What you need to know about venous disease and treatment:
Veins are the blood vessels that return blood from the body to the heart. In healthy veins, one-way valves allow blood to move from the legs toward the heart. When these valves fail to function properly, blood leaks backward into the vein (a condition known as reflux). Blood may then pool in the veins, causing the walls of the veins to enlarge. This bulging appears as varicose veins.
The first step in the treatment of advanced venous disease involves closing the Greater Saphenous Vein (GSV), a large vein that runs along the inside of the upper thigh. Historically, this has been accomplished by removing the vein Ð a process know as vein stripping. Vein stripping procedures are performed in an operating room under general anesthesia, and involve a considerable recovery period for the patient. However, in the past several years the use of Endovenous Laser Therapy (EVLT) has become an accepted alternative to surgical stripping. EVLT is a less invasive procedure that does not require general anesthesia and is performed in an outpatient setting. A laser is inserted through a small entry point in the leg using a local anesthetic. Energy from the laser is discharged, causing the vein walls to close. While the EVLT procedure will be successful at closing the abnormal GSV in greater than 90% of patients, not every patient will experience complete relief of the venous varicosities with this treatment alone. Current estimates suggest that 25% of all patients will realize significant improvement in symptoms following the EVLT procedure, 50% will experience some improvement, and 25% may not experience any significant improvement in symptoms following closure of the GSV. The majority of patients will require supplemental therapy with sclerotherapy or ambulatory phlebectomy to achieve a complete cosmetic result.
Once the GSV has been successfully closed, any remaining visible varicose veins can usually be treated with sclerotherapy, a procedure that involves injecting a small volume of a liquid into the diseased vein. The sclerosing agent irritates the lining of the vein, causing it to seal shut so that blood can no longer pool in the veins.
Sclerotherapy sessions usually last between 10-20 minutes, and patients may require repeated injections to achieve the desired cosmetic results. Sclerotherapy treats only those veins that are currently visible, and will not prevent new veins from surfacing in the future.
Very few serious complications have been associated with EVLT. Common complaints experienced by patients following this procedure include mild to moderate bruising, tenderness, and tightness in the treated leg for as long as two weeks following the treatment or procedure. However, none of these should be so significant as to deter patients from their normal daily activities. Depending upon the individual, the EVLT procedure may cause mild to moderate pain for two weeks following the procedure, which can be treated with acetaminophen (Tylenol) or ibuprofen (Advil). Although very rare, serious complications such as infection, bleeding, nerve injury, or clots in the deep vein system are possible. The use of compression stockings for 10 days following the EVLT procedure is mandatory and insures that the GSV will remain closed. The success of the EVLT procedure is strongly dependent upon the stocking use.
Following sclerotherapy, patients may experience minimal side effects such as bruising, swelling, hyperpigmentation (staining) of the skin, or telangiectatic matting (new spider veins). These side effects are usually temporary. Serious complications such as ulceration, infection, clot formation, intra-arterial injection or allergies to the sclerosant are rare. The use of compression stockings for 3 days following sclerotherapy is required to insure good cosmetic results.