Available Vein Treatments at the Cascade Vein Center:

Almost all procedures are done on-site, at the Cascade Vein Center. All procedures are completed using local anesthetic and oral sedation as indicated. Most procedures require patients to wear compression stockings for a limited time and these are fitted and applied on-site.

Venous Duplex-

A dedicated vascular technician can evaluate your superficial and deep venous system using ultrasound techniques. This allows accurate evaluation of your venous anatomy and identifies abnormalities such as dysfunctional venous valves that allow excessive blood back down the leg when you are upright. Mapping out your specific anatomy allows a customized approach to your treatment. Reflux is a major cause of symptoms, chronic skin changes, and even open non-healing ulcers. The venous ultrasound is often used for guidance while completing the procedures outlined below.

Mult-layered Medical Compression Therapy/UNNA Boot Application-

Therapeutic compression dressings can be applied as definitive conservative management or as part of a comprehensive treatment of chronic skin changes and ulcers.


Unsightly visible “spider” veins or symptomatic ropey varicose veins are injected with a sclerosing or scarring medical solution to cause the veins to close. These treated veins no longer have blood flowing through them and instead flow is directed more efficiently into the normal venous system.

photo of hikers legs


Larger clusters and longer visible and palpable varicose veins are completely removed using minimally invasive techniques. Tiny stab incisions allow a small vein crochet hook to catch, pull out, and remove these veins permanently. The incisions are so small usually butterfly strips are all that is need for closure.

Radiofrequency Ablation-

This minimally invasive technique treats larger superficial varicose veins with significant valve dysfunction and venous reflux. This reflux can cause daily disability, and over time, discoloration, hardening of the shin and ankle tissue, bleeding and non-healing ulcers. A special catheter is inserted through a tiny needle stick into one of these larger symptomatic veins and creates heat against the inner vein wall, essentially melding the vein closed. This allows venous blood flow to be redirected into a more efficient system and can definitively eliminate symptoms and heal ulcers.

Vein Ligation/ Stripping-

Larger incisions are opened to suture closed veins or to strip or pull large superficial veins completely out. There is a significantly more pain and recovery longer. These classic procedures are now reserved for patients with massively dilated veins requiring hospitalization, very superficial veins in order to prevent skin discoloration, and if required by a patient’s insurance coverage.

General/Thoracic/Vascular Surgery Services-

Dr.Mirande is a Board Certified General Surgeon providing a wide variety of other services including:


Laparoscopy-Gallbladder, appendix, colon, spleen, adrenal gland, adhesions, etc

Endoscopy-Esophagus, stomach, colon, etc


Hernia Repair-groin, umbilical, incisional, etc

Skin Cancer/Melanoma excision

Breast- biopsies, cancer removal, implant removal

Abdominal/Pelvic cancer removal

Lipoma/tissue mass excisions


Thoracoscopy- scope the chest, take biopsies, remove lesions

Thoracotomy-remove lung masses/cancers

Mediastinoscopy-remove lymph nodes

Drain effusions/chest fluid


Open or bypass diseased extremity arteries

Treat varicose veins and ulcers

Place and remove central catheters and Portacatheters