What is the latest treatment for varicose veins
Endovenous laser treatment combined with ambulatory phlebectomy has been established as a safe and effective treatment technique for varicose veins.

Varicose veins may vary in severity from a mild condition or spider veins to large veins compounded by leg ulcers. Any vein can become varicose. However, the veins in the legs and feet are the most usually afflicted because standing and walking upright increases pressure in the lower body's veins.

Endovenous laser treatment or endovenous laser ablation therapy (EVLT or EVLA) combined with ambulatory phlebectomy (AP) has been established in recent trials to be a safe and effective treatment technique for varicose veins in the leg.

  • EVLA is a revolutionary procedure to treat varicose veins using a laser.
  • The laser warms and destroys the vein's lining, causing it to collapse, shrivel, and eventually disappear.
  • This treatment can treat large varicose veins in the legs, and the entire procedure takes less than 30 minutes.
  • Apart from these, the development of minimally invasive endovenous ablation therapy has transformed the treatment of varicose veins.
  • The two least invasive procedures for individuals with varicose veins from the great saphenous vein (GSV) are EVLA and radiofrequency ablation (RFA), which uses radiofrequency waves instead of a laser.

What are the benefits of EVLA?

  • Fewer post-treatment complications
  • Minimal post-procedural pain
  • Faster recovery time

However, it appears that radiofrequency ablation is significantly superior. According to a study, though both procedures are useful, quality of life patients treated with radiofrequency ablation experienced lower post-procedural pain than those treated with endovenous laser ablation.

It is advisable to discuss with the doctor to determine the best course of treatment for varicose veins.

Why do I have varicose veins?

Varicose veins are veins in the body that begin to operate improperly because of dilatation (widening) or expansion.

Varicose veins can be found anywhere in the body. However, they are mostly found in the lower extremities. Their occurrence is more common in the legs due to increased pressure carried by veins when a person stands or walks erect.

  • Leg muscles can pump blood back to the heart against gravity.
  • Valves are located inside the veins to prevent blood backflow. These valves are unidirectional and only open to the upper side.
  • These valves become damaged and lose their ability to open unidirectionally in the case of varicose veins.
  • They transform into a two-way street for blood flow, leading to the pooling of blood and consequent widening of the veins.

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What are the common treatment options for varicose veins?

The five main treatment options offered by most vascular surgeons include:

  1. Coil embolization
  2. Phlebectomy
  3. Sclerotherapy
  4. Foam sclerotherapy
  5. Vein closure procedure

Coil embolization

  • With the use of ultrasonography, a catheter is placed into the problematic vein.
  • The catheter is then used to insert a platinum coil into the vein.
  • After that, a measured amount of alcohol is injected into the vein. The alcohol then obliterates the troublesome vein.

Phlebectomy or vein stripping

  • This involves surgical removal of varicose veins.
  • Tiny incisions are made along the leg across the veins' surface.
  • These incisions are then used to remove the veins. The incisions are small skin punctures that are covered with Steri-Strips after the treatment; no stitches are usually used.
  • Following phlebectomy, a bandage or compression stocking is worn for a brief time.
  • The patient will be admitted to the hospital four to five hours following surgery until they have fully recovered from the anesthesia.
  • Your leg will be wrapped extensively.
  • This bandage is put to the leg to reduce bruising and swelling and will remain in place for 48 hours.
  • There could be a dressing in the groin. It is critical not to get these wet.
  • After the procedure, some soreness and bruising of the legs are expected. In general, over-the-counter pain medicines can help alleviate this discomfort.
  • One day after surgery, one can start taking short walks around the house, gradually increasing the duration of the walks.
  • On the first day, avoid walking long distances.
  • Elevate the leg while resting and gradually increase the length of your daily walk to a level that is comfortable for you.
  • Most people can return to work within a few weeks.

Sclerotherapy

  • This procedure entails injecting a sclerosant (a substance that scars or closes the varicose veins) into the afflicted vein.
  • The procedure takes about 20 to 30 minutes and is typically done without anesthesia.
  • Mild discomfort may occur following the treatment, and when larger veins are injected, a cramping sensation may be felt for one to two minutes.
  • The number of veins injected in a single session varies based on their size and location. For any venous location, one or several sclerotherapy sessions may be required.
  • One must wear a venous compression stocking for two weeks after the treatment. A bandage will be wrapped around the stocking for one week.
  • Sclerotherapy is appropriate for most people who have small or moderately large varicose veins.

