Over 30% of adult Americans suffer from varicose vein disorders.
Varicose vein disorders include:
- Spider Veins
- Varicose Veins
- Thickening of the Skin
Symptoms include pain (usually described as burning, aching, and/or throbbing), heaviness, fatigue, and swelling.
Most patients with varicose vein disorders suffer from reflux (abnormal blood flow) in their saphenous veins. Normally leg veins carry blood back to the heart. Refluxing veins allow blood to flow backwards towards the foot. The result is pooling of venous blood in the leg leading to spider veins, varicose veins, and other manifestations of varicose vein disorders.
“Varicose veins are common. About 20% of Americans suffer from varicose veins. varicose veins aren’t just a cosmetic problem. They can cause a lot of physical and emotional suffering.
Varicose vein treatment plans usually begin with addressing saphenous vein reflux. Refluxing saphenous veins are treated by closing them-the medical term is ablation. Treatment closes only diseased veins. Healthy veins are not damaged. Once diseased veins are closed, blood is re-routed into healthy veins. Circulation and symptoms improve.
Saphenous vein ablations are minimally invasive office procedures. Patients return to their normal activities the same or next day. Post procedure discomfort is controlled with over-the –counter analgesics like Tylenol and ibuprofen. The incision is so small that no sutures or tapes are necessary.We have several modalities for closing saphenous veins-heat, pharmaceuticals, and “glue”.
Pharmaceutical ablation of saphenous veins
Pharmaceutical ablation of saphenous veins is closing them by injecting drugs called sclerosants. We use the same FDA approved sclerosants that we use for treating spider veins but in higher concentrations and after agitating the liguid into foam. Pharmaceutical endovenous ablation is often called endovenous foam sclerotherapy. Under local anesthesia, we insert a small catherter into the vein and inject the foam under ultrasound guidance.
Because foam sclerotherapy does not require the use of expensive disposable supplies, it is more affordable than endovenous thermal ablation. Health plans do not usually cover endovenous foam sclerotherapy but it is often a good treatment choice for patients whose treatments are not covered by insurance.
In 2014, the FDA approved a new proprietory foam sclerosant called Varithena. Varithena is more effective than other foam but it is also more expensive and not covered by all health plans.
Heat (Endovenous thermal ablations)
Heat treatments are called endovenous thermal ablations. We insert a spaghetti sized catheter into the vein around the knee and advance it so the tip is near the groin. We are guided by ultrasound. Because we have no feeling in our veins, patients have no pain from passing the catheter. After injecting local anesthetic in the tissues around the saphenous vein, energy is used to heat and close the vein.
Endovenous thermal ablation can be done with radiofrequency or laser energy. We have performed thousands of radiofrequency ablations and prefer t over laser due to its simplicity and safety.
Endovenous thermal ablation is the “gold standard” for saphenous vein ablation in the USA.
Venaseal is a promising new product for ablating saphenous veins. We insert a catheter like in endovenous thermal ablations but inject a cyanoacrylate-based medical adhesive instead of delivering heat. No peri-venous local anesthetic is necessary. Varicose veins are treated by removal and/or injections.
Ambulatory phlebectomy is the procedure used to remove varicose veins. We remove the veins under local anesthesia through multiple micro-incisions. Patients use over the counter analgesics like Tylenol and ibuprofen for discomfort and return to normal activities the same or next day.
Sclerotherapy is a vein treatment where pharmaceuticals called sclerosants are injected directly into the varicose veins or spider veins. Multiple treatments are usually required.
As of early 2016, few health plans are reimbursing for Venaseal treatments.
After saphenous vein ablation, varicose veins will sometimes return to their normal size, “normalize”. Often, however, varicose veins need to be directly treated after a period of observation or at the same time as saphenous vein ablation.
Your team at the Vein Clinic will educate you about these treatments and help you decide what will be the best plan for you.