What are varicose veins?

Varicose veins are enlarged, dilated veins that can no longer perform their function of carrying blood from the legs back up to the heart. Healthy veins have one-way valves which open to allow blood flow to the heart and close to prevent reflux of blood backwards into the legs. When these valves get damaged the force of gravity pulls the blood back down the leg and causes it to pool inside the weakened veins. Over time, the constant overfilling causes the non-functioning veins to develop their typical bulging appearance. Common symptoms caused by varicose veins are tired, heavy, aching, swollen legs which are usually worse by the end of the day. After treatment of the diseased veins, these symptoms will resolve. Without treatment, varicose veins may cause complications such as ulceration, inflammation of the skin and the vein itself, and blood clots.

What causes varicose veins?

This is a common problem that affects between 15-25% of all adults and approximately 50% of all people over age 50. The number one factor contributing to the development of varicose veins is heredity. A genetic predisposition causes the valves to function improperly and the veins to weaken. About 70% of all patients with varicose veins have parents with the same condition. If you have a family history of vein disease, there is nothing you can do to change your genes. Other factors that are thought to contribute to the development of varicose veins are obesity, pregnancy, standing or sitting for long periods of time and traumatic injury to the leg.

How are varicose veins treated?

Conservative Treatment
The mainstay of treatment for chronic venous insufficiency, the condition causing varicose veins, is the daily use of prescription-strength compression stockings. These stockings can alleviate symptoms caused by varicose veins such as swelling, aching and pain. They are also useful in the prevention of the formation of ulcers. Compression stockings do not change the appearance of the varicosities and, to be effective, they must be worn every day for your entire life.

Medical Treatment
Sclerotherapy – Sclerotherapy involves the injection of a mild chemical solution into the diseased veins. It is used to treat small to medium size varicose veins and spider veins. The desired outcome is that the solution will cause the inner lining of the vein to become irritated, therefore causing the vein to collapse and seal closed. The treated vein will gradually disappear as it is absorbed by the body. The injections are relatively painless and only small, very fine needles are used. Anesthesia and sedation are not needed, as this procedure can be performed in the office.

When diseased veins are too deep below the skin surface to be treated with traditional sclerotherapy, ultrasound can be used to guide the injections. The chemical solution can then be administered safely and accurately because the vein can be seen on the ultrasound monitor as the solution is injected.

Sclerotherapy can also be performed using foam instead of liquid. In this technique, the same solutions are used as in traditional sclerotherapy, but they are mixed with air to form foam. The foam is then injected in the same manner as the liquid solutions. Foam stays in the treated area longer, allowing better contact of the sclerosing agent with the inner lining of the vein and therefore, better results.

Ambulatory Phlebectomy – Phlebectomy is a procedure used to remove both large and small varicose veins. Tiny incisions are made over the affected veins, through which they are then removed. The incisions are closed with sterile tape and once healed, are virtually unnoticeable. This procedure is considered minimally invasive and is different from traditional vein stripping.

Vein Stripping Surgery – Traditional treatment for larger varicose veins involves “stripping” the veins. This surgery is painful and requires hospitalization and general anesthesia. The incisions are larger and more numerous, resulting in more obvious scarring. There is also a lengthy and painful recovery associated with this procedure. Vein stripping is known to have a high rate of recurrence, requiring further treatment and inconvenience to the patient. All of these factors have made this procedure the less desirable choice of treatment.

Endovenous Laser Treatment (EVLT) – Endovenous Laser Treatment is a new and effective alternative to vein stripping surgery to treat varicose veins. Using ultrasound guidance, a thin laser fiber is inserted into the diseased vein through a small puncture incision in the leg. Once the fiber is activated, it delivers laser energy in the form of heat and causes the vein to close. The physician gradually removes the fiber and the treated vein seals shut behind it. This procedure is minimally invasive and does not require hospitalization or general anesthesia. It is performed using local anesthesia and conscious sedation. There is minimal pain associated with EVLT and patients are usually allowed to return to normal activities the next day. In some cases EVLT is used in combination with other treatments, such as sclerotherapy, to give the best possible result.