The days of surgically tying off the vein in the groin area
and stripping the veins are all but long gone and patients
who need this type of procedure are few and far between.
Thus, even patients with “terrible” veins, and those with
a history of vein stripping in the past who have recurrent,
severe varicose veins, leg swelling or ulceration are strongly
encouraged to seek evaluation by a qualified vein expert.
Ultrasound evaluation of all patients with significant vein
disease (other than those with only spider veins) is an
integral part of a comprehensive evaluation of venous
disease patterns and is essential in the treatment planning
process. In patients with more advanced and complicated
disease, successful treatment often requires multiple
modalities (injection sclerotherapy, endovenous closure
and microphlebectomy) and repeat ultrasound investigations.
A thorough venous evaluation requires specialty training
in venous diseases, a solid vascular surgical background,
experience in the noninvasive techniques of evaluating
venous disease and, perhaps most importantly, dedication
and patience.
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Compression Therapy
Injection Sclerotherapy
Laser Sclerotherapy
Microphlebectomy
Radio Frequency Closure Procedure & Laser Abation
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Compression Therapy
Compression stockings are the initial line of treatment of
patients with varicose veins and other related signs and
symptoms of venous insufficiency. These symptoms may
include diffuse spider veins, swollen achy legs, "French legs",
"Milk legs", thick calves, skin discoloration and thickening of
the skin around the ankles and in the most advanced stages,
ulcerations. Compression hose should be specifically
measured for the individual patient. They are available in
a variety of lengths (knee, thigh or panty) as well as a variety
of colors. Most insurance companies require a minimum of
3-6 months of compression stocking therapy before one can
be considered for more definitive therapy of their vein problems.
Therefore, Dr. Magnant strongly encourages his patients to
initiate compression therapy as soon as the clinical diagnosis
of significant venous insufficiency is confirmed.
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Injection Sclerotherapy
Injection sclerotherapy is the most common and accepted
treatment of spider veins and most small varicose veins.
A dilute solution is injected into the veins through a tiny
needle. Injection sclerotherapy has the advantage over laser
sclerotherapy of being able to treat a much larger area in
a shorter period of time and without as much discomfort.
Even those patients with “needle phobia” tolerate injection
sclerotherapy very well. The medicine used today causes
less burning and pain than occurred with concentrated
saline solutions used in the past. Injection sclerotherapy
causes injury to the inside of the vein wall which leads
to closing off of the veins and gradual fading of the veins.
Depending on the size and extent of veins injected, final
results may take weeks to months to be fully appreciated. Compression stocking therapy is an important and
mandatory part of successful sclerotherapy treatment.
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Laser Sclerotherapy
Laser sclerotherapy is effective in the treatment of very
superficial, fine spider veins. In order for laser therapy
tobe effective, the hand piece used must be traced over
the individual veins which may be very time consuming.
Therefore, large areas often require multiple sessions.
Patients can return to normal activity immediately after
treatment, but are encouraged to comply with the
compression hose regimen to achieve maximum benefit.
Potential side effects of the treatment include a few days of
redness or swelling and mild discoloration (“matting”) of the
skin which typically disappears within a couple of months.
Avoidance of intense sun exposure for two weeks following
sclerotherapy is recommended.
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Microphlebectomy
In the treatment of varicose veins, microphlebectomy (removal
of veins through a very small incision) is the most common
“surgical” procedure performed. Some varicose veins will
resolve or shrink after the underlying problem vein has been
sealed with endovenous closure. However, other larger veins
may require removal to effectively be treated. Before endovenous
closure was introduced in 1999, the general perception of
varicose vein removal procedures was that it was only a short
term fix and that other veins would start bulging within months.
The size of incisions used in the past were also quite a bit larger
than the tiny incisions (micro) used today to remove varicose
veins (phlebectomy). With the modern techniques available
today, including accurate ultrasound mapping of leaking
veins, endovenous closure of the underlying leaking veins
and skillful surgical removal of large bulging varicosities
through tiny incisions, one can be much more certain of a
favorable and lasting result from their varicose vein or
venous insufficiency treatment.
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Radiofrequency Closure Procedure & Laser Ablation
A relatively new procedure (approved by the FDA in 1999) is
known as endovenous closure. This procedure uses either
radiofrequency energy (VNUS Medical Technologies-1999)
or laser energy delivered through a thin catheter to treat the
underlying cause of the varicose veins. Performed with
ultrasound guidance and under local anesthesia this
process allows a more gentle "minimally-invasive" approach
for the treatment of varicose veins by closing the leaking
veins with heat rather than stripping the veins. There are
no incisions, minimal to no pain and minimal scarring.
Endovenous closure involves the placement of a thin
catheter into the faulty vein through a small needle hole.
The catheter delivers energy to the vein wall by means
of a laser or radiofrequency source causing it to heat and
seal shut. Once the diseased vein is closed, the tortuous
varicose veins will mostly disappear. This vein is
permanently closed off to any future blood flow and
the body will naturally use other healthy veins to return
blood to the heart. Although there are clinical situations
where surgical removal of varicose or bulging veins is still
indicated, the majority of patients with advanced venous
disease can be treated with endovenous closure alone.
Endovenous closure can be done in a physician’s office
under local anesthesia with long term success exceeding
95% and allows patients to return to normal activity almost
immediately.
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