Approaches in Treatment
Major advancements in treatment in recent years have provided significant improvements in how varicose veins are treated. Today the different treatment options for patients can range from traditional High Ligation & vein stripping surgery to newer modalities like endovenous thermal methods or chemical ablation. However, concerns about painful procedures, limited mobility and extensive recovery time as well as post procedure inconvenient bandaging continue to be among the most common reasons patients may avoid treatment. Potential complications pose another major concern with such known risks as matting, induration, nerve damage and temporary neural disorders like migraines or local sensory loss resulting from procedures involving surgery or The use of thermal energy endovenously.
Oftentimes the type of treatment chosen depends on the treating physician. These can include vascular surgeons, interventional radiologists, dermatologists, phlebologists, Interventional cardiologists and general physicians. Regardless of modality, the goal of treatment is always the same: to safely and effectively seal the vein to prevent the reflux or backwards flow of blood into the vein. This is accomplished by either collapsing the vessel walls to induce healing or by blocking or “stripping” the damaged vein entirely.
Some the most common procedures used in practice today are:
- Surgical intervention: These procedures are most commonly used to treat varicosities of the GSV, and include high ligation, vein stripping and phlebotomies. Typically performed in a hospital setting under general or spinal anesthesia, these procedures can take between 60 – 90 minutes with recovery time often involving some days up to several weeks of hospitalization \ limited mobility.
- Endovenous thermal ablation: In endovenous thermal ablation, an interventional radiologist or vascular surgeon guides a probe through the vein using guided ultrasound. Thermal energy in the form of radio frequency, laser light or 120deg. Steamed water is then applied to contract and seal the vessel. Tumescent anesthesia is administered to minimize the patient’s discomfort as well as to isolate the vein in order to prevent the heat created by the thermal ablation from damaging nearby tissue & neural paths. Administering the tumescent anesthesia is a complex technique performed by a specialist prior to the procedure.
- Chemical ablation: Widely considered as the gold standard for treating varicose veins, sclerotherapy involves injecting sclerosing agents into the vein in either liquid or foam form under ultrasound guidance. This minimally invasive procedure irritates and damages the vessel wall, stimulating the body’s natural health process and causing the vein to close. Sclerotherapy often requires 4 – 5 treatment visits, with compression stockings worn for up to two weeks to optimize the chance of treatment success. Varicose veins over 3>4mm diameter requires foaming the sclerosant.
- Non-tumescent treatments: The newest set of minimally invasive procedures are non-thermal, and can be performed without applying heat. This eliminates the need for tumescent anesthesia, allowing physicians to perform the procedure with minimal patient discomfort or risk of nerve damage. Such procedures use an infusion catheter or closure system to target and seal the vein using either a sclerosing agent or a special chemical “glue”. The length of treatment and results may vary depending on the specific technique used.
As newer treatments for varicose veins come to market, physicians and their patients will benefit from those that address concerns about pain, potential risks and limited mobility, while delivering better, longer lasting results to optimize success.