovery.

How is Dr. Mueller's technique different and improved?
By employing preoperative colorflow ultrasound testing and mapping, only the abnormal parts of the saphenous vein are removed. The incisions are kept much smaller as the ultrasound allows Dr. Mueller to make skin markings directly over the targeted veins. Dr. Mueller will combine ligation and stripping with removal of all larger visible varicose veins with refined phlebectomy techniques and, at the same time, will identify and eliminate all other significant feeder veins.

Before and After photos

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