By Dr. Cohen
Venous insufficiency, or varicose veins, typically affects only the superficial veins of the skin. These veins are ubiquitous and normally carry very little blood. While these veins are not very important even when functioning normally, they can be quite problematic when they shift into reverse.
The main concept of treatment is to stop the reverse flow by either 1) closing these veins or 2) removing the veins altogether.
The first line of treatment is called conservative therapy.
The mainstay of this approach is “graduated” compression stockings which must be prescribed by your doctor. Stockings do not cure the condition. They squeeze the skin veins shut and prevent the backwards blood flow. For stockings to work they must typically be worn during all waking hours, indefinitely.
Other “conservative” measures include regular exercise, weight reduction, leg elevation, and avoidance of prolonged standing. Meanwhile, over the counter analgesics can ease pain and anti-histamines can stop itching.
When symptoms fail to respond to conservative treatment, definitive therapy is indicated. Definitive therapy involves either closing or removing the abnormal veins. While invasive vein surgery by a vascular surgeon was the only treatment in the past, now much easier and less invasive treatments are recommended.
Typically treatment starts at the top and proceeds down the leg, starting with the larger veins and proceeding to the smaller ones. A simple, painless ultrasound test allows your doctor to identify exactly which veins to treat. But because most venous ultrasounds are done lying down in order to just look for clots, this specialized ultrasound test should be performed in a standing position, in a vein specialist’s office, in order for a proper diagnosis to be made.
Closing the larger, straighter veins can be done with either endovenous laser ablation (EVLA – using laser energy to heat the vein), or radiofrequency ablation (RFA – using radio waves to heat the vein). We prefer the laser treatment. Unlike older vein surgery, these treatments can be performed in an office setting under local anesthesia and without any incisions or scars.
More effective on the smaller, less navigable veins, is sclerotherapy. These are typically the ones that you actually see on the surface of the skin. This involves injecting a medication into the vein that shuts it down. There are a variety of very safe, FDA-approved, and effective medications (called sclerosants). When the veins are not plainly visible, because of their depth, ultrasound imaging is used to guide the injections.
In the past, the standard treatment was to surgically remove problem veins with an operation called “stripping”. You may have heard of it. It was performed by vascular surgeons and involved general or spinal anesthesia, surgery, significant recuperation time, and residual scars. Thankfully, it’s an approach that has been replaced in most cases with less invasive laser or radiofrequency methods.
Today there are a lot of choices for alleviating and removing problem veins. Find out what your doctor recommends, and always why.
You can arrange for a quick and easy consultation right now by calling 201-265-5300.
About us: There are 20 million Americans with vein problems that can seriously affect the quality of their lives. And as we age, they just get worse. As one of the few New Jersey medical practices committed exclusively to vein care, Advanced Vascular Vein Care is uniquely capable of alleviating those problems, whether they are medical or cosmetic. All treatments are non-surgical, usually covered by insurance, and delivered in an office setting. And we do it as it should be done – with compassion, excellence, affordability, convenience, and the personal touch. Call 201-265-5300 or visit AdvancedVascular.com for a quick and easy consultation.