Varicose Veins are blue/green veins that appear near the surface of the skin. They are usually enlarged, tortuous, and bulging, but in some patients, they are not visible. A varicose vein may be normal size, but can still cause symptoms. Sometime, it may only be detected using a duplex ultrasound machine. It is a mistake to think that the vein has to be tortuous or visible in order to be considered a varicose vein. Many problematic varicose veins are not tortuous, and only found with the help of duplex ultrasound.
What Causes Varicose Veins?
Varicose Veins are caused by defective valves in the vein. Blood travels back to the heart through the veins with the help of one-way valves. When these valves malfunction, blood return is slowed and venous insufficiency occurs. This results in veins stretching out more, and more valves malfunctioning.
Varicose veins are caused by many factors:
- Family history
- Oral contraceptives
- Occupation that requires prolonged standing or lifting heavy objects, and
- Deep vein thrombosis
In addition, conditions that increase pressure in the abdomen, such as tumors, constipation, chronic cough, tight garments can worsen your condition.
What are Symptoms of Varicose Veins?
Initially you may notice just the appearance of the varicose veins. The following may be other symptoms you may experience:
- Legs feel heavy
- Tiredness in the legs
- Muscle cramps
- Burning / throbbing
- Waking up with leg pain
- Skin changes / darkened skin color
- Dry and inflammation of the skin
- Venous ulcers
Subsequently, these symptoms may worsen with prolonged sitting or standing. If you experience any of these symptoms, please call us today to schedule your consultation with Dr. Kim.
Compression therapy is frequently the first and most conservative step in the management of varicose veins. In fact, insurers often require that patients undergo conservative compression therapy prior to becoming eligible for reimbursement for Laser Vein Surgery or other more aggressive varicose vein treatments. Compression stockings are also often used following those same treatments to promote healing by lessening pain, swelling and bruising.
It is important to recognize that compression stockings can alleviate some symptoms of varicose veins but they cannot treat their underlying cause, failed valves (also called venous reflux). Even with faithful use of compression stockings, the disease may progress to the point that more advanced treatment is necessary.
Varicose Veins Treatment with EVLT
Varicose Veins Treatment with EVLT is quickly becoming the gold-standard in the treatment of varicose veins. Endo-Venous Laser Treatment (EVLT) uses laser, delivered via a flexible fiber optic fiber that allows for slight bending and curving. Medical lasers work by delivering this light energy to the targeted tissue with extreme precision, so as not to affect the surrounding tissue. Lasers have proven their safety and effectiveness through years of use in all types of medical procedures, from eye surgery such as LASIKS to kidney stone removals. In the hands of a skilled physician, lasers offer far less risk for complications than conventional surgery.
In EVLT, a thin laser fiber is inserted into the damaged vein through a very small entry point in the skin. A laser beam is emitted at the tip as the fiber is pulled back through the vein. The laser then delivers energy to the entire diseased veins, causing the veins 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 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 and/or light sedation is used. Patients are encouraged to walk immediately after the procedure and can resume normal activities the same day.
Ligation and Vein Stripping
Vein Ligation and stripping had historically been the “Gold Standard” for treating symptomatic venous insufficiency. As a matter of fact, in some backward surgical textbooks, it is still touted as the gold standard. However, with the new scientific data on this barbaric stripping procedure has made this procedure obsolete, if not undesirable. There is tremendous morbidity to this procedure due to pain, bruising, development of chronic nerve irritation, prolonged recovery and “down-time.” Stripping also stimulates incredible amount VEGF secretion along the old GSV track that many patients return to their surgeons with recurrent superficial varicosities and NEO-Greater Saphenous Veins.
The great saphenous vein is ligated (or tied off) near the groin to control gravitational flow of blood backward into the legs. Ligation alone can preserve the vein for subsequent harvesting in case of arterial bypass. However, ligation alone has proven unsatisfactory for preventing the occurrence of reflux, so it is often supplemented by vein stripping. Ligation and stripping require general anesthesia due to their excessive procedural pain, and usually require hospitalizations or severe pain, scarring and lost days from work.
Endovenous radiofrequency (RF) ablation is similar to EVLT except the energy source is RF energy (electricity). It involves insertion of a much larger catheter with bare metal electrodes via a much larger introducer needles. In recent years, endovenous laser therapy has surpassed radiofrequency vein ablation as the predominant minimally-invasive varicose vein ablation procedure due to the improved outcomes and decreased complications with Laser Vein Surgery procedure.
Minimally Invasive Therapies
Minimally invasive techniques are quickly replacing invasive surgeries for many types of therapies. Varicose vein treatment is one of those areas where advancements in technology have enabled physicians to simplify treatment. Typically, minimally invasive procedures do not require hospital stays and use local anesthesia rather than general anesthesia, thereby reducing the risk of some complications associated with anesthesia.