DAKOTA DUNES, S.D. - Dr. Ronald Kolegraff recalled the good old days as general surgeon, when he would perform varicose vein removal.

"The treatment of the disease was often worse than the disease," quipped the board certified phlebologist at the Hogue Vein Institute.

But with the advent of lasers comes a new treatment that is done under local anesthesia and has the patient walking immediately after the procedure.

Varicose veins are veins that no longer function correctly. The enlarged veins may or may not bulge above the skin's surface. They are most commonly found on the backs of the calves or on the inside of the leg and are more prevalent among women than men.

Varicose veins are formed because veins have valves that act as one-way flaps. These valves stop blood from flowing backward as it moves up the legs. If a one-way valve becomes weak, blood can leak back down the leg, going the wrong direction in the vein. The blood slows down and puts increased pressure on the vein, causing the vein to enlarge and it becomes incompetent.

Often the veins don't bulge, but still can cause serious problems, Kolegraff cautioned.

"If bulging doesn't happen, there are other symptoms to look for," he said. "The vein area will itch or hurt or ache. Some times there are ‘rings' around the tops of where your socks hit that may indicate swelling from varicose veins. Varicose veins can even cause restless leg syndrome or ‘ulcers' on your legs that just won't heal."

There's misconceptions related to varicose veins, explained medical director of LazaDerm Skincare Centre, Dr. Lornell Hansen, who is in the process of being board certified as a vein specialist with the Hogue Vein Institute.

"People think they got varicose veins because they've been sitting too long or they've had a leg injury, but it is largely passed down from their parents," he said. "They're also not aware that leg fatigue is often a symptom of varicose veins as is generalized leg aching, even without bulging veins."

For years the standard operating procedure to treat varicose veins was to make up to 40 cuts in the leg, explained Kolegraff.

"Then, the veins were cut out while the patient was under general anesthesia for over four hours," he said. "The risk of complications from anesthesia for that long appears to be about 1,000 times higher than doing the procedure under local anesthesia as we do now."

Laser technology to treat the varicose veins became available in its present form in 2003, Kolegraff said.

"But it took a while to be perfected in those early days," he qualified. "So, it wasn't until 2006 that it was readily available worldwide and incredibly successful. Since then, there's been one person in six million who had this procedure done worldwide who has died."

Endovenous Laser Ablation is a minimally invasive method for treating varicose veins, under a local anesthesia, using laser energy to shrink and collapse the vein.

To diagnose varicose veins, the doctor will first perform an ultrasound, Hansen said.

"Again, a lot of times the veins don't bulge, so an ultrasound is critical to the diagnosis," he said. "We will do a free ultrasound screening because we know people don't want to spend hundreds of dollars to find out they don't have varicose veins. It could be something else, like fibromyalgia or back trouble."

"We make an incision, which is literally the size of a needle poke and run the laser into the vein," Kolegraff noted. "The laser ‘cooks' the vein from within. Then we have the patient walk on the treadmill to start the circulation up."

But where is the blood going if there's no more vein?

"Blood will travel into the deep veins of the legs, which are actually better than the veins that are not working correctly," Kolegraff explained. "The deep veins don't stretch out like the superficial veins which are responsible for varicose veins."

Although women in their golden years seem to suffer from this malady, Kolegraff's youngest varicose vein patient was 16 years old and his oldest was 92.

"The 92-year-old woman was told she needed to have her leg amputated because the ulcers hadn't healed for four years," he recalled. "We did the procedure and her ulcer started to heal within two weeks."

Physicians with the Hogue Vein Institute have done more than 8,000 procedures. Dr. Carl Dando is also a member of the Hogue Vein Institute South Dakota Team. Kolegraff has taken the news of the laser treatment on the road to county fairs and service groups and mailed information out to physicians.

"There's nothing more satisfying for me as a physician to help someone like this," he insisted. "For traditional varicose vein surgery, a person couldn't work for two to three weeks afterwards. Now, the patient is wide awake while it's going on. We have them walking on a treadmill right after the procedure and they can return to work the same day if they want to. The improvements begin immediately."

The Hogue Vein Institute is located at 383 W. Steamboat Drive. Call (605) 232-3737 or visit or hogueveininstitute.com for more information.