Contemporary Noninvasive Varicose and Spider Vein Therapy

By: Lawrence D. Leigh, MD

Varicose veins are leg veins that have become abnormally enlarged due to high pressure. The most common cause of varicose veins is the presence of leaking (incompetent) valves in the superficial venous system. When healthy, these one-way valves allow blood to flow only upwards towards the heart. When the valves are damaged and don’t close, gravity pulls blood down the leg veins with force and, since the veins cannot empty efficiently, high pressure is generated and the veins bulge under the skin. This causes aching leg pain, a sensation of heaviness and muscle fatigue, worsened by standing or sitting for prolonged periods of time, itching, restless legs, eczema and leg cramps. In advanced cases swelling occurs, the skin is inflamed and stained brown and non-healing wounds may develop. Spider veins are tiny blue or red veins on the surface of the skin and occasionally cause mild itching or burning of the skin.

The most important factor for developing varicose veins is heredity. Varicose veins are much more common in women, particularly after pregnancy. Hormone medications, obesity, leg injury and standing occupations also increase one’s risk.

Varicose veins progress over time and don’t spontaneously improve. Symptomatic veins, those that have progressed to the advanced stages described above and those that are cosmetically unappealing should be treated. Varicose vein symptoms may improve with simple measures such as exercise (walking), and the use of medical-grade compression stockings. When conservative treatments are no longer effective, curative therapy should be undertaken. An essential portion of the evaluation is a Doppler ultrasound scan of the leg veins, to determine the most appropriate therapy.

In order to permanently eliminate varicose veins, the underlying incompetent source vein must be treated. Previously this was achieved by vein stripping, a surgical procedure in which the vein was removed. With modern noninvasive treatments the vein is left in place but sealed by a laser fiber inserted intravenously through a small needle stick. Once the vein closes, reversed blood flow is eliminated and blood is redirected to other healthy veins, in which it can flow normally. The elevated pressure is eliminated and the varicosities collapse. The residual larger varicose veins are then usually removed via a small skin nick made with the tip of a needle. The procedure is performed in the office, with local anesthetic and requires no scalpels or stitches. Afterwards, patients walk out of the office and return to their normal activities promptly. Postoperative discomfort is usually mild, requiring simple painkillers like Ibuprofen. Other treatments include sclerotherapy- the injection of an agent into the vein to collapse it. This is best performed on smaller veins and spider veins, and must usually be done repeatedly. Spider veins may also be treated by laser application to the skin surface. Surgical treatments such as vein stripping are performed in hospital under general anesthesia and can be avoided with the new nonsurgical options.

Modern vein therapy is safer and more effective than previously achievable.

Medically necessary varicose vein therapy is covered by Medicare and commercial insurance carriers.


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