Treatment of Varicose Veins

What are Varicose Veins?Legs

Varicose veins are abnormal veins generally appearing as twisting, bulging, rope-like cords on the legs anywhere from the groin to the ankle. Spider veins are the smaller, flatter, red or purple veins closer to the skin surface.

Varicose veins affect 40% of women and 25% of men. There are a number of factors which lead to varicose veins including; heredity (if your parents or grandparents had varicose veins, then you are at increased risk), gender (women have a higher incidence than men), pregnancy (increased blood volume and hormonal effects), age (as we age, the vein walls loose their elasticity), prolonged standing (increased pressure on the lower limbs due to gravity), obesity (increased weight increases abdominal pressure which reduces venous flow from the legs), trauma and hormone levels.

Can Varicose Veins Be Prevented?

There are usually several underlying factors contributing to the formation of varicose veins usually making a cure unlikely. However, certain measures can be performed to relieve the symptoms from existing varicose veins. These include regular exercise which strengthens the legs and improves circulation, avoid standing for long periods of time, elevate the legs, control your weight, and avoid clothing which restricts blood flow from the legs.

What Are The Symptoms?

In addition to the visible, knotted, purple veins, many patients complain of pain, heaviness in the calves, leg swelling, tenderness, leg tiredness. Additional symptoms would include blood clots, inflammation, ankle sores, skin ulcers and bleeding.

How Are Varicose Veins Treated?

Conservative techniques are tried first and then more aggressive therapy is pursued if these fail. Conservative management includes the use of high pressure stockings as well as changes in lifestyle including weight loss, avoiding long periods of standing, elevation of legs.

Once the conservative measures have been exhausted, more invasive measures can be pursued including laser ablation of the saphenous vein and sclerotherapy of the smaller spider veins. Usually, a trial of conservative therapy is initiated for at least six months. If this fails, then other options are available.

For laser ablation, the patient is admitted in the morning to the outpatient holding area of the radiology department of the hospital. Routine labs are checked. The patient changes into a hospital gown and is taken to the Vascular and Interventional Radiology Suite and the appropriate leg is prepped using sterile technique. Lidocaine is used for local anesthesia and ultrasound facilitates advancing the laser fiber from the level of the knee into the Great Saphenous Vein to the saphenofemoral junction. The laser is used to ablate the vein which usually takes only a few minutes. Upon completion of the procedure, the patient is allowed to go home after placing a special high pressure stocking on the appropriate leg. Only a small skin nick is made to place the laser in the vein. This is usually treated with a band aid.

Sclerotherapy is performed in a similar fashion except that the abnormal veins are injected with an FDA approved sclerosing agent. More invasive measures include surgical microphlebectomy and surgical stripping.

Are There Any Complications Associated With Treatment Of Varicose Veins?

Complications, while very rare, do happen. These would include bruising, bleeding, nerve injury, pulmonary embolism, stroke, death, infection among others.

What Happens After The Procedure?

After the procedure, a band-aid is placed over the puncture site and a high pressure stocking is placed on the appropriate leg. The patient returns to the observation floor for a brief period and then the patient usually goes home the same day. The patient will return in two days to have an ultrasound to show persistent occlusion of the saphenous vein. STOCKINS MUST BE WORN DURING THE DAY AND CAN BE REMOVED AT BED TIME. After one month, the stockings only need to be worn in the daytime. Sclerotherapy and phlebectomy can be considered depending on the original outcome with the laser.