Varicose vein - noninvasive treatment
Sclerotherapy; Laser therapy - varicose veins; Radiofrequency vein ablation; Endovenous thermal ablation; Ambulatory phlebectomy; Transilluminated power phlebotomy; Endovenous laser ablation; Varicose vein therapy
Varicose veins are swollen, tortuous, and sometimes painful veins that have filled with blood that does not drain out in a normal fashion.
Description
Varicose veins most often develop in the legs. They often stick out and are blue in color.
- Normally, valves in your veins keep your blood flowing up toward the heart, so the blood does not collect in one place.
- The valves in varicose veins are either damaged or missing. This causes the veins to become filled with blood, especially when you are standing.
The following treatments for varicose veins can be done in a health care provider's office or clinic. You will receive local anesthesia to numb your leg. You will be awake, but will not feel pain.
Sclerotherapy works best for spider veins. These are small varicose veins.
- Salt water (saline) or a chemical solution is injected into the varicose vein.
- The vein will harden and then disappear.
Laser treatment can be used on the surface of the skin. Small bursts of light can make small varicose veins disappear.
Phlebectomy treats surface varicose veins. Very small cuts are made near the damaged vein. Then the vein is removed. One method uses a light under the skin to guide treatment.
This may be done along with other procedures, such as ablation.
Ablation uses intense heat to treat the vein. There are two methods. One uses radiofrequency energy and the other uses laser energy. During these procedures:
- Your provider will puncture the varicose vein.
- Your provider will thread a flexible tube (catheter) through the vein.
- The catheter will send intense heat to the vein. The heat will close off and destroy the vein and the vein will disappear over time.
From the outside, your veins look like nothing more than a few faint blue lines under your skin. But inside your body, they work hard to transport blood from your organs to your heart. Sometimes, blood can get stuck in your veins and make them swell up so they really stick out. These swollen veins are called varicose veins. And if you have them, you may be putting a lot of effort into covering them up. Veins have valves in them that prevent blood from flowing the wrong way. They're kind of like the valves in your bathroom plumbing that prevent hot water in the water heater from backing up into the cold water supply. The valves inside your veins make sure that your blood keeps flowing in the right direction, toward your heart. But if those valves aren't working correctly, blood can back up and get stuck inside a vein. As the blood collects, the vein swells. So, what causes the valves in the veins to malfunction? Well, you may have been born with defective valves. Or, you might be putting on extra pressure on the veins in your legs if you stand for long periods of time, or you're pregnant. When you have varicose veins, you, and your doctor, should be able to tell just by looking at them. They look like raised, thick blue or purple veins. Varicose veins can also make your legs ache and your ankles swell. So, how are varicose veins treated? Well, first, your doctor will recommend rest and support for your varicose veins. Avoid standing for long periods of time, and prop up your feet on a pillow or box whenever you sit. Wearing elastic support hose can also help. If you're in a lot of pain from your varicose veins, or their appearance really bothers you, your doctor may recommend a treatment such as lasers to minimize the veins. Or, you may have a type of surgery called vein stripping. During this procedure, the surgeon threads a thin, plastic wire into each varicose vein and then pulls the vein out. At first, varicose veins are more of a cosmetic problem than a health issue. But over time, they can get worse. Some people develop sores, inflammation from phlebitis, clots, or their varicose vein breaks. Talk to your doctor if you have varicose veins, especially if they hurt or they don't improve from wearing support hose or staying off your feet. Call your doctor right away if you have intense pain, swelling, fever, or a sore on your leg.
Why the Procedure Is Performed
You may have varicose vein therapy to treat:
- Varicose veins that cause problems with blood flow
- Leg pain and feeling of heaviness
- Skin changes or skin sores that are caused by too much pressure in the veins
- Blood clots or swelling in the veins
- Undesirable appearance of the leg
Risks
These treatments are generally safe. Ask your provider about specific problems that you might have.
The risks for any anesthesia and surgery are:
- Allergic reactions to medicines
- Breathing problems
- Bleeding, bruising, or infection
The risks of varicose vein therapy are:
- Blood clots
- Nerve damage
- Failure to close the vein
- Opening of the treated vein
- Vein irritation
- Bruising or scarring
- Return of the varicose vein over time
Before the Procedure
Always tell your provider:
- If you are or could be pregnant.
- About any medicines you are taking. This includes drugs, supplements, or herbs you bought without a prescription.
You may need to stop taking aspirin, ibuprofen (Advil, Motrin), warfarin (Coumadin), and other medicines that make it hard for your blood to clot.
After the Procedure
Your legs will be wrapped with bandages to control swelling and bleeding for 2 to 3 days after your treatment.
You should be able to start normal activities within 1 to 2 days after treatment. You will need to wear compression stockings during the day for 1 week after treatment.
Your leg may be checked using ultrasound a few days after treatment to make sure the vein is sealed.
Outlook (Prognosis)
These treatments reduce pain and improve the appearance of the leg. Most of the time, they cause very little scarring, bruising, or swelling.
Wearing compression stockings will help prevent the problem from returning.
References
Goldman MP, Guex J-J. Mechanism of action of sclerotherapy. In: Goldman MP, Weiss RA, eds. Sclerotherapy. 6th ed. Philadelphia, PA: Elsevier; 2017:chap 7.
Goldman MP, Weiss RA. Phlebology and treatment of leg veins. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 155.
Sadek M, Kabnick LS. Varicose veins: endovenous ablation and sclerotherapy. In: Sidawy AN, Perler BA, eds. Rutherford's Vascular Surgery and Endovascular Therapy. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 155.
Sharma A, Wasan S. Varicose veins. In: Creager MA, Beckman JA, Loscalzo J, eds. Vascular Medicine: A Companion to Braunwald's Heart Disease. 3rd ed. Philadelphia, PA: Elsevier; 2020:chap 53.
Version Info
Last reviewed on: 1/18/2023
Reviewed by: Deepak Sudheendra, MD, MHCI, RPVI, FSIR, Founder and CEO, 360 Vascular Institute, with an expertise in Vascular Interventional Radiology & Surgical Critical Care, Columbus, OH. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
