WHAT CAUSES VARICOSE VEINS?
Veins have one way valves to keep the blood flowing back to the heart. One of the reasons varicose veins develop is because damaged valves inside the veins allow blood flow in the wrong direction. As the blood pools in the veins, pressure builds up, and the veins dilate and lengthen, causing symptoms and the sometimes visible veins known as varicose veins.
WHO GETS VARICOSE VEINS?
About 50 to 55% of American women and 40 to 45% of American men suffer from some form of vein problem. Varicose veins affect 1 out of 2 people age 50 and older. Over 80 million people suffer from varicose veins. It is a very common disorder.
HOW ARE VARICOSE VEINS DIAGNOSED?
Dr. Sussman will perform a history and physical to evaluate both your general health and find out the specifics about your leg discomfort. You will also have a venous mapping. This is a non-invasive, painless test done with ultrasound that will allow Dr. Sussman to evaluate your deep and superficial veins. Dr. Sussman will determine your specific venous anatomy, vein sizes and if you have abnormal blood flow in your leg veins.
WHAT TYPES OF TREATMENTS ARE AVAILABLE FOR VARICOSE VEINS?
Some of the modern treatments used are endovenous ablation, ultrasound guided sclerotherapy and microphlebectomy. These treatments address varying sizes, shapes and locations of varicose veins. Together three types of treatment are utilized for complete and comprehensive treatment of varicose veins. Most patients tolerate these office procedures very well (some patients fall asleep) and report very little discomfort following the procedure as well.
Varicose veins before and after treatment
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WHAT IS ENDOVENOUS ABLATION?
This is a procedure where a physician uses ultrasound guidance to direct a laser fiber into the damaged vein. Anesthetic fluid will be injected around the vein to protect the surrounding tissue. A laser will be activated and will seal the unhealthy vein closed with heat energy. When the unhealthy (varicose) vein closes off blood is then redirected to healthy veins. This procedure is usually done in conjunction with ultrasound guided sclerotherapy and or micro-phlebectomy.
CAN ALL VARICOSE VEINS BE TREATED WITH ABLATION ALONE?
INJECTIONS ALONE? MICROPHLEBECTOMY ALONE?
No. Different types of superficial veins require different approaches. The Saphenous Veins (which are visible with ultrasound) are usually ideal for ablation (which provides the highest vein closure rate). Tributary veins, which are often not appropriate for ablation, are more superficial but often not visible. Tributary veins respond very well to ultrasound guided sclerotherapy after the initial laser ablation. Large tributary veins that are visible on the skin surface respond very well to microphlebectomy. All three approaches are necessary for comprehensive treatment. Treatment of varicose veins is a process- it is not a “one and done” procedure.
WHAT IS ULTRASOUND GUIDED SCLEROTHERAPY?
A sclerosant medication is injected into the vein using ultrasound guidance. This confirms correct needle placement and flow of medication. This treatment is often used in conjunction with ablation. Patients who receive a combination of endovenous ablation, ultrasound guided sclerotherapy and phlebectomy typically have significantly better relief of symptoms than patients who merely receive one type of treatment. Patients who receive the benefit of these three treatment methods in combination can expect much higher vein closure rates and longer lasting symptomatic relief. This is because both large AND small diseased veins are treated leaving only healthy veins.
WHAT IS A MICROPHLEBECTOMY?
Microphlebectomy involves using a medical instrument to make tiny incisions where large bulging veins are visible when standing. This is performed with a local anesthesia that is used to numb the skin of the leg. This procedure may be done on the same day as endovenous ablation or during a separate appointment. There is no down time, patients may return to normal activity after the procedure. The benefit is that the visible superficial veins are removed immediately.
Vein stripping and/or ligation may also be utilized to treat large varicose veins. This often requires several weeks before patients may resume normal daily activities. The stripping procedure usually requires a hospital stay and is performed using general anesthesia. Risks of vein stripping are significant. General anesthesia has some associated serious risks as well. These procedures were much more common in the past when better alternatives did not exist. Many physicians dedicated to providing state-of-the-art treatment for varicose veins consider vein stripping virtually obsolete.