What are Varicose Veins?
Veins serve to return blood back to the heart. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don’t close properly, they allow blood to flow backward, a condition called reflux. Veins that have lost their valve effectiveness, become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux.
What are the symptoms?
- Aching pain
- Often invisible
- Venous stasis changes
- Visible varicosities (Bulging veins)
What causes Varicose Veins?
- Female gender
- Previous pregnancy (pregnancies)
- Birth control pills
- Hormonal replacement therapy
- Prolonged standing
- Increasing age
Is venous reflux common?
- Almost 80 million Americans are affected by venous reflux.
- Affects one out of two people age 50 or higher
- 50 – 55% of women
- 20 - 25% of women will have visible varicose veins
- 40 – 45% of all men
- 10 - 15% of men will have visible varicose veins
How is it diagnosed?
Venous reflux is diagnosed with a specialized ultrasound examination. This is used to look at the veins in the lower extremities and also to look at the direction of blood flow. This test will also look at the abnormal connections between the veins. It will determine if the blood is flowing normally or if the blood is flowing backwards.
What is “reflux”?
Reflux is the medical term for abnormal flow within the venous system. In reference to varicose veins, it usually means that there is damage to the valves of the vein with backwards flow in the damaged veins of the legs.
Treatment of venous reflux (varicose veins) involves several steps. The first, and most important step, is to treat the source of the reflux. This is most commonly the great saphenous vein. Large veins are always treated first, before small veins. After treating the source of the reflux, the next step is to treat the smaller veins. Larger bulging veins can be treated with ambulatory phlebectomy. Smaller reticular and spider veins can be treated with sclerotherapy. It is important to stress that complete treatment of lower extremity venous reflux (varicose veins) takes time and patience.
Endovenous laser ablation:
This minimally-invasive treatment is an outpatient procedure performed using imaging guidance. Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance.
After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh. Then laser energy is delivered through the fiber to the precise location of the damaged vein under ultrasound guidance. This causes the vein to collapse and close. Once the diseased vein is closed, other healthy veins automatically take over to carry blood from the leg, re-establishing normal flow. This revolutionary technology has all but replaced surgical vein stripping. Results are remarkable.
(A and B ) The laser fiber is inserted into the damaged, leaking vein
(C) The fiber starts to deliver laser energy, collapsing and closing the damaged vein
(D) As the fiber is withdrawn, the entire vein is treated and closed with one treatment
View the following animation of the procedure below:
Benefits of endovenous laser ablation:
- The treatment takes less than an hour and provides immediate relief of symptoms.
- Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
- No scars or stitches – because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.
- High success rate and low recurrence rate compared to surgery
Compression stockings increase the ability of your leg circulation to move blood by squeezing your veins, decreasing the “pooling” effect of varicose veins. Many patients find this uncomfortable. They can help improve the symptoms but will not treat the underlying cause of reflux.
Use of traditional surgery is decreasing largely due to the effectiveness of minimally invasive procedures. Surgery can be quite painful, has a long recovery time, and is associated with recurrence rates between 10 to 25 percent. Surgical vein stripping is performed in an operating room, with general anesthesia, and involves two large incisions at the groin and knee. The vein is tied off, cut and then pulled (from other attached tributaries) out of the leg. Bruising and swelling often occur post-procedure and nerves surrounding the treated vein can be damaged, causing numbness or burning around the surgical scar. There can be up to a six week recovery period.
After treating the source of reflux, attention can then be turned to treating the remainder of the damaged veins. This is done with the following treatments:
A minimally invasive procedure used for the removal of larger visible bulging veins. These veins are removed through tiny no-stitch incisions (approximately 1 to 2mm) that leave little to no scars. This procedure is done under local anesthesia on an outpatient basis. It usually takes about 60 to 90 minutes. There is minimal discomfort if any associated with the procedure that usually resolves in 1 to 2 days. Recovery is fast with no down time.
A special solution (sclerosant) is injected into small veins, using a micro-needle. This causes the vein to collapses or closes off. This is usually reserved for smaller veins (spiders and/or reticular-bluish veins). The number of treatment sessions is based on individual need, but the average is anywhere from 2 to 6 sessions.