Common Treatment Options for Varicose Veins

The commonly used treatment options for varicose veins include; compression therapy, thermal ablation, sclerotherapy, phlebectomy and high ligation and stripping. It is important to familiarize yourself with these treatment types and then discuss the best option with your doctor. Most experts in the field of venous disease consider thermal ablation to be the safest, simplest, and most effective treatment type in producing the best long-term results when treating GSV or SSV problems.

Compression Therapy

This conservative treatment is aimed at wearing compression stockings. While this may alleviate some of the symptoms of varicose veins, it does not stop progression of the venous disease. Compression is measured in mmHg. Most people cannot tolerate more than 30 mmHg for prolonged periods of time. Compression therapy is typically used to temporarily relieve symptoms associated with varicose veins and is not a long-term solution to the underlying problem.

Thermal Ablation

This is done with either a laser or radio frequency (RF) catheter. The aim of both of these treatments is it to destroy the vein from the inside using heat. This requires a local anesthetic and an ultrasound. A small needle puncture is made in the saphenous vein. A guide wire is introduced through the needle and over this wire a catheter is placed. The catheter allows for the insertion of the laser filament or (RF) catheter. The filament is directed to just below where the saphenous vein comes off of the femoral vein (3cm below). Next the tumescent solution is placed around the saphenous vein and the laser is then activated and gradually pulled back along the course of the vein. A slightly different technique is used with RF. This heat damages the inside of the vein and over a period of time the vein scars and disappears.

Complications are possible with any medical procedure, however, are rare with thermal ablation. There is a very low incidence of deep venous thrombosis (clot) - (DVT) and infections and skin burns are very rare. Most patients have minor issues such as bruising and discomfort in the thigh. Walking soon after a treatment is encouraged. Tumesecent anesthetic is a very dilute solution of xylocaine, sodium bicarbonate, and epinephrine and in most patients, less than 500 cc is needed. A safe dose is over 3 liters.

In this photo, the catheter is placed in the saphenous vein. You can see the laser filament here just before it is placed in the catheter. Once the filament has been placed, tumescent solution is placed around the vein and laser firing begins.

Phlebectomy

Besides closing the vein responsible for the varices, many times your doctor will recommend a procedure called a phlebectomy. The visible veins protruding under your skin are actually branches from a deeper (superficial) vein. Even though the deeper vein, such as the GSV or SSV is removed or closed, these visible veins still remain. This is because the vein has been weakened beyond the point where it can contract to normal size. In this case, a phlebectomy offers the best cosmetic result for removing these veins. A phlebectomy is the removal of a vein through a very small incision under a local anesthetic. A small hook is passed through this incision to elevate and hook the vein. This may be done in conjunction with the primary procedure or done at a later date.

High Ligation and Stripping

This technique is rapidly being abandoned for newer treatments. This procedure requires an incision in the groin and a wire is passed down the saphenous vein so that it can be removed by a technique called stripping. However, this procedure just causes more veins to occur in the future. The invasiveness of this procedure causes more discomfort for the patient than other methods of treatment. You should avoid high ligation and stripping.

Sclerotherapy for GSV/SSV insufficiency

Internationally in many clinics, sclerotherapy is used to treat the incompetent saphenous vein. Most times, the chemical solution is mixed with a gas to form a mixture called foam. In most cases, this form of therapy is less effective than thermal ablation. However, many parts of the world do not have the capability to perform thermal ablations and the foam sclerotherapy technique provides a good alternative.

Follow-Up After Treatment

With any medical procedure, it is always important to schedule the recommended follow up visits with your doctor. Follow up visits are key in determining whether the procedure has produced the desired medical and cosmetic results. Remember that veins can reoccur years after the procedure through new channels and for this reason follow up is essential.

Ron Bush, MD, FACS
Peggy Bush, APN, CNS, MSN