VARICOSE VEIN TREATMENTS

Varicose veins are swollen blood vessels that have incompetent valves, causing the veins to appear as bluish veins on the surface of the skin.

Varicose veins typically occur on the legs (although they can occur elsewhere), are often unsightly, and can produce a dull ache in the legs after prolonged standing.

Some available treatments include:

Sclerotherapy

This is the most common treatment for both spider veins and varicose veins. The doctor injects a solution into the vein that causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood and the vein turns into scar tissue. In a few weeks, the vein should fade. The same vein may need to be treated more than once.

This treatment is very effective if done the right way. Most patients can expect a 50% to 90% improvement. Microsclerotherapy uses special solutions and injection techniques that increase the success rate for removal of spider veins. Sclerotherapy does not require anesthesia, and can be done in the doctor's office.

Possible side effects include:

Temporary stinging or painful cramps where the injection was made
Temporary red raised patches of skin where the injection was made
Temporary small skin sores where the injection was made
Temporary bruises where the injection was made
Spots around the treated vein that usually disappear
Brown lines around the treated vein that usually disappear
Groups of fine red blood vessels around the treated vein that usually disappear

The treated vein can also become inflamed or develop lumps of clotted blood. This is not dangerous. Applying heat and taking aspirin or antibiotics can relieve inflammation. Lumps of coagulated blood can be drained.

Laser surgery

New technology in laser treatments can effectively treat spider veins in the legs. Laser surgery sends very strong bursts of light onto the vein. This can makes the vein slowly fade and disappear. Lasers are very direct and accurate. So the proper laser controlled by a skilled doctor will usually only damage the area being treated. Most skin types and colors can be safely treated with lasers.

Laser surgery is more appealing to some patients because it does not use needles or incisions. Still, when the laser hits the skin, the patient feels a heat sensation that can be quite painful. Cooling helps reduce the pain. Laser treatments last for 15 to 20 minutes. Depending on the severity of the veins, two to five treatments are generally needed to remove spider veins in the legs. Patients can return to normal activity right after treatment, just as with sclerotherapy. For spider veins larger than 3 mm, laser therapy is not very practical.

Possible side effects of laser surgery include:

Redness or swelling of the skin right after the treatment that disappears within a few days.
Discolored skin that will disappear within one to two months.
Rarely burns and scars result from poorly performed laser surgery.

The doctor puts a very small tube called a catheter into the vein. Once inside, the catheter sends out radiofrequency or laser energy that shrinks and seals the vein wall. Healthy veins around the closed vein restore the normal flow of blood. As this happens, symptoms from the varicose vein improve. Veins on the surface of the skin that are connected to the treated varicose vein will also usually shrink after treatment. When needed, these connected varicose veins can be treated with sclerotherapy or other techniques.

Possible side effect is slight bruising.

Endovenous Techniques (radiofrequency and laser)

These methods for treating the deeper varicose veins of the legs (the saphenous veins) have been a huge breakthrough. They have replaced surgery for the vast majority of patients with severe varicose veins. This technique is not very invasive and can be done in a doctor's office.

The doctor puts a very small tube called a catheter into the vein. Once inside, the catheter sends out radiofrequency or laser energy that shrinks and seals the vein wall. Healthy veins around the closed vein restore the normal f low of blood. As this happens, symptoms from the varicose vein improve. Veins on the surface of the skin that are connected to the treated varicose vein will also usually shrink after treatment. When needed, these connected varicose veins can be treated with sclerotherapy or other techniques.

Possible side effects:
- slight bruising.

Surgery

Surgery is used mostly to treat very large varicose veins. Types of surgery for varicose veins include:

Surgical Ligation and Stripping - With this treatment, problematic veins are tied shut and completely removed from the leg. Removing the veins does not affect the circulation of blood in the leg. Veins deeper in the leg take care of the larger volumes of blood. Most varicose veins removed by surgery are surface veins and collect blood only from the skin. This surgery requires either local or general anesthesia and must be done in an operating room on an outpatient basis.

Possible side effects: Serious side effects or problems from this surgery are uncommon.

With general anesthesia, a risk of heart and breathing problems.
Bleeding and congestion of blood can be a problem. But the collected blood usually settles on its own and does not require any further treatment.
Wound infection, inflammation, swelling and redness.
Permanent scars.
Damage of nerve tissue around the treated vein. It is hard to avoid harming small nerve branches when veins are removed. This damage can cause numbness, burning, or a change in sensation around the surgical scar.
A deep vein blood clot. These clots can travel to the lungs and heart. Injections of heparin, a medicine that reduces blood clotting reduce the chance of these dangerous blood clots. But, heparin also can increase the normal amount of bleeding and bruising after surgery.
Significant pain in the leg and recovery time of one to four weeks depending on the extent of surgery is typical after surgery.

Ambulatory Phlebectomy � With this surgery, a special light source marks the location of the vein. Tiny cuts are made in the skin, and surgical hooks pull the vein out of the leg. This surgery requires local or regional anesthesia. The vein usually is removed in one treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment.

Possible Side Effects:

Slight bruising
Temporary numbness

Endoscopic vein surgery � With this surgery, a small video camera is used to see inside the veins. Then varicose veins are removed through small cuts. People who have this surgery must have some kind of anesthesia including epidural, spinal, or general anesthesia. Patients can return to normal activity within a few weeks.