Treatment Methods

How are varicose veins treated?

Generally, there are two options: 1) conservative measures such as compression stockings or, 2) corrective measures such as thermal ablation treatment, surgery and/or sclerotherapy. In many cases, a combination of treatment methods works best.

Do all treatments remove the varicose veins?

No, certain procedures like Laser/RF treatment only remove the source of the varicose veins, in most cases the saphenous vein. This is analagous to fixing a leaky basement. If you stop one source of water getting into the basement sometimes the rain water will find another way. It may take a little time, but water usually finds the way. The same holds true for a varicose vein. By eliminating the saphenous vein, this may diminish or eliminate the symptoms of the varicose vein, but the vein is still there and if the blood finds another way to it, then the varicosity may return.

Surgery

Surgery is generally used to treat large varicose veins and may be performed using local, spinal or general anesthesia. It is performed in either a manual or powered (TRIVEX) manner.

Traditional surgical techniques to treat varicose veins include ambulatory hook phlebectomy and stab avulsion, which involve making numerous (5 - 40, or more) small incisions and “blindly” hooking the veins to pull them out manually.

Laser/RF Treatment

Several types of thermal (i.e., heat) ablation devices are available today as a treatment for the condition of varicose veins. In these treatments a laser (light beam) or radio-frequency (heating element) probe is pulsed into the saphenous vein in the thigh area to seal it off and cause it to collapse. It is the faulty one-way valves in the saphenous vein that allow blood to flow back (“reflux”) into lower veins and make them varicose. The thermal ablation devices are rarely used on the varicose veins themselves; only on the saphenous vein, which is the source of the varicose veins. Sealing off the saphenous vein relives the pressure on the varicose veins and causes them to shrink, which will also alleviate the symptoms. However, in the future the varicose veins may reappear and become symptomatic again (fed by newly developed sources of blood flow) since they have not been removed with these treatments.

Other Treatment Methods-Sclerotherapy

Sclerotherapy is usually used to treat smaller varicose veins and spider veins (“telangiectasias”) often times without anesthesia.

In sclerotherapy, a tiny needle is used to inject the vein with a medication that irritates the lining of the inner vein wall. This causes the vein to collapse. The surface veins are no longer visible, and most patients experience symptom relief.

Several sclerotherapy sessions may be required for any vein region. Treatment of tiny spider veins is often consider a cosmetic procedure and is not covered by insurance.

Complications of sclerotherapy are rare but can include blood clots and ulceration. Anaphylactic reactions are "extraordinarily rare but can be life-threatening," and doctors should have resuscitation equipment ready. There has been one reported case of stroke after ultrasound guided sclerotherapy when an unusually large dose of sclerosant foam was injected.