Treatment Options for Venous Insufficiency and Varicose Veins
Following physical examination and a diagnostic ultrasound exam, options for treatment of varicose veins and/or spider veins may include one or more of the following non-surgical or minimally invasive alternatives:
Conservative treatment: in patients who are only desiring some degree of pain control, this option may provide satisfactory relief. Conservative treatment includes special prescription medical grade compression stockings which have slightly more compression of the leg at the level of the foot than at the level of the thigh. These stockings help promote blood flow through the veins and may keep varicose veins compressed and collapsed. Conservative treatment also often includes leg elevation for extended periods of time to allow blood to drain from the veins of the leg. This is particularly important in patients who have skin changes, such as ulceration, in order for these areas to heal.
Conservative treatment will often not be practical for many patients, particularly due to work requirements, and progression of varicose veins may occur despite proper conservative treatment. Unfortunately, for some patients with severe leakage in the deep veins of the leg, a small minority of patients with venous disease, conservative treatment may be the only possible treatment option.
Ablation: a treatment that has largely replaced the traditional invasive surgical stripping procedure as the treatment of choice for leaking saphenous veins.
In the ablation procedure (also referred to as ELVS or VNUS procedure), a small needle is placed into the saphenous vein in the thigh or calf using ultrasound guidance. A small plastic tube, called a catheter, is then advanced into the vein through the needle hole and positioned in the uppermost aspect of the vein using ultrasound guidance. Energy is then transmitted through the catheter as the catheter is pulled back through the vein. This energy heats and damages the vein wall. The vein goes into immediate spasm and scars down, permanently closing the vein and preventing further leakage of blood back through the vein. The procedure is performed using local anesthetic, with typically no sense of discomfort whatsoever during the ablation procedure.
Endovenous ablation used principally in the treatment of leakage which occurs in the main greater or short saphenous veins of the leg.
Microphlebectomy: often performed in combination with endovenous ablation, or occasionally with sclerotherapy, microphlebectomy is used for the removal of typical, bulging branch veins which lie just below the skin's surface. Tiny microincisions are made along the course of the vein to be removed. A special instrument is then used to hook the vein and the segment of vein is then removed through the tiny incision. These microincisions are so small that there is usually no need for a suture to close the tiny hole. Small sterile adhesive strips are placed over the microincisions.
Sclerotherapy: developed in the 1930ís, and one of the oldest treatments available for varicose veins, sclerotherapy still remains the treatment of choice for small spider veins in the leg. It remains less expensive and more effective, with less patient discomfort, than other treatment options available. Sclerotherapy is also used to treat larger veins in the legs which are not amenable to treatment with other means. An extremely fine and usually painless needle is placed into the vein. A small amount of sclerosing solution is then injected into the vein. This solution causes irritation of the lining of the vein wall, which causes the vein to spasm and become a small fibrous thread, resulting in permanent closure of the vein. These closed veins will be absorbed by the body and typically disappear in 1-3 months. While closure of the spider veins is permanent, it is possible for the body to form new spider veins in the future. A short follow-up treatment may be useful in future years.
A varicose vein being removed using microphlebectomy techniques.
Spider vein immediately following sclerotherapy.
Sclerotherapy is often performed at The Vein Clinic utilizing a technique called transillumination. The technique uses a high intensity light positioned close to the skin to identify slightly larger feeding veins that supply the spider-like veins. When sclerotherapy of these slightly larger feeding veins is performed using transillumination, treatment of the overlying spider veins is often more effective and long-lasting.
Laser Therapy: utilized in the treatment of spider veins and some slightly-larger reticular veins in the leg. Laser therapy has its effects in similar fashion to sclerotherapy in that it will result in a mild irritation of the vein wall, causing the vein to spasm and become a small fibrous thread with resultant permanent closure of the vein. State-of-the-art treatment offered at The Vein Clinic utilizes Syneron Elos technology which utilizes a unique combination of radio frequency energy and light to treat the problem areas. This combination approach allows maximal effectiveness with the least risk of harmful side effects that may occur with systems that utilize only a single energy source.
Laser therapy is a no-downtime procedure, typically requiring less than 30-45 minutes for an average session, with absolutely no need for any sedation. Patients can return to a normal daily schedule immediately following treatment.