Treatment for Varicose Veins
Treatment for varicose veins depends on the cause and severity of the condition. In many cases, multiple modalities are used. For example, laser or radiofrequency ablation may be used in conjunction with sclerotherapy.
Compression stockings are the most conservative treatment. The stockings, which come in different lengths and pressures, do not cure the problem, but should improve symptoms. The valves remain incompetent (leaky) and once the patient removes the stockings, symptoms recur. Most insurance companies require a trial of wearing compression stockings (usually for 3 months) before authorizing payment for other treatments.
Sclerotherapy to Treat Varicose Veins
In this treatment, the physician injects the veins with a solution (e.g., sodium tetradecyl sulfate, Polidocanol) that causes irritation of the vessel walls and stimulates inflammation and closure of the vessel. Hypertonic saline may also be used; however, if this solution leaks out of or is injected outside of the vein, it can cause skin necrosis.
This therapy, which often is used in small and medium size veins, is not recommended during pregnancy or in nursing mothers because the safety has not been established.
Radiofrequency Ablation to Treat Varicose Veins
This treatment uses heat (high-frequency current) to shrink varicose veins. A small incision is made in the skin of the lower leg and a thin tube (catheter) is threaded up through the vein. Ultrasound is used to make sure that the catheter is in the right position. Once the catheter is in place, a local anesthetic is injected into the skin and tissues surrounding the vein to form a barrier that prevents energy from the treatment from harming other structures or tissue.
A metal electrode is then threaded into the catheter and deployed from the end of the catheter into the vein. This electrode comes into contact with the inside of the vein (endothelium) and heat from the electrode damages (ablates) the endothelium as the catheter is slowly pulled through the vein. The entire vein is treated, causing it to shrink, and the catheter is withdrawn.
Endovenous Laser to Treat Varicose Veins
In this procedure, a needle is placed into the vein through the skin and a laser fiber is inserted through the needle and advanced into the vein. The final position is confirmed by ultrasound as well as an "aiming light" that is projected from the end of the laser and can be seen through the skin when the lights are dimmed.
Local anesthetic is used to separate the vein from surrounding tissue so heat from the laser does not damage surrounding tissue. The laser is fired and then pulled back a short distance, damaging the endothelium and causing closure of the vein. This procedure is repeated along the course of the vein.