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Treatment of Varicose Veins2
2006-10-17
Treatment of Varicose Veins
In my last column, I discussed the causes of varicose veins and how to prevent them. Today I will focus on how to treat veins. In general, treatment of varicose veins can be divided into non-surgical and surgical methods. It must be stressed that the treatment of varicose veins by any method is not curative – the body has a tremendous number of veins and the ability to generate new veins, so prevention should be practiced at any stage of the condition.
The non-surgical methods of vein treatment are compression sclerotherapy and laser treatment. Compression sclerotherapy, in which the veins are injected with a medication that causes them to close, is the mainstay of vein treatment in Europe and is becoming more popular in North America as techniques become more modern and successful. The main reason for the increased success of injections is the use of ultrasound to look at leg veins and determine the source of the pressure in the vein. Once problem veins are identified on ultrasound, they can be targeted for injection. This increases the success of the initial injection and helps prevent rapid recurrence of new varicose veins.
Compression sclerotherapy is appropriate for almost all varicose veins. From the large blue veins that stick out from the skin to the small purple or red spider veins, sclerotherapy is a safe, simple, and successful method of treatment. It is done in a clinic setting without any anesthetic required and has no downtime whatsoever. The type of medication to be injected, its strength, and its amount depend on the size and location of the vein to be treated. Veins that are not visible from the skin surface can now be successfully injected with the use of ultrasound to guide the needle. After treatment, a compression stocking is worn temporarily to keep the veins flat and to keep the pressure low in the veins feeding into the treated veins, increasing the chance of successful closure.
Lasers are generally used in two extremes – the biggest of veins too large for sclerotherapy and the smallest of spider veins too small to inject with a needle. Endovenous laser ablation is a very successful treatment of the great saphenous vein, a large vein that runs from the groin down the inner part of the thigh and right down to the ankle. A laser wire is inserted into the vein and threaded up to the point where the superficial vein joins the deep vein. The laser is turned on and slowly withdrawn, closing the vein as it goes. It requires only local anesthesia with some light sedation and has almost no downtime. It is very well tolerated and has a high success rate in closing the vein permanently. Small spider veins are treated with surface lasers that direct heat to the blood in the veins, destroying them in the process. It is important that the skin not be too tanned, as darker skin will absorb heat from the laser and burn the skin. It must be mentioned that laser treatment hurts more than injections, contrary to the public perception that lasers are painless.
Surgical treatment of veins is becoming less common as injection and laser techniques become more popular, but are still widely done in North America. The great saphenous vein is the subject of “vein stripping”. This procedure is done in an operating room and involves an anesthetic and several incisions along the course of the vein to tie off the branches. It has a considerably longer downtime compared to laser, usually in the range of 2 or more weeks, with more pain associated. Phlebectomy is the removal of veins visible from the skin surface and is an option for veins that don’t respond to injections or that aren’t appropriate for injection, like on the foot. It can often be done under a local anesthetic.
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