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Varicose Vein Stripping may not be the Best Treatment Option 2008-01-31 Dear Dr. Proskiw: I am 43 years old and my varicose veins are bothering me. I was told that my only option is varicose vein stripping is my only option. I have three children and my veins became most noticeable during my last pregnancy 11 years ago. I am active and not overweight and wear compression stockings but nothing seems to help. I now have burning feet at the end of the day, leg cramps at night, restless legs and itching ankles that drive crazy all night. Is there any treatment option besides surgical stripping? Answer: You have classical symptoms of advanced vein disease and if you don’t treat it you will probably develop an ulcer and skin discoloration and skin thickening in the area of you lower legs where you now experience itching. I would be interested in knowing if you have a family history of varicose vein disease and if you also had varicosities originating in the groin during your pregnancy? There are several new options now available for treating varicose veins including Endovenous laser and ultrasound guided Sclerotherapy using foam. Question: My mother has varicose veins and had hers stripped 30 years ago. She told me she would not have it done again since they came back and the procedure was very painful. It also took her 6 weeks to recover after getting an infection in one of the incisions. I do have some varicosities high up in the groin but was told nothing can be done for these. Can you tell me more about my treatment options? Answer: You first need a thorough venous evaluation including ultrasound by a medical doctor. Ultrasound is crucial in evaluating the vein system. It allows me to see where the problem if your varicose veins originate. Because the venous system in our legs have a series of valves to keep blood flowing towards the heart I need to know if all the valves are functioning properly. Ultrasound gives me this information. Usually there are defective, faulty or absent valves higher up towards the groin. When these valves fail to function properly the column of blood in the vein pools and dilates the vein. The pressure from the column of blood becomes greater and greater as the length of the vein and column of blood increases. This is why you first notice varicose veins in the lower part of the leg and symptoms are most severe in the calves and feet. Varicosities of the groin are common in women because they may communicate with the pelvic venous system. They are usually treated by sclerotherapy since this is a simple straight forward office procedure. There is no downtime and you can resume normal physical activities immediately. Question: Can you tell me more about laser vein treatments? Answer: If the varicose veins are large, I believe Endovenous laser treatment is the best treatment option available today. Small varicose veins are usually treated by sclerotherapy since this is a very effective treatment option. However if the vein measures larger than 8-9mm. by ultrasound examination at the groin I believe Endovenous laser is your best treatment option. It is 98% effective vs. 85% for surgical stripping and is a walk in walk out office procedure. The laser fiber is usually passed from below the knee to the groin under ultrasound guidance and when it is correctly positioned cauterizes the vein from the inside. This performed with only local anesthesia so the patient is awake and pain free. The patient is usually in the office for 1.5 – 2 hours, but the procedure usually takes less than 30 minutes to perform. This procedure is known by several trademark names that reflect the name of the laser used but all work basically the same. I use a laser procedure known as ELVeS or VVLT (Varicose Vein Laser Treatment). If you have any further questions or concerns please see your Primary Care physician for a referral to have complete venous assessment. If you have internet access I would suggest that you look at www.phlebology.org or www.aestheticsolutions..ca for more information on this procedure. Recommended Links: http://aestheticsolutions.ca/procedures/elves.html

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