Foam sclerotherapy

  • The fundamental difference between sclerotherapy and foam sclerotherapy is that the solution is injected into a vein in liquid form during sclerotherapy treatment. In the case of foam sclerotherapy, however, the air is combined with the sclerosing agent to create a consistency comparable to shaving cream.
  • It can be utilized to treat some of the bigger underlying aberrant veins that would ordinarily not be treated with traditional sclerotherapy.

Vein closure procedure

  • One of the novel minimally invasive endovenous catheter-based methods that can be used as an alternative to standard vein stripping operations.
  • This employs “thermal energy” to reduce the venous wall of the afflicted vein and seal it shut.
  • When a vein is occluded, blood flow automatically reroutes through other healthy veins.
  • The doctor will insert a catheter into the damaged vein through a small incision in the skin using ultrasound.
  • The catheter is propelled by radio-frequency energy, which heats the vein wall.
  • The vein shrinks and collapses as a result of the heat.
  • The catheter is withdrawn, thereby sealing the vein.
  • Catheter-based treatments are frequently paired with a phlebectomy, a minimally invasive surgery used to remove varicose veins on the leg's surface.
  • A bandage and, if necessary, compression are applied to the incision site.
  • The patient will be advised to walk but not to stand or engage in vigorous activities for the suggested period. Patients usually return to normal activity within a day.
  • Patients report minimal or no discomfort post-procedure.
  • The vascular surgeon will first perform an ultrasound scan on the leg to see if the patient is a good candidate.
  • This treatment is not appropriate for everyone. People with large, twisting veins and recurring varicose veins following earlier surgery are inappropriate candidates.

8 signs and symptoms of varicose veins

In most cases, varicose veins do not cause any symptoms in the early stages. However, the patient may begin to feel symptoms after a few years.

The following symptoms should not be ignored and reported to a doctor if they occur regularly:

  1. Feeling of heaviness in the lower extremities
  2. Leg discomfort
  3. Spider veins in the affected leg
  4. Swollen ankles (which may increase in the evening)
  5. Skin discoloration over the affected area
  6. Stasis dermatitis, also called venous eczema, is a type of dermatitis that affects the veins
  7. Leg cramping while standing or walking
  8. Lipodermatosclerosis (shrinkage of the skin over the affected area)

4 risk factors of varicose veins

  1. Age: The valves inside the veins deteriorate and fail as people age, causing blood to flow back into the veins.
  2. Sex: Females are more prone to varicose veins. Hormonal fluctuations, menstruation, and pregnancy are variables that raise the likelihood of females getting varicose veins.
  3. Family history: Individuals with a family history of varicose veins are more likely to develop them.
  4. Obesity: Obese people put additional strain on their legs, which can lead to varicose veins.

5 conservative methods to manage the symptoms of varicose veins

  1. Maintaining the raised position of the leg
  2. Using compression stockings that are well-fitting around the legs
  3. Intermittent pneumatic compression devices are used
  4. Anti-inflammatory or pain medicines
  5. Using topical gels to alleviate symptoms

Varicose veins may not appear to be a major condition at first, but they can worsen over time. If varicose veins are not treated promptly, they might develop into problems, such as inflamed veins, ulcers, or persistent sores.

Congestion of blood in the leg can cause persistent swelling, soreness and heaviness in the legs, eczema, discoloration of the skin around the ankle, and difficult-to-treat leg ulcers. The doctor is the best person to assess which sort of treatment is best for varicose veins.

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Medically Reviewed on 4/8/2022
References
Image Source: iStock Images

WebMD. New Treatments for Varicose Veins. https://www.webmd.com/skin-problems-and-treatments/features/new-treatments-for-varicose-veins

Campbell B. New treatments for varicose veins. BMJ. 2002;324(7339):689-690. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122628/

Cleveland Clinic. Varicose Veins. https://my.clevelandclinic.org/health/diseases/4722-varicose-veins

ClinicalTrials.gov. A New Method of Surgically Treating Varicose Veins and Venous Ulcers - a Study to Assess Clinical and Economic Value. https://clinicaltrials.gov/ct2/show/NCT00759434

The University of California. Varicose Veins. https://surgery.ucsf.edu/conditions--procedures/varicose-veins.aspx