Varicose Vein Surgery

Is it time for Varicose Vein Surgery or a Minimally Invasive Treatment?

Compression hose, elevation, exercise, appropriate clothing and shoes, weight loss, and avoidance of heat are all excellent options to treat the swelling, throbbing, heaviness, and cramping of varicose veins.  There comes a time when these therapies may no longer provide relief, or other complications arise such as weeping from the legs, skin ulcers or infections, and blood clots in the varicose veins. When that occurs, it may be time to consider alternative therapies. These alternative therapies are procedural, or surgical, performed by a vascular surgeon. 

There are three "surgical" options for varicose veins:

• Sclerotherapy
• Endovascular laser therapy (EVLT)
• Surgery

Sclerotherapy

Sclerotherapy is a procedure that is performed in the clinic.  This type of treatment uses a special type of medication, called a sclerosing agent, that causes scarring.  A local acting numbing medication is placed around the area of the vein and the sclerosing agent is administered directly into the vein to allow the vein to scar.  The scarring prevents blood flow in that vein and the blood flow must move through alternate veins in the legs.  Sclerotherapy works best for smaller varicose veins or those found on the surface of the skin, called spider veins, and is less effective for large varicose veins.  

Endovascular laser therapy (EVLT)

Endovascular laser therapy (EVLT) is another clinic based procedure that uses an endovascular laser that uses a type of light radiation.  Much like sclerotherapy, only local anesthetics on the skin and surface tissue are used prior to an incision being made in the vein.  A long tube-like structure, called a catheter to allow for the placement of the endovascular laser.  The endovascular laser is then slowly moved through the vein allowing the radiation to scar the vein. 

This scarring causes the vein to close off, preventing any blood flow.  Blood will flow through alternate veins to return to the heart.  This procedure is better at treating large varicose veins than the sclerotherapy and usually only a single procedure is necessary.  It is also a largely successful procedure, with about 90% of patients being successfully treated.  The veins may shrink after EVLT, but those concerned with the cosmetic appearance of their legs may need other procedures.