Treatment of Varicose Veins of the Legs
Treatment of Varicose Veins of Legs
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Treatment of varicose veins is one of the main focuses of our vascular center. Varicose veins are abnormal bulging blue veins that lie beneath the skin of the legs (see About Varicose Veins page of website). These veins contain deformed valves that cause the veins to become dilated and the blood begins stagnate as the vein walls stretch and thin out. The blood that “pools” inside these bulging veins caused abnormal blood flow direction and pressure build-up inside the leg veins. These varicose veins cause a multitude of problems, ranging from unsightly cosmetic appearance to significant pain and swelling symptoms. Most of the people that present to the doctors with concerns regarding the varicose veins on their leg(s) present due to concerns about the appearance of the unsightly legs. They typically look as if they are bulging from beneath the skin and they have a blue discoloration to them. Many other patients presents with symptoms of vein or leg discomfort. The most common complaints of vein discomfort are aching, dull pain, throbbing, burning, itching, and pressure sensations. Other individual report fatigue of their legs when they are on their feet for prolonged periods of time. Another frequent symptoms of varicose vein disease is swelling of the lower leg, ankle, or foot. This gravity dependent swelling of the lower extremity is referred to by the medical term peripheral edema.
Luckily there are many available treatment options for varicose veins of the legs. These treatments range from treating mild disease with the use of prescription compression stockings and supplements to treating more severe disease with interventional procedures. Most of the vein procedures performed today involve minimally-invasive procedures that are performed in the doctor’s clinic. These more modern vein treatments have little associated pain or down time. The most common of these vein procedures involve the use of lasers, radiofrequency energy, or sclerotherapy solutions, all of which will be described below. Less commonly, more traditional surgery will be required, such as vein strippings or micro phlebectomy. Although these more traditional surgeries are a little more invasive, they are very effective; they are also sometimes the best option if the anatomy of the abnormal veins is not amendable to the other options. All of these treatment options tend to provide good cosmetic outcomes as well as excellent symptom relief.
Endovenous Laser Varicose Vein Treatment – EVLT
Endovenous Laser Varicose Vein Treatment, also known as “EVLT” is one of the most common varicose vein treatments performed in the United States today. It involves an office-based procedure in which the abnormal leg veins are first made numb with Novacaine and then a laser energy is used to heat the abnormal leg veins shut. This laser vein treatment is very well-tolerated by patients since it is associated with very little discomfort and allows return to work almost immediately. The success rate of the treatment is 98% effectiveness and so the patient satisfaction level with this therapy is very high. Our physician has performed thousands of these procedures and is considered a local expert in EVLT treatment. Dr. Gotvald has been performing these laser vein treatments since they were FDA approved in 2002, and has personally performed thousands of EVLT procedures.
Radiofrequency Varicose Vein Ablation Treatment – Venefit Procedure
One of the most modern varicose vein treatments available is known as radiofrequency ablation or the “Venefit” ClosureFast RFA procedure. This revolutionary treatment involves the use of the state-of-the-art technology of harvested radiofrequency energy. In essence, the electrical current produced by oscillating radiofrequency waves in harvested by a specially designed vein catheter. This varicose vein ClosureFast catheter then delivers the radiofrequency heat energy directly to the varicose vein wall, causing the vein to collapse and disappear. This technology has been FDA approved for vein treatments since 1999 and is now one of the most widely performed treatments for varicose vein disease. Our vein specialist performed a formal residency and fellowship in vein diseases at Baylor in Dallas, where he achieved expertise in performing this type of vein therapy.
Sclerotherapy of Varicose Veins – Vein Injections
Sclerotherapy is a proven effective varicose vein treatment that has been around since the 1920s. This therapy involves the introduction of a medication into the veins that causes them to collapse and fade away. The techniques have evolved so that is is now considered a very safe procedure for treatment of varicose veins. Some of the medical advances in sclerotherapy have included the use of high-resolution ultrasound machines to help visualize the veins, allowing more precisely delivery of the medication into the abnormal veins. Other areas of improvement have been the use of special lighting, such as near-infrared light, to help guide visualization of abnormal veins and to help guide injections. Such devices include the VeinViewer device, the AccuVein device, and the VeinLite, all of which are utilized at our vein center. Lastly, the advances in pharmaceuticals have made the sclerotherapy medications much safer, with minimal risk of side effects. The modern medications are now almost painless to administer, since they have a numbing quality to them. patient satisfaction levels with the treatment are above 85%.
For varicose vein sclerotherapy, a specially formulated drug referred to as Varithena is utlized. This medication is a patented microfoam that maximizes contact wall of the medication with the diseased vein wall. This leads to improvement in vein resolution and the patient satisfaction rate with the end results. Varithena also goes by the name of Polidocanol or foam sclerotherapy. Others refer to Varithena treatment as endovenous chemical ablation. The medication has been extensively tested in both Europe and the United States and it is felt to be very safe and very effective. Varithena is the only FDA approved microfoam for treatment of varicose veins. Varithena was released for use by the FDA in 2013.
VenaSeal Super Glue for Varicose Veins
The latest state-of-the-art therapy for the treatment of leg varicose veins is the use of a medical glue called VenaSeal. VenaSeal uses a patented vein glue to literally glue abnormal veins shut. The procedure is done under ultrasound guidance in the doctor’s office. This technology allows for closure of veins with almost no discomfort. Benefit of this medical “super glue” is less pain than conventional treatments, no need for any activity limitations after the therapy, and no need for use of hot uncomfortable compression stockings. Compression stockings are often required for up to 2 weeks after other varicose vein treatments, but they are not needed after VenaSeal therapy. VenaSeal only required a single IV access site for treatment, so only a single needle stick is needed. VenaSeal received FDA approval for use in 2015. This is the newest varicose vein therapy available.
Ambulatory Microphlebectomy Varicose Vein Surgery
Ambulatory micorphlebectomy (or simply “phlebectomy) involves numbing the leg with medication and then making small 2-3 mm incisions over the varicose veins to physically remove them. Some people may refer to this as vein stripping, but this is not correct terminology. Vein stripping is a older surgical procedure that required general anesthetic in the hospital. Stripping is more invasive and more painful that phlebectomy, and in modern times stripping is very rarely done. Phebectomy, on the other hand, is minimally invasive, is most frequently done in a physician’s office, is much less painful that stripping. Phlebectomy tends to give excellent visible results with a high patient satisfactino rate.
Despite the previously mentioned advanced vein technologies that were discussed in prior paragraphs, there is still an important role for phlebectomy in many individuals with vein disease. Your vein doctors will examine your legs and decide which option is best for you. An ultrasound of the leg veins is often necessary to help your vein specialist determine your best treatment options.
Cosmetic Varicose Vein Removal Procedures
In addition to the above mentioned procedures, there are also many other cosmetic vein treatments available, including the use of surface lasers, Veinwave treatment, VeinGogh treatment, the Clarivein Procedure, standard sclerotheray, and other ultrasound-guided therapies. Only a vein specialist can determine which treatment(s) are right for you. If you are interested in discussing cosmetic vein treatments with our board-certified vein specialists, please contact our office my email or phone using our Contact Page.