Varicose Vein Treatment

Varicose veins are mainly gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. Because of standing and walking upright position, the pressure increases in the veins of your lower body and this causes varicose vein problem.

Varicose veins (and spider veins) can cause cosmetic problems or more severe problems like aching pain and discomfort. Sometimes varicose veins might be a signal for some high-risk health problems like circulatory problems. There are some treatment options available to solve the varicose vein problems.

Causes

Veins are the main carriers of the blood throughout the body. Arteries carry blood from your heart to the rest of your body. Veins return blood from the rest of your body to your heart, so the blood circulation process occurs continuously. In this process, to return the blood to hearth, the veins on your legs must work against gravity. Muscle contractions in your lower legs act as pumps, and elastic vein walls help blood return to your heart. Tiny valves in your veins open as blood flows toward your heart then close to stop blood from flowing backward.

- As you get older, your veins can lose their elasticity causing them to stretch. The valves in your veins can lose its function to pump the blood through heart and thus blood may flow backward. As a result, blood pools in your veins and your veins enlarge and become varicose. The veins appear blue because they contain deoxygenated blood, which is in the process of being re-circulated through the lungs.

- Pregnancy may also cause women to develop varicose veins. Pregnancy increases the volume of blood in your body, but decreases the flow of blood from your legs to your pelvis. This circulatory change is designed to support the growing fetus, but it can produce an unfortunate side effect — enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Changes in your hormones during pregnancy also may play a role. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.

Risk Factors

There are some factors, which may increase the possibility of having varicose vein problems:

- Varicose veins occur most often in people ages 30 to 70, with your risk increasing as you age. Aging causes wear and tear on the valves in your veins that help regulate blood flow. Eventually, that wear causes the valves to allow blood to flow back into your veins where it collects instead of flowing up to your heart.

- Women are more likely to develop the condition. Hormonal changes during pregnancy, pre-menstruation or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins.

- If other family members had varicose veins, there's a greater chance you will too.

- Being overweight puts added pressure on your veins.

- Your blood doesn't flow as well if you're in the same position for long periods.

Symptoms

If you have dark purple or blue color veins and if you have twisted and bulging (often like cords on your legs); then you may have varicose vein problems. Note that varicose veins can be in different parts of your leg (from your groin to your ankle).

Because of varicose veins; you may have following discomfort and pain in various parts of your legs:

- An achy or heavy feeling in your legs

- Burning, throbbing, muscle cramping and swelling in your legs

- Worsened pain after sitting or standing for a long time

- Itching around on or more of your veins

- Skin ulcers around your ankle (which is an indication that you have a serious vascular disease and required medical actions should be taken immediately)

There are some ways available to reduce the pain and discomfort caused by varicose veins. Doing exercise, elevating your legs and wearing compression stockings may reduce; even prevent the pain and discomfort. If you still have the pain and discomfort and if the appearance of your legs gives you a cosmetic concern; then you can consider the available treatment options. In some cases varicose vein problem can be aggravated in the certain period of time (depending on how severe varicose vein problem you have). In this case, we strongly suggest you to seek for a medical attention to solve the problem before it gets more severe. A professional medical assistance and treatment organized by our Thoracic and Cardiovascular Surgeon will solve out your varicose vein problem and correct unaesthetic appearance caused by spider veins.

Treatment: Endovenous Ablation of Varicose Veins

Varicose vein treatment, or endovenous ablation, is a minimally invasive treatment that uses radiofrequency or laser energy to cauterize (burn) and close abnormally enlarged veins in the legs, a condition called varicose veins.

What Does the Equipment Look Like?

In this procedure, an ultrasound machine, catheter, laser fiber or radiofrequency electrode, and laser or radiofrequency console are used.

Ultrasound scanners consist of a console containing a computer and electronics, a video display screen and a transducer that is used to do the scanning. The transducer is a small hand-held device that resembles a microphone, attached to the scanner by a cord. The transducer sends out inaudible high frequency sound waves into the body and then listens for the returning echoes from the tissues in the body. The principles are similar to sonar used by boats and submarines.

The ultrasound image is immediately visible on a video display screen that looks like a computer or television monitor. The image is created based on the amplitude (loudness), frequency (pitch) and time it takes for the ultrasound signal to return from the area of the patient being examined to the transducer (the device used to examine the patient), as well as the type of body structure and composition of body tissue through which the sound travels. A small amount of gel is put on the skin to allow the sound waves to travel back and forth from the transducer.

