VASCULAR & IR
Venous Disease: Varicose Veins and Venous Insufficiency
Nonsurgical Outpatient Procedure Treats Varicose Veins
Venous insufficiency is an abnormal circulatory condition, with decreased return of blood from the leg veins up to the heart and pooling of blood in the veins. Normally, stop valves in the vein close to keep blood from flowing downward with gravity. When the valves in the vein become weak and do not close properly, they allow blood to flow backward, or reflux. Varicose veins are prominent veins that have lost their valve effectiveness and, as a result of dilation under pressure, become elongated, rope-like, bulged and thickened. A common cause of varicose veins is reflux within the greater saphenous vein in the thigh, which leads to pooling in the visible varicose veins below.
Symptoms caused by venous insufficiency and varicose veins include aching leg pain, easy leg fatigue, and leg heaviness, all of which worsen as the day progresses. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms. In more severe cases, venous insufficiency and reflux can cause skin discoloration and ulceration that may be very difficult to treat. One percent of adults over age 60 have chronic ulceration.
People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins as well as from varicose veins because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.
Diagnosis & Assessment
An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, will use duplex ultrasound to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. The doctor will map the greater saphenous vein and examine the deep and superficial venous systems to determine whether the veins are open to pinpoint any reflux. This will help determine if the patient is a candidate for a minimally invasive treatment, known as vein ablation.
Minimally Invasive Vein Ablation Treatment
This minimally invasive treatment is an outpatient procedure performed using imaging for guidance. After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the greater saphenous vein in the thigh. Then laser or radiofrequency energy is applied to the inside of the vein. This heats the vein and seals it closed.
Reflux within the greater saphenous vein leads to pooling in the visible varicose veins below it. When the greater saphenous vein is closed, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.
Benefits of Vein Ablation Treatment
The treatment takes less than an hour and provides immediate relief of symptoms.
Immediate return to normal activity with little or no pain.
There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
No scar; because the procedure does not require a surgical incision, just a nick in the skin about the size of a pencil tip, there are no scars or stitches.
The success rate for vein ablation ranges from 93-95 percent.
Many insurance carriers cover the vein ablation treatment, based on medical necessity for symptom relief.
Surgical Treatment of Veins
Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures. One study found a 29 percent recurrence rate after ligation and stripping of the great saphenous vein, and a rate of 71 percent of high ligation. These recurrence rates are similar to those reported in other studies.
Other Treatments for Varicose Veins
Ambulatory phlebectomy and injection sclerotherapy are also use. Ambulatory phlebectomy is a minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.
Injection sclerotherapy can be used to treat some varicose and nearly all spider veins. An extremely fine needle is used to inject the vein with a solution that shrinks the vein.