Varicose vein therapy
Definition
Varicose vein therapy is used to treat enlarged veins (varicose veins) that have problems with their valves.
Alternative Names
Vein stripping; Sclerotherapy of veins; Endovenous ablation therapyDescription
Varicose veins usually occur in the legs. Normally, valves in your veins keep blood flowing. But the valves in varicose veins are either damaged or missing. This causes the veins to remain filled with blood, especially when you are standing.
Varicose veins treatments help remove non-moving (stagnant) blood and re-route blood flow through deeper veins in the legs. There are several types of treatment:
- Surgical vein stripping is an outpatient procedure. You receive general anesthesia, which means you are asleep and do not feel pain. The surgeon makes a cut at the bottom (ankle end) and the top (groin end) of the varicose vein. A thin, plastic, tube-like instrument is placed into the vein and tied around it. When the tube is pulled out, it pulls the vein from out under the skin. Small surgical cuts can also be made over individual veins to remove them.
- Sclerotherapy is done while the patient is standing. A solution is injected into each varicose vein to cause clotting, which closes off the vein. An elastic bandage is wrapped snugly around the legs after the procedure.
- Endovenous ablation therapy is an outpatient procedure. The therapy uses heat to destroy vein tissue. A thin catheter (or tube) is inserted into the vein through a tiny skin incision under local anesthesia. Then, using either laser or radiowave (radiofreqency) energy, the vein is heated and cauterized. This closes off the vein.
Today, fewer doctors are performing the traditional vein stripping surgery as more patients choose the less invasive endovenous ablation procedure. The endovenous ablation procedure has shown to work as well as surgery. Patients have significantly less pain and a quicker recovery.
Why the Procedure is Performed
Varicose vein therapy may be recommended for:
- Varicose veins that cause circulatory problems (venous insufficiency)
- Leg pain, often described as heavy or tired
- Skin irritation and sores (ulcers)
- Blood clots in the veins (phlebitis), which can travel to the lungs (embolism)
- Cosmetic purposes
Risks
The risks for any anesthesia include:
- Reactions to medications
- Problems breathing
- Bleeding
- Infection
- Bruising
Unique risks of endovenous varicose vein surgery include:
- Blood clots (call your doctor if your feet or legs swell)
- Treated vein opens up
- Skin burns from heated catheter
Unique risks to sclerotherapy treatment include:
- Irritation of the vein from the solution
- Blocked blood flow caused by the solution
- Leakage of the solution out of the veins into other tissue (can damage surrounding tissue and form ulcers)
Risks associated with any treatment for varicose veins include:
- Nerve injury
- Return of the varicose veins
Outlook (Prognosis)
Most patients who undergo varicose vein surgery have good results. Some patients, however, have inflammation and skin discoloration that last for several months following surgery.
Talk to your physician about these risks and your chances for good results.
Recovery
After endovenous ablation therapy and sclerotherapy the patient can almost immediately resume most of their normal activities. Surgical stripping usually requires at least 3 – 7 days rest, but you could need up to several weeks.
After treatment your legs are wrapped tightly in bandages. Walking is possible the day of surgery. In fact, walking is encouraged to minimize swelling and avoid the risk of deep venous thrombosis, especially with catheter or endovenous treatment.
It is important that feet are kept raised above the heart whenever possible.
References
Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg. 2007 Aug;46(2):308-15.
Kalteis M, Berger I, Messie-Werndl S, Pistrich R, Schimetta W, Pölz W, Hieller F. High ligation combined with stripping and endovenous laser ablation of the great saphenous vein: early results of a randomized controlled study. J Vasc Surg. 2008 Apr;47(4):822-9.
Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 68.
Reviewed By: Shimul A. Shah, MD, Assistant Professor of Surgery, University of Massachusetts Medical School, Worcester, MA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
