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Varicose vein - noninvasive treatment

Definition

Varicose veins are swollen, twisted, painful veins that have filled with blood. They commonly occur in the legs. Your doctor may be able to treat this problem in noninvasive ways. The traditional surgery for varicose veins is called vein stripping.

Alternative Names

Sclerotherapy; Laser therapy - varicose veins; Radiofrequency vein ablation; Endovenous thermal ablation; Transilluminated power phlebotomy; Endovenous laser ablation; Varicose vein therapy

Description

Valves in your veins keep your blood flowing forward so that it does not collect in one place. When you have varicose veins, the valves may be damaged, deformed, or missing. As a result, the veins stay filled with blood, especially when you are standing.

The problem is worse when you are standing. Varicose veins look like large, bluish vessels and may feel like a "rope."

Nonsurgical treatments for varicose veins can be done in a doctor's office or clinic. You will receive local anesthesia to numb your leg. You will be awake but will not feel pain.

Sclerotherapy is one common treatment for varicose veins. Your doctor will inject salt water (saline) or a chemical solution into the varicose vein. The vein will harden and then disappear. Sclerotherapy works best for small spider veins.

Other methods to treat varicose veins are radiofrequency ablation and endovenous laser ablation. 

Both of these methods uses intense heat to treat the vein. During these procedures:

  • Your doctor will puncture the varicose vein. Ultrasound is used to guide the treatment.
  • Your doctor will thread a a flexible tube (catheter) through the vein up to your groin. The doctor will inject a special solution into your vein to numb it.
  • The catheter will send intense heat to the vein. The heat will close off and destroy the vein and the vein will disappear over time.

Why the Procedure Is Performed

Most people should try self-care treatments first. Common self-care includes:

  • Keeping your leg raised
  • Wearing compression stockings.
Talk with your doctor about the kind of treatment that might be best for you if self care does not help.

Varicose vein therapy may be recommended for:

  • Making the leg (a common reason for sclerotherapy)
  • Easing leg pain (often described as a heavy or tired feeling)
  • Treating lipodermatosclerosis - fatty tissue under that skin that hardens over time from high blood pressure in a vein
  • Treating repeated phlebitis (inflamed or swollen veins)
  • preventing or treating skin ulcers or sores that are caused by poor blood flow in the veins

Risks

These treatments are generally safe. Ask your doctor about specific problems that you might have.

The risks for any anesthesia are:

The risks for any procedure are:

The risks of endovenous laser ablation are:

The risks of sclerotherapy are:

  • Blocked blood flow in the treated vein
  • Damage to surrounding tissue if the solution leaks out of the vein
  • Vein irritation

The risks of any treatment for varicose veins are:

  • Bruising or scarring
  • Nerve injury
  • Return of the varicose vein over time

Before the Procedure

Always tell your doctor or nurse:

  • If you are or could be pregnant
  • What medicines you are taking, even drugs, supplements, or herbs you bought without a prescription.

You may need to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and other medicines that make it hard for your blood to clot several days before your treatment.

After the Procedure

Your legs may be wrapped with bandages to control swelling and bleeding for 2-3 days after your treatment.

Most of the time, people can start normal activities within 1-2 days after treatment. You will need to wear compression stockings during the day for 1 week after treatment.

Your doctor may check your leg using ultrasound a few days after treatment to make sure the vein is sealed.

Outlook (Prognosis)

Most of the time, these treatments are very successful. They reduce pain and improve the appearance of the leg. Many of these treatments cause very little scarring, bruising, or swelling.

Wearing compression stockings will help prevent the problem from returning.

References

Freischlag JA, Heller JA. Venous disease. In: Townsend CM, Jr Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2012:chap 65.

Nijsten T, van den Bos RR, Goldman MP, et al. Minimally invasive techniques in the treatment of saphenous varicose veins. Journal of the American Academy of Dermatology. Jan 2009;60(1).

Van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten T. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg. 2009;49:230-239.

Review Date: 1/23/2013
Reviewed By: John A. Daller, MD, PhD, Department of Surgery, Crozer-Chester Medical Center, Chester, PA. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
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