Indications
Veins are blood vessels that carry blood back to the heart from all parts of the body. When we are standing, veins in the legs face the challenge of fighting gravity to keep the blood moving forward. To help keep blood flowing in the right direction, there are one way valves in the veins. When valves are faulty, they do not close completely and blood can leak backwards. When this happens, there is pooling of blood in the leg veins. This leads to increased pressure within the veins. Over time, this pressure can cause the veins to stretch and dilate. Veins on the surface can protrude and are called varicose veins. Smaller veins, or capillaries, that appear like red or purple webs are called spider veins.
While no one knows what causes varicose and spider veins, we do know that a number of factors can increase the likelihood of developing leg vein problems. We also know that the primary factor contributing to the development of varicose and spider veins is heredity, or the genetic predisposition to weak vein walls and vein valves resulting in leg vein problems. There are number of lifestyle variables known to accelerate and aggravate the development of varicose or spider veins.
- Prolonged sitting or standing
- Obesity
- Lack of exercise
- Pregnancy
- Birth control pills
- Hormone replacement therapies
- Constipation
- Aging
Varicose veins and spider veins can cause varying degrees of discomfort. Symptoms may be mild, but if left untreated, advanced problems can develop. These symptoms can include swelling, throbbing, and heaviness. In addition, patients with varicose veins can experience leg cramps, burning, and itching. Over time, patients can experience skin discoloration, poor wound healing and ulceration, and bleeding. Patients experiencing these symptoms may be candidates for procedures offered by Albany IR to improve their comfort.
Procedural Details
The goal of medical treatment is to restore proper venous blood flow by eliminating varicose and spider veins from the venous circulation. The choice of medical treatment depends on the type, size, location, and depth of the vein problem as determined by non-invasive diagnostic tests, such as ultrasound. Through physical examination and diagnostic testing, we choose one or more treatment methods to achieve the desired results.
Initially, we often discuss conservative treatment with our patients. The objective of the conservative approach in treating varicose veins is to help support the venous circulation of the legs in order to slow the development of new veins and to minimize symptoms. Conservative treatment methods will not cure or eliminate existing vein problems, however they will help slow the progression of the disease and alleviate symptoms such as swelling, aching, and cramping. As a result, conservative treatment is a viable alternative to medical treatment for some people. Most conservative treatment plans use graduated compression stockings. Weight loss and exercise can also help you manage some of the painful or uncomfortable symptoms associated with varicose veins.
As technology has evolved, the treatment of varicose veins has gotten easier and less invasive. All of the procedures can be performed i our office. Often patients take a light sedative before their procedure. Some patients are treated at one of our partner hospitals if more sedation is required or if pre-existing medical conditions require additional monitoring. We will discuss which option would be best for you.
Endovenous Ablation: There are two techniques that the our physicians use to treat abnormal refluxing veins in the legs. The goal of both treatments is to seal the abnormal veins closed. Both of these procedures are safe and effective and have been approved by the FDA for treatment of saphenous vein reflux. Overall success rate are greater than 97%. These results are considered better than those of traditional surgery.
- Radiofrequency Ablation (RFA): Radiofrequency ablation is performed in the office as a minimally invasive method for treating reflux in the saphenous veins. Under ultrasound guidance, a tiny catheter is inserted directly into the vein. The catheter uses radio frequency energy to heat the inside of the vein wall. This causes the vein to seal shut. This procedure is performed through a small nick in the skin and local anesthesia. The patient walks out of the office and may return to his or her normal daily routine within 24 hours. This technique can be combined with ambulatory phlebectomy for the treatment of ropy varicose veins, along with follow-up sclerotherapy to eliminate any remaining spider veins.
- Endovenous Laser Ablation (EVLA): Endovenous laser ablation is performed in the office as a minimally invasive method for treating reflux in the saphenous veins. Under ultrasound guidance, a tiny catheter is inserted directly into the vein. The catheter uses laser light energy to heat the inside of the vein wall. This causes the vein to seal shut. This procedure is performed through a small nick in the skin and local anesthesia. The patient walks out of the office and may return to his or her normal daily routine within 24 hours. This technique can be combined with ambulatory phlebectomy for the treatment of ropy varicose veins, along with follow-up sclerotherapy to eliminate any remaining spider veins.
Ambulatory Phlebectomy: Ambulatory Phlebectomy is an in-office surgical technique performed under local anesthesia. The procedure involves removing the bulging varicose veins through minute incisions that require no stitches and leave almost no scar. Patients walk out of the office and may participate in normal daily activities within 24 hours.
Sclerotherapy: Sclerotherapy is a common treatment for spider and small varicose veins on the legs. During treatment, a mild chemical solution is injected into the abnormal veins. This medication irritates the walls of the vessel, causing it to scar. The body then absorbs the vein and blood is re-routed to healthy veins, restoring proper venous circulation in the area. At times, we may aid injection therapy by transilluminating the surrounding area to make the problem veins more visible to the naked eye. A single sclerotherapy treatment session involves multiple injections. Patients describe the injections as feeling like a pinprick or mosquito bite. The number of treatment sessions needed will vary from patient to patient, depending on the number of veins treated. We will discuss the number of treatment sessions you may need before you start treatment.
Foam-Sclerotherapy: Foam Sclerotherapy is a type of sclerotherapy for larger varicose veins. The foam solution has the consistency of shaving cream, which improves treatment in two distinct ways. First, the foam displaces blood within the vein, permitting the full strength of the medication to be in direct contact with the vein wall for an extended period of time without any dilution effects. Second, the foam is visible via ultrasound imaging and can be easily tracked and guided to the source of the venous problem.
Results
Following all vein procedures, patients wear a compression stocking when leaving the office. We ask that patients wear the stocking as directed. If there are bandages under the stocking, do not remove the stocking for at least 24 hours after your procedure. The stocking and bandages should be removed in the evening of the day following the procedure. The stocking should be worn every day for one week while awake. It may be removed to sleep and to shower. There may also have an Ace bandage on over the stocking; this should be kept on for 24 hours.
Patients may experience some mild discomfort following one of these procedures. We will discuss which over the counter pain medications may be taken for pain relief. Occasionally pain medicine may be prescribed. Some people find it helpful to take a few days off work, although we expect that most will be able to resume all pre-procedure activities quite rapidly. Normal daily activities can commence immediately after treatment, although patients are not allowed to exercise vigorously or get into a sauna or hot tub. We would like you to continue to keep moving and maintain a normal level of activity. Walking twice daily for 20 minutes is encouraged and promotes speedy healing.
There are very few potential complications associated with these procedures. We will discuss these with you at your pre-procedure office visit and answer any questions you may have.