Treatment of Varicose Veins

Varicose Veins

Varicose veins are caused by an abnormal circulatory condition called venous insufficiency. The purpose of the venous system is to return blood to the heart. In order to do this, veins contain one-way valves, which prevent blood from flowing downward with gravity. When these valves become weak, they lose their effectiveness and do not close properly, causing blood to flow backwards (reflux) and pool in the veins. This causes the veins to enlarge, becoming more prominent under the surface of the skin. Venous insufficiency most commonly affects the veins in the lower extremities.

Risk Factors

Vein disease affects both men and women. Risk factors include:

Age
Family history
Female gender
Pregnancy- In women, pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of varicose veins.

Symptoms

Varicose veins can cause a variety of mild to moderate symptoms, including:

Aching leg pain, cramping and throbbing.
Leg heaviness and easy leg fatigue.
Itching, burning or swelling.
Skin discoloration or ulceration.

Symptoms can arise from spider veins as well as varicose veins. Because these symptoms are caused by pressure on nerves from dilated veins, it is possible to experience symptoms without visible varicose veins.

How is chronic venous insufficiency diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for chronic venous insufficiency may include duplex ultrasound - a type of vascular ultrasound procedure done to assess blood flow and the structure of the leg veins. The term "duplex" refers to the fact that two modes of ultrasound are used - Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the vessel being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.

A Progressive Condition

Left untreated, varicose veins will usually become more pronounced over time and may lead to serious complications including inflammation (phlebitis), skin discoloration and skin ulceration or bleeding.
Chronic venous insufficiency treatment may include:

Leg elevation and compression stockings - Elevating the legs reduces pressure in the leg veins and compression stockings apply pressure to the superficial veins and reduce swelling. Other methods include keeping the legs uncrossed when sitting and regular exercise. Chronic venous insufficiency treatment may include:
- Medications - Several types of medications may be used to treat chronic venous insufficiency. Diuretics (medications used to draw excess fluid from the body through the kidneys) may be used to reduce swelling. Pentoxifylline, which improves the flow of blood through the vessels, may be used in combination with compression therapy to help heal leg ulcers. Anticoagulation therapy (blood thinning medication) may be recommended for those persons who have recurring deep vein thrombosis.
- Sclerotherapy - For patients whose condition is more advanced, sclerotherapy may be prescribed. This involves injecting a chemical into the affected veins. The chemical causes scarring in the veins so that they can no longer carry blood. Blood then returns to the heart through other veins and the body absorbs the scarred veins.
- Catheter ablation - Radiofrequency and laser catheters can be placed inside varicose veins using ultrasound guidance. This causes the vein to clot, scar and shrink.
- Surgery- Surgery is recommended in fewer than 10 percent of people with chronic venous insufficiency. Surgical procedures that may be used to treat the condition include:
  - Ligation - tying off an affected vein so that blood no longer flows through it. If the vein and/or its valves are heavily damaged, the vein will be removed ("vein stripping").
  - Surgical repair - a vein and/or valves may be surgically repaired, either through an open incision or with the use of a long catheter (hollow tube).
  - Vein transplant - transplanting a healthy vein from another body area and replacing the diseased vein with the healthy vein.
  - Subfascial endoscopic perforator surgery - a minimally invasive procedure performed with an endoscope (a small, flexible tube with a light and a lens on the end). The perforator veins (veins found in the calf area) are clipped and tied off. This allows blood to drain into healthy veins and improves ulcer healing.

Non-Surgical Treatment of Varicose Veins

Venous insufficiency typically affects the greater saphenous vein which runs from the inside of the foot to the top of the thigh. This condition can be treated using an outpatient procedure called vein ablation.

After applying local anesthetic to the skin, your interventional radiologist will insert a thin catheter into the vein and use ultrasound imaging to guide it up to the top of the greater saphenous vein. Then laser (EVLT®) or radiofrequency (VNUS® Closure®) energy is applied to the inside of the vein, causing it to heat and seal closed.

Once the vein is closed, the twisted and varicosed branch veins shrink and improve in appearance. Other healthy veins then take over to carry blood from the leg, re-establishing normal flow.

Treatment takes less than one hour.
Once the faulty vein is closed, symptoms improve. Most patients return to normal activity immediately.
Some patients may experience minor soreness or bruising; these symptoms can be treated with over-the-counter pain relievers.
No scars or stitches. No surgical incision is required, just a small nick in the skin the size of a pencil tip.

To schedule with an expert MedStar Harbor Hospital interventional radiologist, please call 410-350-3300

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