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Fifty percent of the adult population of the United States has some abnormality related to the venous system. These can be large and painful varicose veins or smaller spider veins. Both men and women are affected, with a higher incidence in women. Heredity remains the primary cause of venous disease. Pregnancy, obesity, hormonal influences, and environmental factors - such as prolonged sitting or standing - all can also contribute to the development and progression of vein disease.
All veins have valves. A valve is a check system. The valve keeps blood flowing in the right direction. If the valve is abnormal then blood can reverse its flow. This leads to higher pressure in the vein and gradual enlargement. This is the cause of varicose veins. The longer the process continues, the larger the vein becomes and the symptoms can increase.
Over time the increased pressure can lead to significant symptoms such as: swelling of the ankles or legs, severe pain and aching, and complaints of tired legs. Long-standing varicose vein problems can cause more serious problems such as: skin changes, ulceration, phlebitis (inflammation of the vein), and possible clot formation.
Many times the veins visible on the skin’s surface are the result of failure of a vein that lies deeper in the leg. The most common source is failure of the valves within the saphenous vein, either the greater or short, which places increased pressure on leg veins. Non-invasive ultrasound testing will determine where the problem lies. Your physician will be able to design an individualized treatment plan for you with this information.
Treatment
Endovenous Laser Ablation of Saphenous Vein / Radiofrequency
Since 2001, the treatment for varicose veins has dramatically changed. Instead of old-fashioned vein stripping, new techniques allow for a virtually painless correction of the problem. Heat energy from a laser or a radio frequency source is now used to treat the underlying problem (saphenous vein). The laser treatment is a minimally invasive in-office procedure. Your physician will gain access into the affected vein through a needlestick. Next a laser fiber will be gently threaded into the problematic vein under ultrasound guidance. Heat energy from the laser (or radio frequency source) is used to eliminate flow in the affected vein. The entire procedure is performed under a local anesthetic which is administered around the vein. Patient comfort is of utmost importance and is monitored throughout the entire procedure.
In some cases sclerotherapy may be used to clear up the smaller branches that are from the main saphenous vein once it has been closed or a procedure called hook phlebectomy may be used. Being skilled surgeons, whatever modality is selected you can be assured of an excellent cosmetic result.
Complications from this procedure are minimal. In most cases you can return to normal activities in 2-3 days. Bruising may occur and usually subsides within 1-2 weeks. Mild analgesics are usually prescribed. Ongoing studies up to five years show a 95-98% success rate in closing the saphenous vein (the main cause for larger visible varicosities).
Ambulatory MicroPhlebectomy
A phlebectomy is performed in the office under local anesthetic. This procedure addresses (treats) the varicose veins on the skin’s surface. Small segments of the dilated veins are removed through 1-2mm openings, similar to the size of a freckle. Pressure will be applied over each area and blood flow will be redirected through competent veins. Results are immediate; the body will begin the healing process leaving virtually no scarring. If the patient requires the laser treatment, this procedure may be done at the same time.
Complications from this procedure are minimal. Mild bruising may occur. Depending on the extent of varicose veins to be treated, some patients return to work the next day. Over-the-counter analgesics are usually sufficient for minor discomfort.
Perforating Veins
Less commonly, diagnostic testing may reveal competent saphenous veins with failure present in perforating veins. Perforating veins connect the superficial venous system to the deep veins. Regardless of origin (derivation), the result of high pressure in veins tends to progress, resulting in surface veins dilating and emerging as varicose veins. Incompetent perforating veins have been linked to chronic venous insufficiency and its most severe manifestation, venous ulceration.
Based on ultrasound testing your physician may recommend closure of an incompetent perforating vessel contributing to your venous disease. Your physician will select the best method to obtain successful closure of the perforator, utilizing either thermal ablation or sclerotherapy. Visualized and guided by ultrasound, your physician will use a needle to enter the perforating vein and either inject a sclerosant (medication) or pass a laser fiber into the vein and use laser therapy to irritate the vein wall causing it to collapse. Your body will seal the incompetent vein from the inside. Regardless of which method the physician recommends, both are minimally invasive in-office procedures using a small amount of local anesthetic.
Complications from this procedure are minimal; most commonly there can be a small amount of discomfort at the treatment site. Normal activity is possible immediately following a procedure. If patients require the laser treatment or a phlebectomy (as described above), these procedures may be performed in the same setting.
Your physician will follow the progress of your varicose vein treatment with an ultrasound. Usually in 3-4 months the vein is barely visible. If flow occurs in part of the vein after treatment, this can easily be handled with an injection of solution to stop the flow.
More recent techniques such as endovenous laser treatment allow for a safer, less expensive and superior cosmetic result. Using endoluminal thermal laser ablation, there is less chance of deep vein thrombosis compared with older methods such as high ligation and stripping. The patient is more comfortable and able to ambulate much quicker. There is rarely a need for the outdated stripping method or a hospital visit for varicose vein surgery. All of our surgeons are experts in the technique of endovenous thermal ablation of the saphenous vein in the office setting.
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