A varicose vein is an enlarged vein located in the leg. These blue veins are superficial, meaning that they lie close to the skin’s surface. Varicose veins work with deeper veins to help with blood flow, and valves connecting these veins force blood to flow in one direction. If a valve weakens over time, blood can flow backwards, from the deeper veins to the superficial veins, where blood can accumulate.
An estimated 25 million people have varicose veins. Though often harmless, patients frustrated with symptomatic or unattractive varicose veins may wish to undergo treatment aimed at improving the look and health of the leg.
Why Varicose Vein Treatment is Performed
Most of the time, varicose veins cause no significant physical symptoms, though they may lead to annoyances such as swelling or the sensation of achy, heavy legs. Simple vascular surgery, vein removal, and compression hose therapy have all been used with success to eliminate varicose veins. In more recent years, minimally-invasive procedures such as sclerotherapy and endovenous ablation have emerged as primary treatment approaches. Sclerotherapy involves injecting a special solution into smaller sized veins, causing scarring to redirect blood through a healthy vein. Endovenous ablation is the application of energy to close off the vein(s). Both of these have been demonstrated to alleviate possible effects of varicose veins, such as:
- Leg pain/achiness
- Skin irritation and discoloration
- Vein inflammation (called phlebitis)
What to Expect During Varicose Vein Treatment
A diagnostic imaging study is often required for a provider to fully understand the extent of a patient’s varicose veins and related symptoms, and to determine the most appropriate treatment.
Veins that are smaller in size (called spider veins) are good candidates for sclerotherapy. During this procedure, a liquid medicine called a sclerosant is injected into the vein. This creates swelling which eventually scars to close off the vein. The loss of blood flow causes the vein to shrink and dissolve over a period of several weeks. The procedure itself typically only takes a matter of minutes.
Endovenous ablation, often the recommended route for larger veins, is also performed as an outpatient interventional radiology procedure. After the vein area is numbed, cleaned, and sterilized, a small incision is made. From here, a catheter (thin plastic tube) is threaded into the vein with the assistance of ultrasound technology for visualization and enhanced patient safety. Next, the vein itself is injected with local anesthesia. Once the vein is numb, a radiofrequency electrode that creates energy is applied to the vein using the catheter. The resulting heat cauterizes (burns) the vein, shrinking it and sealing it off from further blood flow. This procedure usually takes about an hour.
Risks and Benefits of Varicose Vein Treatment
Both sclerotherapy and endovenous ablation are well tolerated, low-risk procedures that seek to offer relief from varicose veins with minimal downtime. Sclerotherapy may lead to minor side effects including bruising, swelling, and skin discoloration. As with any medical procedure, infection and bleeding are also possible, though not significant enough to cause major concern. With an endovenous ablation, there may also be mild bruising and some residual numbness, but overall the procedure is highly effective, with a fast recovery.
How to Prepare for Varicose Vein Treatment
Sclerotherapy and endovenous ablation are outpatient procedures, with no general anesthesia or sedation used. There is very little preparation needed ahead of time. Patients will be asked about their medication usage and may be instructed to pause certain therapies (like blood thinners) ahead of the scheduled procedure. Eating and drinking are encouraged prior to the appointment, as is showering and dressing in comfortable, loose-fitting clothes. Patients should also make sure to have a nonsteroidal anti-inflammatory aid, such as Advil, available for use at home.
Post Varicose Vein Treatment
Interventional approaches to varicose vein treatment are fast and take less than an hour each. Patients with larger or multiple varicose veins may require subsequent procedures. In this case, a follow-on procedure is scheduled for about a month later.
Patients may go home with elastic bandages on their leg to help with recovery and decrease swelling. Fluid drainage and bruising are possible, but these issues resolve quickly. Most patients can return to work within a day.
Patients are advised to avoid vigorous exercise for the first week or so, but daily short walks are encouraged. Travel and water activities may need to be restricted during this timeframe. The care team will also educate the patient about preventive approaches to limit the emergence of new varicose veins.