Varicose Veins

Overview

Varicose veins are enlarged, swollen and twisted veins, appearing blue or dark purple in color. They result from a disorder in the circulatory system where faulty valves in the veins allow blood to flow in the wrong direction or to “pool.”

When veins become varicose, the valves in the saphenous veins in our legs no longer close properly, resulting in Venous Valve Incompetence. This causes the blood to accumulate in the lower leg instead of flowing upward to the heart, through the lungs where it is replenished with oxygen, and continue to be circulated throughout the body. This “pooling” of the blood in the lower legs, also known as Reflux Disease, is a chronic condition that leads to enlarged veins and corresponding medical and cosmetic issues.

More than 70 million people across the United States and Europe suffer from varicose veins. This includes approximately 23% of adults in the U.S. and 50% of adults over the age of 50. Women are more prone to developing varicose veins and make up 60% of those affected. Risk factors include pregnancy, family history and obesity.

More than 70% of patients with varicose veins suffer from reflux in the Great Saphenous Vein (GSV), which runs the length from the foot to the groin. The GSV together with the short or lesser saphenous vein make up the principle vessels of the superficial venous system in the legs.

Since the GSV is primarily responsible for returning blood back to the heart via the femoral vein, it is considered the main underlying cause of varicose veins and is therefore the most commonly treated.

Symptoms & Diagnosis

Varicose veins can range from small, purple lines on the surface of the skin (known as “spider veins”) to thick, bulging, cord-like veins that are often painful. In all cases, they are an indication of Venous Reflux or Insufficiency, which can lead to various medical issues and potential risks if left untreated. The worst of them include pain during both activity or rest, Restless Leg Syndrome (RLS), edema, heavy or swollen legs, or discoloration. Eczema, ulcerations and blood clots may appear during later stages of the disease.

The sheer prevalence of varicose veins and the substantial cost of treating late complications contribute to a high burden on health care resources and a significant reduction in quality of life.

Diagnosing varicose veins typically involves a physical exam to check for any swelling in the legs. Ultrasound imaging is used to identify a malfunctioning valve in the legs as well as potential blood clots. Further medical examinations can include Venography, Pletismography or CT imaging using contrast media. A physician will also refer to the CEAP medical classification system
where 1 is rated as a minor, light disorder and 6 is rated as severe.

The most common symptoms of varicose veins include:

  • Leg pain, fatigue & heaviness
  • Swollen ankles and calves
  • Restless Leg Syndrome
  • Skin discoloration, matting, induration
  • Visible tortuous varicosities
  • Pigmentation, eczema, lipodermatosclerosis
  • Skin ulcers- incurable wounds
  • Burning and itching skin
  • Skin sensitivity, susceptibility to outside impact, hemorrhage, thrombophlebitis.
  • Blood clots
  • Increased risk for DVT and tissue necrosis

Approaches to Treatment

Treatment of varicose veins has made great strides in recent years with a variety of options available to patients. These can range from traditional methods of ligation and vein stripping/removal surgery to newer modalities such as endovenous thermal or chemical ablation to seal the affected veins.

However, many patients avoid treatment due to concerns about the pain involved in these procedures, limited mobility and extensive recovery time. Potential complications pose another major concern with risks such as matting, induration, nerve damage and temporary neural disorders such as migraines or topical sensory loss resulting from either surgery or from the use of thermal energy within the vein that dissipates to the surrounding tissues.

The type of treatment chosen often depends on the site and severity of the disease, the age of the patient, vessel size and 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 and down to the lower leg. This is accomplished by either ablating the vessel walls or by blocking the damaged vein entirely.

Some of 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 phlebectomies. Typically performed in a hospital setting under general or spinal anesthesia, these procedures can take between 60 – 90 minutes with recovery time often involving a few days up to several weeks of hospitalization and limited mobility.

Endovenous Laser/Thermal/RF ablation: With these methods, an interventional radiologist or vascular surgeon guides a catheter through the vein under ultrasound imaging guidance. Thermal energy in the form of radio frequency, laser light or 120⁰ 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 from damaging nearby tissue and neural paths. Administering the tumescent anesthesia is a complex technique performed by a specialist prior to the procedure.

Sclerotherapy/chemical ablation: Widely considered 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 2-3 treatment visits, with compression stockings worn for 1-2 days to optimize the chances of treatment success. Varicose veins over 3mm in diameter require sclerosant in a foam form.

NT-NT (Non-thermal, 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 other closure system to target and seal the vein using either a sclerosing agent or cyanoacrylate (biological/tissue glue). The length of treatment and results may vary depending on the specific technique used.

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The Next Generation NT-NT Approach

Among the newer treatments available, VVT Medical offers an NT-NT approach that is superior to all known treatments. It is minimally invasive, non-thermal and tumescent-free, involves little to no pain, poses no risk for complications and delivers immediate, long-lasting results.