A catheter is a long, thin plastic tube that is considerably smaller than a "pencil lead", or approximately 1/8 inch in diameter.

Laser fibers (fiber optics) or radiofrequency electrodes carry laser or electrical energy from their respective power generators into the body.

How does the procedure work?

Using ultrasound to visualize the enlarged vein, a catheter or vascular access sheath is inserted through the skin and positioned within the abnormal vein. A laser fiber or radiofrequency electrode is then inserted through the catheter and advanced to the desired location. Laser or radiofrequency energy is then applied, heating the vessel and causing it to close. Following the procedure, the faulty vein will shrink and "scar down."

How is the procedure performed?

A cardiac surgeon and a specially trained interventional radiologist performs image-guided and minimally invasive endovenous ablation at the same time. This procedure is done on an outpatient basis. The physician will use a topical anesthetic cream over the abnormal vein area before the procedure in order to reduce discomfort. The physician will numb the area where the catheter will enter into the abnormal vein with a local anesthetic and use the ultrasound transducer or wand to study the vein and track its path. The leg being treated will be cleaned, sterilized and covered with a surgical drape. A very small skin incision is made at the site. Using ultrasound guidance, the catheter is inserted through the skin into the vein and positioned within the abnormal vein. The laser fiber or radiofrequency electrode is inserted through the catheter and the tip of the fiber or electrode is exposed by pulling the catheter back slightly. Local anesthetic is injected around the abnormal vein with ultrasound guidance. Laser or radiofrequency energy is applied as the catheter is slowly withdrawn. Pressure will be applied to prevent any bleeding and the opening in the skin is covered with a bandage. No sutures are needed. This procedure is usually completed within an hour.

What will I experience during the procedure?

You will be asked to wear protective glasses if and when lasers are in use. An area of your leg will be cleaned, shaved and numbed. You will feel a slight pin prick when the local anesthetic is injected. The area will become numb within a short time. You may feel slight pressure when the catheter is inserted, but no serious discomfort. Injection of local anesthetic around the abnormal vein is the most bothersome part of the procedure because it usually requires multiple injections along the vein. Actual closure of the vein with laser or radiofrequency is usually not painful. Following the procedure, you will need to wear a gradient compression stocking to help reduce bruising, tenderness, and minimize the rare possibility that blood clots may form. You may resume your normal activity immediately, with the exception of air travel or prolonged sitting (such as a long car trip). You should remain active and not spend too much time in bed during the recovery period since this increases the chance of complications.

Who interprets the results and how do I get them?

A follow up ultrasound examination is essential in order to assess the treated vein and to check for adverse outcomes. Within one week, the target vein should be successfully closed. Additional procedures (such as sclerotherapy or phlebectomy) may be necessary to treat associated veins.

What are the benefits vs. risks?

Benefits

- No surgical incision is needed—only a small nick in the skin that does not have to be stitched closed.

- When compared with traditional vein stripping techniques, endovenous ablation is more effective, has fewer complications, and is associated with much less pain during recovery.

- Endovenous ablation is generally complication-free and safe.

- This procedure leaves virtually no scars because catheter placement requires skin openings of only a few millimeters, not large incisions.

- Endovenous ablation offers a less invasive alternative to standard surgery.

- Most of the veins treated are effectively invisible even to ultrasound 12 months after the procedure.

- Most patients report symptom relief and are able to return to normal daily activities immediately, with little or no pain.

Risks

- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.

- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection.

- Some postoperative bruising and tenderness may occur, but may be alleviated by wearing a compression stocking.

- Some instances of thermal (heat) damage to nerves have been reported. This is rare and generally goes away in a short time.

- Thrombophlebitis (inflammation of the vein) is not uncommon and may cause pain and redness over the treated area, but generally responds well to non-steroidial anti-inflammatory drugs (NSAIDs). Blood clots that formed in the veins can travel to the lungs (pulmonary embolism); however, this is an extremely rare occurrence.

What are the limitations of Endovenous Ablation of Varicose Veins?

Ablation catheters cannot be easily passed through a tortuous vein, or a vessel with many turns and bends. Consequently, the procedure is typically used to treat larger varicose veins, such as the great saphenous vein, which extends from the groin down the inside of the thigh into the inner calf. Endovenous ablation is successful at closing the abnormal target vein almost 100 percent of the time, but small dilated branches that persist in the skin often require additional treatment with phlebectomy (minor surgical procedure to extract them) or sclerotherapy (injection of a liquid medication to seal them off). Subsequent treatments are usually scheduled after an ablation procedure.