What are varicose veins?
Varicose veins are enlarged, weakened, dilated veins that have permanently lost their ability to carry blood from the legs back up to the heart against the force of gravity. As the blood falls back down the leg and pools due to gravity, the veins overfill giving them their typical unsightly bulging appearance. Varicose veins cause tired, heavy, aching, throbbing, swollen legs which are typically worse at the end of the day. Night time leg cramps and leg restlessness (sometimes called Restless Leg Syndrome) are also very common problems caused by varicose veins. Treatment of the diseased veins will eliminate these symptoms. If left untreated, varicose veins always worsen over time, and may lead to the formation of blood clots (thrombosis), inflammation of the vein (phlebitis) and inflammation of the skin (dermatitis), and finally ulceration.
What causes varicose veins?
Heredity is the number one contributing factor causing varicose veins. A genetic tendency causes veins to weaken and wear out over time. The greater this genetic tendency the sooner it will happen. So regardless of treatment, if you have a strong hereditary predisposition, you will probably form new problems as time goes on. Other contributing factors include pregnancy, obesity, hormone-containing medications, standing for long periods, and traumatic injury to the leg. In most cases, nothing can be done to prevent veins from wearing out, but if effective treatment is given early in the course of the disease, complications like phlebitis, blood clots and ulcerations can be prevented and symptoms relieved.
How are varicose veins treated?
Discussed below are several methods of treating varicose veins. The procedure or combination of procedures is based upon the extent of your specific condition and your overall health and age. The doctor will recommend an ultrasound examination to assess the severity and extent of your vein disease, most of which may not be visible on the surface of the leg. Without an accurate ultrasound map of your veins we cannot determine the source of your problem or treat it effectively.
The most conservative way to manage varicose vein disease is wearing prescription-strength compression stockings. Compression stockings help alleviate the swelling and pain caused by varicose veins. These stockings will also help heal any skin inflammation or ulcerations which have developed. However, there has never been any evidence to show that compression stockings prevent the formation of varicose veins. Since the diseased veins that are causing the symptoms are not being eliminated, the compression stockings have to be worn indefinitely. Some insurance companies are now requiring patients to wear prescription strength compression stockings for 3-6 months before they will consider reimbursement for treatment.
Sclerotherapy and ultrasound guided sclerotherapy
Sclerotherapy is ideal for treating small to medium size varicose veins. It involves the injection of a solution into diseased veins with the intent to create scar tissue inside the vein that will seal it closed. The veins then shrink and gradually disappear. The solution used is extremely safe and relatively painless. Anesthesia and sedation are not needed. For deeper varicosities ultrasound is often used to “guide” the injections into the underlying diseased veins below the surface of the skin. This allows the medication to be administered to precise locations safely and accurately. Sclerotherapy is often done during post operative visits to eliminate any diseased veins that were too small or too deep to remove during surgery. Thus, surgery and sclerotherapy are often complementary, ensuring that all the diseased veins are eliminated with treatment.
Ambulatory Phlebectomy or “hook” phlebectomy is a micro-extraction procedure used to remove varicose veins, both large and small, which are close to the surface through very small micro-incisions. The micro-incisions are so small that they are closed with sterile tape and not stitches. Once healed they are rarely visible. Bruising will occur and will take a few weeks to go away. A compression bandage is worn for only 3 or 4 days. When removed patients are amazed how good their legs look with the “ropey” veins gone. Then a compression stocking is worn for another week. Patients can return to normal daily activities including work the next day and walking is encouraged.
Vein ligation is a minor surgical procedure where a large varicose vein is tied off through a small incision. This is necessary when veins are not working properly and the blood in them is leaking (refluxing) back down the leg. These incompetent veins are the source of most of the visible varicose veins seen on the surface of the leg. These refluxing larger veins must be separated or disconnected from the rest of the healthy venous system. Ligation is performed in combination with ambulatory phlebectomy and/or sclerotherapy which eliminates the source and surface diseased veins.
Endovenous laser treatment (EVLT)
The endovenous laser treatment is performed right in the office. Under local anesthesia, a thin laser fiber is inserted into the vein through a tiny incision. The laser delivers laser energy (heat) to the vein wall, causing it to heat, collapse, and seal shut. Most patients return to work and near normal daily activities the very next day. The laser is used to treat large diseased veins inside the leg which are often the cause of unsightly varicose and spider veins on the surface. In some cases, other treatments including sclerotherapy, ultrasound-guided sclerotherapy, ambulatory phlebectomy or ligation are used in combination with endovenous laser treatment to achieve the best possible results. For more information visit www.evlt.com.