Varicose Veins

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Treatment

Treatment for varicose veins depends on the cause and severity of the condition. In many cases, multiple modalities are used. For example, laser or radiofrequency ablation may be used in conjunction with sclerotherapy.

Compression stockings are the most conservative treatment. The stockings, which come in different lengths and pressures, do not cure the problem, but should improve symptoms. The valves remain incompetent (leaky) and once the patient removes the stockings, symptoms recur. Most insurance companies require a trial of wearing compression stockings (usually for 3 months) before authorizing payment for other treatments.

Sclerotherapy
In this treatment, the physician injects the veins with a solution (e.g., sodium tetradecyl sulfate, Polidocanol) that causes irritation of the vessel walls and stimulates inflammation and closure of the vessel. Hypertonic saline may also be used; however, if this solution leaks out of or is injected outside of the vein, it can cause skin necrosis.

This therapy, which often is used in small and medium size veins, is not recommended during pregnancy or in nursing mothers because the safety has not been established.

Radiofrequency Ablation
This treatment uses heat (high-frequency current) to shrink varicose veins. A small incision is made in the skin of the lower leg and a thin tube (catheter) is threaded up through the vein. Ultrasound is used to make sure that the catheter is in the right position. Once the catheter is in place, a local anesthetic is injected into the skin and tissues surrounding the vein to form a barrier that prevents energy from the treatment from harming other structures or tissue.

A metal electrode is then threaded into the catheter and deployed from the end of the catheter into the vein. This electrode comes into contact with the inside of the vein (endothelium) and heat from the electrode damages (ablates) the endothelium as the catheter is slowly pulled through the vein. The entire vein is treated, causing it to shrink, and the catheter is withdrawn.

Endovenous Laser
In this procedure, a needle is placed into the vein through the skin and a laser fiber is inserted through the needle and advanced into the vein. The final position is confirmed by ultrasound as well as an "aiming light" that is projected from the end of the laser and can be seen through the skin when the lights are dimmed.

Local anesthetic is used to separate the vein from surrounding tissue so heat from the laser does not damage surrounding tissue. The laser is fired and then pulled back a short distance, damaging the endothelium and causing closure of the vein. This procedure is repeated along the course of the vein.

Ambulatory Phlebectomy
Varicose veins that are cosmetically unappealing and will not resolve on their own even when the reflux is corrected may be removed in a procedure called ambulatory phlebectomy. In this technique, the vein is removed through a series if tiny incisions in the skin.

The physician uses a hooked instrument to pull the vein up into the incision and removed. As much of the vein as possible is removed through the incision and then another incision is made along the course of the vein and another segment of the vein is removed. This procedure is repeated until the varicose vein is completely removed.

Ambulatory phlebectomy usually is performed under local anesthesia. Cosmetic results are much better than formal phlebectomy, which requires large (disfiguring) incisions and general anesthesia.

Saphenectomy
The saphenous veins are two superficial veins in the leg. Removal of one of these veins (called saphenectomy) is performed less often than in the past. In this technique, a special catheter is advanced into and secured to the vein. Then the catheter is pulled out of the vein, causing the vein to turn inside out (invert) as it is pulled out of the body.

Endoscopic Vein Surgery
In this procedure, a small camera is inserted into the vein and is used to visualize the vein. Small incisions along the course of the vein are made in order to remove the vein. Endoscopic vein surgery is performed under general anesthesia.

Alternative/Homeopathic Treatment
There is some literature to suggest that chestnut seed oil can decrease the inflammation and swelling associated with varicose veins.

Prevention

Varicose veins cannot be prevented in all cases. Ways to help minimize the condition include the following:

• Maintain a healthy weight — Obesity/overweight increases pressure on veins. Additionally, a low salt diet causes less swelling (edema) in the body.
• Shoes and clothing — Low-heeled shoes can help vein-pumping muscles in the calves work harder and increase vein circulation more than high heels. Wearing support stocking can improve blood flow in the legs. Avoid wearing tight clothing that constricts the waist or upper thighs.
• Exercise — Moderate exercise (e.g., walking) can increase circulation in the legs and is beneficial.
• Elevate the legs — Putting the feet up (higher than heart level) increases circulation in the legs. Rest your feet on the couch armrest with a pillow behind your head while watching television.
• Standing and sitting — Avoid standing for long periods of time and if you must stand for a long time, shift your weight form one leg to the other often. While sitting, avoid crossing your legs since this restricts blood flow out of your legs.

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