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The 411 on Varicose Vein Treatments

Unsightly varicose and spider veins are easy to ignore when they’ve covered up during the winter, but when skirts and shorts replace winter pants they become painfully obvious.

Varicose veins are a result of venous insufficiency or poor venous circulation, explained Dr. Varuna Sundaram, a board certified vascular surgeon at Penn State Health St. Joseph.

varicose veins

This occurs when the deep veins that keep blood moving up from your legs to your heart and lungs do not work properly, and blood backs up into the superficial veins under the skin. The veins swell because of the blood that collects in them, resulting in varicose veins that are enlarged, bulging and often blue or red in color. Spider veins are smaller varicose veins that appear on the surface of the skin.

Varicose and spider veins don’t cause serious problems for most people, but they can be the source of pain or discomfort, and in some cases increase the risk of cellulitis and bleeding wounds. In severe, chronic cases, venous ulcers can occur and could result in the loss of a limb or even death, Dr. Sundaram said.

If you suffer from unsightly varicose veins, whether or not they cause pain or discomfort, there are effective evaluations and treatments that can help alleviate the condition.

The first step in treating varicose veins is graded compression stocking therapy which Dr. Sundaram called the “best first line, non-invasive method of treatment.” Also, many insurance companies require that compression therapy be tried before any other treatment will be approved.

If compression stockings fail to improve the condition, a vascular surgeon will use a venous duplex ultrasound to further evaluate and determine if a patient might benefit from surgical intervention.

If so, available treatments include the following:

  • Cosmetic laser surgery
    This procedure utilizes a laser that delivers pulses of light energy, causing blood within the vein to coagulate. This eventually destroys the vessel and forces the blood back into the deeper veins. Several treatments normally are needed to achieve optimal cosmetic results.
  • Sclerotherapy
    A solution containing an ingredient that irritates the vein lining is injected into the vein, causing an inflammatory response. That response results in localized swelling, or phlebitis of these tiny veins, and causes them to close. Several treatments are usually required.
  • Endovenous Laser Ablation Treatment
    A fairly new technique, endovenous laser ablation uses a laser to create intense, localized heat in the varicose vein. The heat causes the vein to shrink and close, but leaves it in place, causing little bleeding or bruising. The procedure requires no surgical incisions.

Cosmetic laser surgery, sclerotherapy and endovenous laser ablation treatment are performed in the office as outpatient procedures, requiring little or no anesthesia. Patients generally can resume normal activity with a day or two of the procedure. Typical time off for endovenous laser ablation is three days.

  • Vein ligation with stripping
    This surgical removal of the vein is the traditional treatment for large varicose veins. The procedure is performed in the operating room under anesthesia. Incisions are made at the groin and below the knee, and a wire passed through the vein. A bullet is attached to the end of the wire that, when pulled back, tears and removes the vein. Bleeding is minimized using compression stockings, but vein stripping can result in significant swelling and bruising that usually resolves within six weeks.
  • Ambulatory Phlebectomy
    Also performed in the operating room under anesthesia, this procedure entails making small incisions over bulging veins and using specialized tools to remove them. The tiny incisions do not require stitches and heal with minimal scarring, but can cause moderate bruises and discomfort. Compression stockings are used for several weeks following the procedure.

Vein ligation and ambulatory phlebectomy also are outpatient procedures, usually requiring three days off from normal activities.

Nearly a quarter of adults suffer from varicose veins, and 6 percent have more advanced, chronic venous disease that includes skin changes and venous ulcers, Dr. Sundaram said. If you are bothered by varicose veins and want to learn more about available treatments, which may or may not be covered by insurance, you can contact the Vein Center for a consult at 610-378-2499.

Varuna Sundaram, MD, RPVI, is a board-certified vascular surgeon at The Vascular Institute at Penn State Health St. Joseph. Appointments can be made by calling 610-378-2499.

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