Varicose Vein Treatment Choices Hinge on Severity
When it comes to spider (superficial) veins and varicose veins, there are many different treatment options. Dr. Horowitz, a premier vascular doctor in Orlando at Central Florida Vein & Vascular Center, wants to make sure you understand the treatment options, and in which circumstances for which each is called. Not all treatments are appropriate in every instance.
Superficial and varicose veins occur when veins just below the skin’s surface become swollen with blood. Superficial veins tend to be smaller than varicose veins and can be blue, red or purple, and tend to occur on the legs and sometimes on the face. Varicose veins usually form in the legs and typically appear blue, swollen, kinked, or twisted. While varicose veins may sometimes cause discomfort, superficial veins usually don’t. Common symptoms of varicose veins often include a dull ache, leg heaviness or pressure, swelling in the feet and/or ankles, and itching near the site affected.
In many cases, a vascular doctor can treat both superficial and varicose veins with sclerotherapy, which is the oldest and most common treatment for superficial leg veins. In sclerotherapy, a sclerosing agent is injected into the veins to irritate them, which causes them to scar and become less noticeable. Sclerosing (which mean irritating) options include a concentrated (hypertonic) saline solution, foam or some other agent. In this procedure, the veins are not eliminated in most cases, but rather they become less visible. There is sometimes a slight discomfort at the injection site, but this does not tend to last long. Downtime is virtually nonexistent.
Veinlite-guided sclerotherapy is a minimally invasive form of the procedure using a special illumination tool to help the physician find the source of superficial veins. The Veinlite transilluminates the vascular structure; even the vessels not visible to the eye. This way, the physician can see all of the feeder vessels (reticular veins), even those that are four to eight inches away from the visible superficial vein where they originated, prior to injecting them with the sclerosing agent. This is particularly important, as finding and closing all feeder vessels is crucial to ensuring the superficial veins do not return. While Veinlite-guided sclerotherapy is good for treating superficial veins, there is another process for dealing with deeper sources of venous reflux.
Ultrasound-guided foam sclerotherapy is a needle-based technology that eliminates medium and large veins with an ultrasound machine employed to find the origin of the veins (which is the injection site). This treatment involves mixing a sclerosing agent with air or another gas to create a foam for the physician to inject into the affected vein. The foam causes a reaction in the vein that causes it to collapse, after which the body absorbs the vein with no scarring. With this technique, veins typically need only two or three treatments before they respond fully. At Central Florida Vein & Vascular Center, we have found this to be an outstanding procedure with excellent long-term cosmetic results.
Vein Stripping and Ligation
Considered obsolete and no longer the standard of care in the treatment of venous disease, vein stripping and ligation, is the oldest way of treating varicose veins. Vein ligation and stripping are just what it sounds like: a surgeon does surgery to cut out the bad veins. If several valves in a vein and the vein itself are heavily damaged, all or part of the vein is stripped (removed) as necessary. The surgeon makes an incision below the vein and then threads a flexible instrument up the vein, and then grips and removes the vein. Of course, there are remaining veins that must be ligated (tied off). The process of vein ligation and stripping is performed on as an outpatient procedure with local or regional anesthesia and typically doesn’t require a hospital stay. The recovery period usually means staying home from work for a few days and not resuming normal leisure activities until a few weeks have passed. This is why a skilled physician will chose a more minimally-invasive procedure.
Another outpatient surgical procedure is ambulatory phlebectomy, which removes veins through small incisions. With the patient under local anesthesia, the physician makes the incisions with a surgical blade, and then grasps the veins with a phlebectomy hook in the vein, or around the vein with a vein retractor. The physician then extracts the damaged vein. This procedure is referred to as ambulatory because patients usually return to normal daily activity immediately after the procedure, wearing compression stockings or bandages for one or two weeks afterward.
Fortunately, Central Florida Vein & Vascular Center is on top of the latest minimally invasive procedures and rarely has to resort to these more invasive procedures (vein stripping and ligation, and ambulatory phlebectomy). Instead, we perform sclerotherapy (mentioned previously) and laser therapy (see below) whenever possible to ensure a better overall patient experience.
Endovenous Laser Treatment
Laser therapy is another varicose vein treatment option. Because of the precision of the laser, this treatment can be used for even the smallest of varicose veins. Endovenous laser treatment (EVLT) is a minimally invasive alternative to surgical stripping. Between the procedure’s level of precision and less-invasive nature, it is greatly preferred over surgical stripping. Using ultrasound to view the veins, the physician uses heat (delivered through a small catheter or tube) to collapse and seal shut the vein. At Central Florida Vein & Vascular Center, we do this procedure in our offices with the patient under local anesthesia. Patient follow-up involves a leg wrap or prescription compression stocking, which is worn for a week or two. The good news is that patients are able to walk immediately after having EVLT, and most return to work the following day.
A Final Note on Venous Treatments
While it’s true that these treatments can relieve symptoms, they don’t guarantee against future occurrences of varicose veins. Nevertheless, it’s highly important to treat varicose veins as they arise. If you suffer from varicose or superficial veins, contact Central Florida Vein & Vascular Center at 407-545-3385 or 352-658-5547 today to set up a consultative appointment to talk with our vascular doctors in Orlando about what treatment is best for you.