Endovenous Laser Ablation for the elimination of varicose veins is quickly becoming the gold-standard in the treatment of varicose veins. Endovenous Laser Ablation uses laser energy, which is simply a highly concentrated beam of light. A thin fiber is inserted into the damaged vein through a very small entry point in the skin. A laser light is emitted through the fiber as the fiber is pulled back through the vein, delivering just the right amount of energy. The targeted tissue reacts with the light energy, causing the vein to close and seal shut. The veins that are closed are superficial veins that handle less than five percent of the body's blood flow. The blood is automatically routed to other, healthy veins.
Some physicians are now using a jacketed fiber, which prevents any contact between the fiber and the vein wall. This prevents much of the pain and bruising that is often associated with the more conventional method of ligation and stripping. Some patients may experience temporary soreness or some slight swelling, which can be treated effectively with over-the-counter, non-aspirin pain relievers and typically subsides within the first five days.
The procedure is minimally invasive and requires no general anesthesia. Only local anesthetic is used to numb the area where the physician is working. Patients are encouraged to walk immediately after the procedure and can resume normal activities the same day.
Radiofrequency Ablation (RF) is a minimally invasive varicose vein treatment procedure that uses radiofrequency energy (electricity) to heat, collapse and seal off the targeted blood vessels. A catheter (thin tube) is inserted through a small incision into the diseased vein and is threaded through the blood vessel into the groin area. Electricity is delivered to a heating element in 20-second pulses, heating and contracting the collagen within the walls of the vein until they shrink and shut down. This process is called ablation. The vein is treated in segments as the catheter is gradually inched back down towards the incision. When the entire vein has been ablated, the blood flow is automatically rerouted through healthier adjacent veins, restoring healthy circulation and reducing swelling. The ablated vein becomes scar tissue and is absorbed by the body.
Approved for use in the United States by the Food and Drug Administration in 1999, the RF treatment procedure is performed under local anesthesia in a physician's office, ambulatory surgical center or hospital. Patients are encouraged to walk immediately following the procedure, and are usually able to resume their normal activities within a day. The use of compression stockings is generally prescribed for a week or two.
The success rate of RF treatment is reportedly slightly lower than that of endovenous laser ablation, and the risk of developing deep vein thrombosis (DVT) or a pulmonary embolism (blood clot), while rare, is higher. Other potential side effects of RF treatment include temporary bruising, swelling and numbness of the treated area, thermal skin burns, numbness that comes and goes, and an allergic reaction to anesthesia.
The traditional technique for surgical stripping is ligation and stripping of the great saphenous vein (GSV), the long vein that extends from the anklebone along the inside of the leg and thigh and empties into the femoral vein in the groin. Ligation and stripping involves tying off the abnormal vein (ligation) and physically removing it (stripping).
Ligation and stripping are performed in a hospital setting or outpatient surgical center under local, spinal, or general anesthesia. The surgeon makes a small incision in the groin to expose the diseased GSV, which is tied off. The surgeon then makes a series of incisions along the leg from the thigh to a point just below the knee. Using a specialized stripping tool that is inserted and threaded through the incisions, the surgeon strips out the diseased vein.
During stripping, branch veins attached to the GSV are broken, causing blood to leak into surrounding tissues. This causes the postoperative pain, soreness and bruising experienced by ligation and stripping patients. Other potential complications include numbness from damage to surrounding nerves, chronic leg swelling from damaged lymphatic tissue, incision scars and allergic reaction to anesthesia. Although the patient is usually able to return home the same day, recovery from vein stripping surgery typically takes up to four weeks, with patients sidelined for several days in the beginning.
Ambulatory phlebectomy, a minimally-invasive surgical procedure that removes surface varicose veins, is usually performed in a doctor's office using local anesthesia. First, a local anesthetic fluid is injected into the area of varicose vein clusters to be treated. The doctor then uses a small scalpel or needle to puncture the skin next to the varicose vein, inserts a small hook into the hole, grasps the vein and removes it. The area is covered with a compression bandage and/or compression stockings. No stitches are required and the scars are nearly imperceptible. The patient is able to walk immediately following the procedure, which is often performed following an endovenous laser ablation procedure to remove any large surface veins left behind after the procedure. The possible risks of ambulatory phlebectomy include an allergic reaction to the anesthetic and localized numbness
The objective of the conservative approach in treating varicose veins is to help support the venous circulation of the legs in order to slow the development of new veins and to minimize symptoms. These treatment methods will not cure or eliminate existing vein problems, however, they will help slow the progression of the disease and alleviate symptoms such as swelling, aching, and cramping. As a result, conservative treatment is most suitable for people who are sick, elderly, or pregnant. Some of the more popular conservative treatments are:
Support compression stockings provide external graduated counter-pressure to aid in venous blood flow to the heart. They reduce pooling and pressure in the veins and may also reduce the risk of forming a deep vein blood clot. Consider wearing them during long plane or car rides.
Lifestyle changes include losing weight and increasing activity and exercise.
There is no known scientific method for preventing varicose veins, but there are ways of improving your circulation and muscle tone, thereby reducing the risk of developing varicose veins or getting additional ones. Some of the more popular preventive measures are:
Elevate Your Legs - Elevate your legs when possible by keeping your feet positioned higher than your heart level to reduce pooling and pressure on your legs.
Exercise Daily - Walking, climbing stairs, cycling and swimming keep your calf muscles in motion to activate the calf muscle pump. This reduces pooling and pressure in the veins.
Maintain a Healthy Body Weight and Diet - Maintaining your ideal body weight will reduce excess pressure on your legs. A low-salt, high-fiber diet can cut the swelling that results from water retention and constipation, plus it can help with weight loss.
Actively Moving - On long car or plane trips, activate your calf muscle pump by flexing your ankles periodically to pump the blood out of your legs (simulating walking). During periods of prolonged sitting or standing, flex your ankles 10 times and repeat this every 10 minutes. You should also consider stopping for short walks every few hours.
Avoid Sitting Extensively - Try to avoid sitting for extended periods throughout your day.
Avoid Excessive Heat - Try to avoid excess heat on your legs, such as hot tubs and hot baths. Heat tends to increase vein distention and lead to more pooling of blood.
Change Your Attire - Wear low heels instead of high heels. Not only are they vein friendly because they work calf muscles more, but they're more comfortable overall. Tight clothes (like panty-leg girdles, uncomfortable footwear and tight hosiery) can cut off blood flow to your lower body.