Originally Published: March 9, 2014 6 a.m.
Newer outpatient treatments for varicose veins have come to the fore in the past decade, replacing the older technique of vein stripping and ligation. Use of laser, radiofrequency probes, foam sclerotherapy and microphlebectomy for treating varicose veins have all been used more or less interchangeably, but a recent study reported in The Journal of Vascular Surgery by Ronald Bush, M.D., has shown a definite advantage of using laser ablation for closing these veins.
Under local anesthesia, a laser is inserted into the problem vein and the vein is heated to seal it. This procedure called endovenous laser ablation can be completed in less than 30 minutes with the patient returning to work immediately. In the study, 95 percent of veins treated with laser remained closed after three years, whereas veins treated with other modalities including VNUS radiofrequency or RF had closure rates of only 80 to 90 percent, requiring retreatment of the same vein months or years later.
Varicose veins are only one symptom of venous disease and may require treatment even if they have been present for many years. Leg aching, heaviness, restless legs and cramps are all common symptoms of venous reflux disease. These symptoms appear so gradually, that many people mistake these aches as "just getting older." Other aches in the legs can be caused by sciatica, knee or hip problems or muscular disorders; however, venous disease is the most common cause of leg aching and leg cramps. An ultrasound study should be performed in most cases to determine if treatment is indicated.
Veins carry blood from the legs back to the heart. Since humans are upright most of the time, this presents the problem of how to pump liquid blood up hill against gravity. Veins are equipped with small flaps called valves which open and close to permit upward flow and prevent downward reflux of blood in the legs. As long as the valves do not leak, the system works quite well.
Aging, trauma to the legs, heavy lifting, standing for long hours and pregnancy all can damage valves, leading to reflux: the downward flow of blood in the leg veins. Reflux damages more valves since the pressure in the veins increases as blood pools in the legs. With increasing pressure in the veins, blood cells and plasma oozes out of the veins into the tissues of the leg. This increased fluid in the leg appears as swelling or edema, and red blood cells deposited in the skin break down releasing iron. Iron staining of the skin leads to mottled brown and eventually black discoloration of the skin of the legs. Iron is very irritating to the skin and will eventually lead to disruption of the skin called a leg ulcer or venous ulcer.
If left untreated, varicose vein disease can lead to leg ulcers, blood clots and chronic venous insufficiency. Because of the long-term risk of these complications, insurance companies routinely cover the treatment of venous reflux disease. Be sure to ask your physician whether laser or RF will be used to close your veins since it is now evident that laser ablation is a superior method.
To learn more about varicose and spider veins, visit www.prescottvein.com or call (928)778-7000.
Robin Fleck, M.D., is a board-certified dermatologist and internist. She is founder and medical director of Vein Specialties and Body Oasis Medical Spa, and is the director of Southwest Skin and Cancer Institute. Send questions via www.rejuvadoc.com.