Diagnosing and Treating Vein Disease:
In years gone by the treatment for varicose veins was sometimes worse than the condition itself. This largely refers to vein stripping, a highly invasive procedure. More on this later. Suffice it to say that much gentler methods are available today. One of the main changes in how vein conditions are treated today is Duplex imaging.
Says Dr. G, “we now have Duplex ultrasound to look at the entire network of leg veins. There’s no more educated guesswork anymore. This is essential because if you’re not treating the right vein you’re not going to solve the patient’s problem.”
Now back to vein stripping. A thin, flexible rod was inserted into the vein being treated via an incision in the groin. When it had gone as far as possible an access incision was made. A metal cap was screwed onto the rod, firmly trapping the vein. Finally, the rod was withdrawn, literally turning the vein inside out while pulling it from the body. To make things worse Doppler ultrasound hadn’t been invented yet, so the procedure was being done blind.
Thankfully much more sophisticated (and gentle) treatments have evolved. “Vein stripping isn’t necessary anymore. Now we’re using thin wire catheters which heat the vein from the inside. There’s no need to pull them out,” says G. “Stripping was a bad procedure whose time has come and gone.”
As mentioned, ultra-thin catheters are used to apply brief burst of intense heat to the vein walls. This causes the vein to collapse in on itself and eventually it’s reabsorbed completely. This usually takes about 8 weeks, and at this point it’s as if the vein were never there. As with other procedures of this type the deep veins take over the circulation. It’s a permanent solution to the problem.
Invasive surgery isn’t the only effective option.
In years past varicose vein stripping surgery was the only real option for varicose vein sufferers. This was unfortunate, since stripping was a highly invasive procedure that often left excessive scarring. It also required extended hospital stays and often required general anesthesia. Today, however, technology has come up with several minimally invasive treatments. These procedures are safe and are generally more effective than stripping.
Heat-based ablation (destruction) of the veins has largely taken its place.
As a result, stripping is now rarely performed. “We use this technology all the time. It’s safer than stripping and won’t leave scars. It’s all we do,” says Dr. G. “We use a special catheter with a heating element at the tip. We inject lots of local anesthesia medication for pain control and to work as a liquid heat shield. This protects the surrounding tissue. We just heat up then remove the catheter and the vein collapse behind it.” The treated vein is then reabsorbed by the body. After a few months it’s gone completely. “The vein wasn’t working anyway, so this actually improves your circulation,” explains Giraldo. “You’ve literally got miles of veins in each leg.”
For varicose veins very close to the surface surgical removal can solve the problem completely.
This procedure is known as a microphlebectomy. Says Giraldo, “we completely numb the area and remove the veins with specialized tools. It’s actually quite simple. Also, we use very tiny access incisions. Scarring is minimal or nonexistent.”
Other techniques being used today are even less invasive.
These are usually only effective on spider veins or very small varicose veins. Even so, these methods are becoming very popular since there’s almost no risk of scarring or other adverse effects.
Chief among these newer methods are sclerotherapy and laser treatments. Both have the same goal as other vein treatments. Namely, collapsing the vein so that it can be reabsorbed.
Sclerotherapy is an injection-based method. Using a fine needle small amounts of an irritating solution is deposited inside the vein. This causes the walls to swell, eventually closing down the vein entirely. The vein is then reabsorbed in a 3-4 weeks. Note that sclerotherapy is only effective on spider vein clusters and very small varicose veins (less than 3 mm).
Skin resurfacing lasers are effective on spider veins
This method isn’t invasive at all, however. As a result it’s become extremely common. Laser therapy uses rapid pulses of light to achieve the same ends as sclerotherapy. Although intense heat is being produced this is primarily limited to the vein walls so there’s very little damage to surrounding tissue. At most the only adverse effects are temporary skin redness and possible blisters. Says Dr. Giraldo, “My staff and I use skin lasers and sclero probably about 12 times every day. Patients love it!”