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Two Doctors performing Varicose Vein Stripping or Ligation Surgery


Treating Vein Disease with Vein Stripping

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. Much gentler methods are available today. One of the main changes in how vein conditions are treated today is Duplex imaging.

Says Dr. Giraldo, “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.”

Vein stripping was performed by insertion of a thin, flexible rod into the vein being treated via an incision in the groin. When the rod was pushed into the vein 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 Finally, the rod was withdrawn, literally turning the vein inside out while pulling it from the body.

Today, more sophisticated and gentle treatments are available. “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 Dr. Giraldo. “Stripping was a bad procedure whose time has come and gone.”

As mentioned, ultra-thin catheters are used to apply brief bursts 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 varicose vein problem.

When to Consider Treatment for Spider or Varicose Veins


If you are bothered by the cosmetic appearance of spider veins, you might want to think about having them treated. You may be considered a good candidate for spider vein therapy by your doctor if:

You can adhere to the aftercare recommendations.

Your perspective is upbeat, and you have reasonable prospects for growth.

Conservative management techniques like weight loss, exercise, and compression stocking use haven’t been successful.

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 allows several minimally invasive treatments. These procedures are safe and are generally more effective than stripping.

Heat-based ablation (destruction) of veins has largely taken the place of vein stripping.

As a result, stripping is now rarely performed. “We use ablation all the time. It’s safer than stripping and won’t leave scars. It’s all we do,” says Dr. Giraldo. “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 collapses 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 Dr. Giraldo. “You’ve literally got miles of veins in each leg.”

Patient before image of Spider vein treatment with sclerotherapy
Sclerotherapy for Spider Veins

Surgical treatment for varicose veins close to the skin surface.

This procedure is known as a microphlebectomy. Says Dr.Giraldo, “we completely numb the area and remove the veins with specialized tools. It’s actually quite simple. 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. 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.

Spider Vein Removal on patient's calf with laser machine

Intravenous laser therapy

Endovenous laser treatment, like radiofrequency ablation, entails inserting a catheter into your vein and utilizing an ultrasound scan to guide it into the ideal place. Your catheter is used to insert a tiny laser, which is then placed at the top of your varicose vein.

The vein is heated and sealed shut by the laser’s brief energy bursts. The ultrasound scan is used to guide the laser as it is progressively dragged along the vein, closing it along its full length. A local or general anesthetic may be used during endovenous laser therapy. Your legs may feel a little tighter after the surgery, and the bruised and painful areas may still be there. Another possibility is nerve damage, however this normally only lasts temporarily.

Sclerotherapy

If endothermal ablation therapy is not a good fit for you, you will typically be offered a procedure called sclerotherapy. During this procedure, a particular foam is injected directly into your veins. The veins become scarred by the foam, which closes them. If you’ve previously experienced deep vein thrombosis, this type of treatment might not be appropriate for you.

An ultrasound scan is used to direct the injection to the vein. In a single session, multiple veins may be treated. Typically, foam sclerotherapy is performed under local anesthesia, which numbs the area being treated with a painkiller.

Your varicose veins should start to disappear a few weeks after Sclerotherapy when stronger veins replace the damaged vein, which is no longer carrying blood.

Compression hose

To assist in getting the blood back to your heart, these stockings exert consistent pressure. Additionally, the constant pressure diminishes the swelling in your lower legs and lowers your risk of developing a blood clot. Still, you’ll be able to see the veins in your legs.

A dermatologist can check you to determine whether you need compression stockings and determine the appropriate size and level of compression.

SKIN RESURFACING LASERS ARE EFFECTIVE ON SPIDER VEINS 

Laser treatment for spider veins is non-invasive. 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!”

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