Dr. Ari Salis, M.D., an interventional radiology specialist at Concord Hospital, recently discussed varicose veins and various treatment options at a panel presentation in Laconia that featured numerous providers from the Concord Hospital Cardiovascular Institute.
What are varicose veins?
There are two types of veins: deep veins and superficial veins. Varicose veins occur in the superficial veins when blood fails to return to the heart and instead refluxes, or moves backward and pools. This causes the vein to swell, creating a twisted and bulging appearance under the skin. Varicose veins usually occur in the legs and are relatively common, affecting around 20 million people in the United States. Though not usually considered to be very serious, varicose veins can cause discomfort, indicate other health issues, or lead to more concerning conditions.
What causes varicose veins?
Valves within the veins may become stretched or weakened allowing for reflux. Numerous things can cause this weakening such as obesity, pregnancy, age, and trauma. Another potential cause for varicose veins is standing for long periods of time. Also, there may be a genetic factor to the formation of varicose veins, making them possibly hereditary.
Why is it important to treat them?
Though aesthetics may play a role for many, it is not the only reason to seek treatment. The presence of varicose veins can cause fatigue, aching, swelling, pain, itching, throbbing, and restless leg syndrome. Even more serious is the potential for the progression to skin changes and ultimately a venous stasis ulcer, which can be very difficult to treat.
What treatment options are available?
Historically, the gold standard of care for varicose veins was surgery called vein stripping. This procedure requires an overnight stay, involves significant patient discomfort, has a significant risk of complications, and necessitates a long recovery time. Now, we do it from the inside out using a minimally invasive, ultrasound-guided procedure that employs a laser. Endovascular laser venous treatment is primarily performed by interventional radiologists and involves inserting a small tube into the vein, numbing up and down the entire vein, and then passing a laser fiber back and forth for three to five minutes to close off the problematic vein. This procedure is minimally invasive, quick, and results in minimal discomfort and few complications. It is performed on an outpatient basis and is very effective, with a closure rate of 88 to 100 percent. Symptom relief is typically seen three days post-procedure with appearance improving in four weeks. Another treatment option called sclerotherapy is available for small varicose veins and spider veins. This treatment involves injecting a medication directly into the problematic veins causing them to dry out, shrink, and to eventually disappear as the body absorbs them.
What are some new treatment developments?
A newer procedure, known as Venaseal, has been shown to rival the laser in its effectiveness. Also minimally invasive, a catheter is guided by ultrasound to the end of the vein and is withdrawn slowly as an applicator injects glue in precise quantities. The procedure is repeated in five-centimeter intervals and seals off the vein with a 96.4 percent closure rate. Another option that is now available is called Varithena, which uses similar techniques to inject foam into the veins. This procedure is very low-risk and is even less invasive with an 85 percent closure rate.
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