Martha had a really hard time sleeping through the night because her legs felt so achy and heavy. During the day, Martha’s legs and ankles would swell and ache. She also had unsightly varicose veins. Martha was fed up with her legs bothering her so finally she came to see me in our Fort Myers office. She was surprised when I told her that her leg swelling, achiness and varicose veins could be related to the leaking veins in her legs.
Martha had a venous insufficiency ultrasound performed on both of her legs in vascular testing lab. After reviewing her test results, I was able to identify from the ultrasound her underlying disease process. The swelling in Martha’s ankles and feet, the aching in her legs and her unsightly varicose veins were all related to her leaking blood vessels. This disease is called venous insufficiency.
Part of the body’s intricate circulatory system, veins are specially designed to pump blood back toward the heart, against the force of gravity. Inside these blood vessels are a series of one-way valves that open and close with the rhythm of muscle contractions. Healthy valves close tightly, keeping blood moving upward toward the heart. With venous insufficiency, the valves do not close properly. This allows blood to flow backward down the legs, or reflux, and pool in the veins, leading to complications, such as swollen, achy legs or leg cramping; varicose veins and skin changes that can lead to bleeding veins and leg ulcers. Varicose veins are the most commonly recognized sign that vein disease is present but varicose veins are not the disease. I make it a point when I talk to patients in the office to explain to them that the diagnosis is, in fact, venous insufficiency, not varicose vein disease. Also, not all patients with venous insufficiency will have varicose veins but patients with varicose veins have some kind of venous reflux in their veins.
Varicose veins are just one sign of the underlying problem of venous insufficiency. There are symptoms and signs of venous insufficiency, leaking veins or venous reflux disease. The symptoms are what patients feel, and the signs are what patients see. You feel like your legs are getting heavy as the day goes on. You feel like you’re having leg cramps in bed at night. You feel fatigue in your legs. Those are symptoms that patients report.
Historically, the only treatment available to offer patients with venous insufficiency was surgical vein excisions or vein stripping, which often required hospitalization and general anesthesia along with an extended recovery period.
Today, there is something we can do to fix the problem that is not invasive, is not a stripping, is not done in the hospital, is not done with general anesthesia and does not have a lot of complications or require a lot of recovery time. The name for the treatment is endovenous ablation. With endovenous closure, there are no incisions, minimal to no pain and minimal scarring.
Endovenous ablation allows the treatment of leaking veins by sealing the vein with heat. It can be performed with one of two technologies. The first, called the ClosureFAST procedure, uses radiofrequency heat and was FDA-approved in 1999. Dr. Magnant used this technique to treat Martha’s leaky veins. During the ClosureFAST procedure, a small caliber, sophisticated catheter is inserted into the vein through a small needle. Radiofrequency energy is transmitted through the device, heating the vein in segments to seal the vein walls. The other procedure is called endovenous LASER treatment (ELT). It uses a laser to impart energy or heat to the vein wall and basically shrink it down by scarring it.
The two procedures are similar, but use two different heat sources. Which one you use is really dependent more on the anatomy of the patient than anything else. I use the radiofrequency on one person and the laser on another depending on the size of the patient’s veins, the length of the veins and a number of other factors.
If you have any of the signs and symptoms of venous insufficiency, you should find a local vein specialist and get a vein evaluation! Vein treatment is efficient and effective and most of the time, covered by your medical insurance.