Venous insufficiency is a very common condition that is caused by decreased blood flow from the leg veins up to the heart, resulting in the pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing up toward the heart. When these valves become weak and don’t close properly blood collects in the legs and pressure builds. The result can be twisted, enlarged veins near the surface of the skin, generally in the legs and ankle.
Risk Factors for Varicose Veins
- Family history
- Female gender
- Pregnancy, especially multiple pregnancies
- Being overweight
- Stand for long periods of time.
In general, varicose veins are not a sign of a serious problem. In some cases, varicose veins can be a sign of a condition called deep vein thrombosis that may require treatment.
Patients who need treatment or who are concerned about the appearance of varicose veins have several options, including:
- Sclerotherapy to close off the vein
- Laser treatment to destroy the vein
- Radio-frequency treatment to close off the vein
- Surgery to tie off or remove the vein
A common cause of varicose veins in the legs is reflux in a thigh vein, called the great saphenous, which leads to pooling in the visible varicose vein below. Chronic venous disease of the legs is one of the most common conditions affecting people of all races.
Diagnosis and Assessment
Duplex ultrasound can be used to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. The doctor will map the great saphenous vein and examine the deep and superficial venous systems to determine if the veins are open, and to pinpoint any reflux. This will help determine if the patient is a candidate for a minimally invasive treatment, known as vein ablation.
Minimally Invasive Vein Ablation Treatment
This minimally-invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, interventional radiologists insert a thin catheter into the vein and guide it through the great saphenous vein in the thigh. Laser or radio-frequency energy is applied to the inside of the vein to heat it and seal the vein closed.
Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. When doctors close the great saphenous vein, it often causes the twisted and varicosed branch veins, which are close to the skin, to shrink and improve in appearance. After the diseased vein is closed, other healthy veins take over to carry blood from the leg and re-establish normal flow.
This treatment takes less than an hour and usually provides an immediate relief of symptoms and return to normal activity with little or no pain. There are no scars or stitches because the procedure does not require a surgical incision. It only requires a nick in the skin, about the size of a pencil tip.
There is a high success rate and low recurrence rate compared to surgery. The success rate ranges for vein ablation ranges from 93 to 95 percent.
Surgical Treatment of Veins
In the past, surgical ligation or vein stripping was the most common treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures. One study found a 29 percent recurrence rate after ligation and stripping of the greater saphenous vein, and a rate of 71 percent after high ligation. These recurrence rates are similar to those reported in other studies.
Ambulatory phlebectomy is a minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.
- Injection sclerotherapy involves the use of an extremely fine needle to inject a solution that helps shrink the vein. This therapy can also be used to treat some varicose and nearly all spider veins.
- During ultrasound-guided sclerotherapy, an interventional radiologist passes a thin tube called a catheter into the vein using ultrasound guidance and injects a substance that causes the veins to scar and close. Blood flow is then rerouted to healthier veins. The affected vein forms a knot of scar tissue that is absorbed by the body over time.