A Closer Look at Varicose Veins
Varicose veins are enlarged and twisted rope-like veins that appear near the surface of the skin. While they can develop anywhere in the body, they are most commonly found in the legs and ankles because standing and walking increase pressure in the lower extremities. In normally functioning veins, tiny one-way valves open as blood flows toward the heart and close to prevent blood from flowing backward. When these valves malfunction, blood pools in the veins, resulting in a buildup of pressure that weakens their walls and causes them to bulge. Over time, the increased pressure can cause additional valves to fail. This venous reflux, or venous insufficiency, leads to the development of varicose veins and spider veins.
Although varicose veins are not life-threatening, a proper medical evaluation is important to rule out other diagnoses such as peripheral vascular disease , heart problems, and deep vein thrombosis.
Options for Minimally Invasive Treatment
Historically, ligation and vein stripping had been the main option - requiring anesthesia, more scarring, and recovery time.
Today, Dr Brooks offers three office-based, minimally-invasive options for varicose vein treatment:
- Sclerotherapy, for injection treatment of the small veins.
- Stab Phlebectomy, for treatment of medium-sized unnamed vessels
- EndoVenous Laser Treatment (EVLT), involving laser-based obliteration of the Greater Saphenous Vein, the Lesser Saphenous Vein, and the Anterolateral branch
Sclerotherapy uses an injection of a chemical (Sodium Tetradecyl) into a varicose vein to damage and scar the inside lining of the vein. This causes the vein to close.
During this procedure, the legs is elevated, the sclerosant is injected into the affected vein, and this is repeated depending on the determined need.
Afterwards, compression stockings may need to be worn in order to maintain pressure on the veins.
In this procedure, after numbing the each area, several tiny incisions are made in the skin, through which the varicose vein is removed.
Like Sclerotherapy, this procedure can be combined with other office vein treatments for optimal management.
Endovenous Laser Treatment (EVLT)
EVLT uses several steps to achieve vein closure in the
- Greater Saphenous Vein,
- the Lesser Saphenous Vein, and
- the Anterolateral branch vein
The procedure involves several steps. Dr Brooks will first use an ultrasound to map out the vein. A local anesthetic is injected. Then, a thin laser fiber is inserted through a tiny entry point, often near the knee. Laser energy is delivered to seal the faulty vein.
Walking immediately after the procedure is encouraged. Normal daily activity can be resumed - although strenuous activity should be avoided.
There may be minor soreness and bruising. Discomfort is generally manageable with NSAIDs such as Ibuprofen or Naproxen.
Compression stockings are often the first line of defense in treating venous conditions. They are commonly required by insurers prior to approval for the EVLT procedure reimbursement. Although compression stockings may alleviate some of the symptoms of venous disease, they do not directly treat its underlying cause (reflux or failed valves).
Gradient compression stockings give a gentle squeeze at the ankles and up the legs to get the blood flowing back toward the heart. Compression is tightest at the ankle, and gradually decreases up the leg.
Frequently Asked Questions
Q: How does EVLT work?
A: The laser energy damages the vein walls, shrinking them and closing the faulty vein so that the blood cannot flow through it. This eliminates vein bulging at its source.
Q: Is loss of this vein a problem?
A: No. After treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg.
Q: What are the complications of this procedure?
A: Occasionally a patient will have numbness, but this passes quickly.
Q: Am I at risk from the laser?
A: No. Just as a precaution against accidental firing of laser energy outside the body, you will be given a pair of special glasses to protect our eyes.
Q: How successful is EVLT?
A: Published reports show that EVLT has a 98% initial success rate with excellent long-term results.