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Varicose vein - noninvasive treatment
Definition
Varicose veins are swollen, twisted, painful veins that have filled with blood. They usually develop in the legs. Your doctor may be able to treat them in noninvasive ways instead of vein stripping, the traditional surgery for this problem.
Alternative Names
Sclerotherapy; Laser therapy - varicose veins; Radiofrequency vein ablation; Endovenous thermal ablation; Transilluminated power phlebotomy; Endovenous laser ablation; Varicose vein therapy
Description
Normally, valves in your veins keep your blood flowing forward so it does not collect in one place. But the valves in varicose veins may be damaged, deformed, or missing. As a result, the veins stay filled with blood, especially when you are standing.
When you stand up, you can see varicose veins as large, bluish vessels that may feel like a "rope."
Nonsurgical treatments for varicose veins can be performed in a doctor's office or clinic. You will receive local anesthesia to numb your leg. You will be awake but will not feel pain.
Sclerotherapy is one common treatment for varicose veins. Your doctor will inject salt water (saline) or a chemical solution into the varicose vein. The vein will harden and then disappear. Sclerotherapy works best for small spider veins.
Newer methods are also being used to treat varicose veins. One is called radiofrequency ablation. Another is called endovenous laser ablation. Each of these methods uses intense heat to treat the vein. During these procedures:
- Your doctor will puncture the varicose vein. Ultrasound (a painless way to see inside your leg) will guide your doctor during the treatment.
- Your doctor will thread a a flexible tube (catheter) through the vein up to your groin. The doctor will inject a special solution into your vein to numb it.
- Intense heat will reach the vein through the catheter in the vein. The heat will close off and destroy the vein. The vein will disappear over time.
These newer procedures can treat varicose veins in the upper thigh only.
Why the Procedure Is Performed
Most patients should try self-care treatments first. Common self-care includes keeping your leg raised and wearing compression stockings. If self-care does not help, talk with your doctor about which treatment might be best for you.
Varicose vein therapy may be recommended for:
- Improving the appearance of the leg (a common reason for sclerotherapy)
- Leg pain, often described as heavy or tired
- Lipodermatosclerosis - fatty tissue under that skin that hardens over time from high blood pressure in a vein
- Repeated phlebitis of the vein
- Ulcers or sores that are caused by blood pooling in the veins
Risks
These treatments are generally safe. Ask your doctor about specific problems that might occur.
The risks for any anesthesia are:
- Allergic reactions to medicines
- Breathing problems
The risks for any procedure are:
- Bleeding
- Bruising
- Infection
The risks of endovenous laser ablation are:
- Blood clots
- Damage to the nerve
- Failure to close the vein
- Opening of the treated vein
- Paresthesias (prickly, tingly skin)
- Pulmonary embolism (a blood clot in your lungs)
- Skin burns from the heated catheter
- Thrombophlebitis (inflammation in a vein with a blood clot that attaches to the vein)
The risks of sclerotherapy are:
- Blocked blood flow in the treated vein
- The solution leaks out of the vein into other tissue (this can damage surrounding tissue and cause ulcers to form)
- Vein irritation
The risks of any treatment for varicose veins are:
- Bruising or scarring
- Nerve injury
- Return of the varicose vein over time
Before the Procedure
Always tell your doctor or nurse:
- If you are or could be pregnant
- What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot several days before your treatment.
After the Procedure
Your legs may be wrapped with bandages to control swelling and bleeding for 2 to 3 days after your treatment.
Usually patients can start their normal activities within a day or so after many of these treatments. You will need to wear compression stockings during the day for a week after treatment.
Your doctor may look inside your leg using ultrasound a few days after treatment to make sure the vein is sealed off.
Outlook (Prognosis)
These treatments are usually very successful. They reduce pain, and are also a good way to improve the appearance of the leg. Many of these treatments cause very little scarring, bruising, or swelling.
To prevent varicose veins from coming back, it is important for you to wear compression stockings.
References
Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 68.
Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. Journal of the American Academy of Dermatology. Jan 2009;60(1).
Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. 2009;49:230-239.
Reviewed By: Shabir Bhimji, MD, PhD, Specializing in General Surgery, Cardiothoracic and Vascular Surgery, Midland, TX. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
