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Doctors Take Aim at Varicose Veins

NEW YORK (Oct 1, 2012)

Steve Elias, M.D.
Steve Elias, M.D.

For some people, varicose veins are a cosmetic issue. But for many patients, varicose veins produce symptoms such as swelling, painful aching, throbbing, and cramping in the feet and legs, which can worsen as the day goes on. Today doctors have an arsenal of more targeted tools to take aim at troublesome veins, including novel endovenous approaches, causing veins to shrink and ultimately disappear.

Varicose veins develop when the specialized, one-way valves that propel blood upward through the legs toward the heart deteriorate. As the valves become damaged, some blood flows backward, increasing pressure in the vein and causing it to stretch. The result: dark, bulging, twisted veins that usually appear on the back of the calf, on the inside of the leg, or in the groin.

As we age, our risk of developing varicose veins rises as well. "So with the aging of the population, we can expect to see a rise in the incidence of varicose veins," noted Steve Elias, M.D., Director of NewYork-Presbyterian/Columbia University Medical Center's Division of Vascular Surgery Vein Programs. People whose parents had varicose veins are more likely to get them as well: The risk is 33 percent if one parent had them and 95 percent if both parents had them. Being overweight, standing much of the day, and having multiple pregnancies also raise the risk.

While varicose veins can be diagnosed by a physical examination, sometimes doctors also perform venous ultrasound (Doppler) to determine the cause or severity of the condition and to see whether the enlarged veins contain blood clots. Initial care to alleviate symptoms of discomfort may include compression stockings and elevating the legs.

Patients who need more intensive treatment may benefit from one of the following approaches, which are minimally invasive procedures:

  • Endovenous Therapies: A vein specialist introduces a catheter into the body through a needle puncture in the lower part of the leg and directs it to the vein. Laser, radiofrequency, or mechanochemical energy is delivered through the catheter to the inside of the vein to shrink it, and it eventually disappears. Healthy blood vessels nearby absorb the blood flow of the treated vein. "Endovenous therapies have a very high rate of success," explained Dr. Elias. "Patients are able to resume their regular activities, including exercise, the next day."
  • Sclerotherapy: This approach can be used to treat smaller varicose veins (spider veins). The doctor injects a medication into the affected veins, which irritates the lining of the vein and causes it to close up or collapse. Patients usually wear compression stockings or elastic bandages for several days after the procedure. They may resume their normal activities the same day, with no restrictions.
  • Microphlebectomy: This procedure, performed with local anesthesia, removes visible varicose veins through small microincisions that do not require stitches. Microphlebectomy is usually reserved for very large varicose veins that cannot be treated successfully using other approaches.

Newer procedures may soon become available which use steam or a special type of glue. These approaches, currently in clinical trials, may further simplify the treatment of varicose veins for patients and vein care specialists.

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