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.
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.
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.
True complications after thermal ablation are very rare.
There have been a few reported cases of pulmonary embolism (PE) - (clot to lung), after these procedures. The occurrence is very rare, but if you have chest pain or difficulty breathing after having this procedure, you should immediately go to the emergency room.
DVT is also rare, but a clot may occur in the femoral vein after these procedures. In most cases, these clots are of no clinical significance and go away after a week or two. The clots are called endovenous heat induced thrombus EHIT). If the clots are large, your doctor may prescribe an anticoagulant (blood thinner), for a week or two.
Untreated superficial varicosities may clot after thermal ablation because the source of reflux is closed (saphenous vein). Many times this can be prevented by doing a phlebectomy with thermal ablation.
Infection is extremely rare.
Pain and discomfort may occur in some patients and gradually resolve over a week.
Sometimes you may get mild sensory nerve damage. This can occur on the lower medial or lateral side of the lower leg. This occurs because the sensory nerve branch may be very close to the greater saphenous vein or small saphenous vein. With surgical techniques (high ligation/stripping), this occurs much more frequently.
Allergic reactions can occur and are extremely rare with lidocaine which is the medication used for the tumescent anesthesia.
Remember this procedure forms a clot in the treated vein, but is a clot that the laser or radio frequency makes and acts much different from a clot your body makes. All this means, is that this clot does not travel.
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.
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.
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.
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.