Treatment of Varicose Veins of the Leg

by Ronald L. Nath, MD

Definition

This procedure involves the removal or destruction of enlarged veins in the leg that are just under the skin.

There are different methods to remove veins, such as:

  • Chemical ablation (called sclerotherapy)
  • Radiofrequency (heat energy) or laser ablation
  • Vein stripping
  • Surgery (called phlebectomy)

Varicose Veins

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Reasons for Procedure

Veins have one-way valves to channel blood back to the heart. Varicose veins develop when the valves of the veins become damaged. This causes blood to pool in the veins, enlarging them and often making the veins just beneath the skin visible. The skin can also turn dark purple or brown because of increased pressure.

Treatment may be done for cosmetic and health reasons. In some cases, the areas of discolored skin may break down and form open sores (called stasis ulcers). Clots can also form in the pooled blood. When the valves are functioning poorly, your leg may burn, ache, or throb.

Treatment for this condition can involve either destroying or removing the damaged veins.

Possible Complications    TOP

Complications are rare, but no procedure is completely free of risk. If you are planning to have treatment for varicose veins, your doctor will review a list of possible complications, which may include:

  • Recurrence of varicose veins
  • Bleeding
  • Infection
  • Skin discoloration at the surgical site (usually goes away within a few weeks)
  • Deep vein thrombosis (blood clot)

Factors that may increase the risk of complications include:

What to Expect    TOP

Prior to Procedure

Your doctor will:

  • Evaluate your deep and superficial vein systems and decide which veins will be removed
  • Do an ultrasound—a test that uses sound waves to examine the veins in your legs

Leading up to the procedure, you may be advised to:

  • Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin)
    • Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
  • Wear special support stockings.
  • If you have a stasis ulcer, wear Unna boots. This is a type of cast that will aid in healing the ulcer.

Anesthesia

The anesthesia depends on the type of procedure that you are having, for example:

  • Sclerotherapy—no anesthesia is needed
  • Radiofrequency, laser ablation, or surgery:
  • Stripping—general or epidural anesthesia

Description of the Procedure

Sclerotherapy

With this procedure, the doctor will inject a chemical into each of the damaged veins. This chemical will scar the vein so that it will no longer be able to carry blood. This will be a short, simple office procedure.

Radiofrequency or Laser Ablation

This is done on one of the largest superficial veins, called the greater saphenous vein. The doctor will view the vein using an ultrasound. She will then puncture the vein near the knee. A catheter (small tube) will be threaded up to the groin. The space between the vein and the skin will be filled with a special solution. This solution will provide local anesthesia. The catheter will then be attached to a radiofrequency generator or a laser. Heat or light energy will seal the vein closed so that there is no longer any backflow of blood.

Vein Stripping

The doctor will remove the veins by threading a long wire into them. Each vein will be tied to this wire and then stripped out. This will leave the smaller side branches broken off and in place. This procedure is usually not used on the saphenous vein.

Phlebectomy

This surgery is used to remove larger veins that cannot be injected. The doctor will make many small incisions to access each varicose vein. The vein will either be tied off or removed.

After the Procedure

If the doctor does vein stripping, you will have many loose vein ends in your leg. Your leg will be tightly wrapped. This it to prevent blood from leaking out of the veins.

How Long Will It Take?

  • Sclerotherapy—short office visit
  • Radiofrequency or laser ablation—1 hour
  • Vein stripping—1-1½ hours
  • Phlebectomy—2-4 hours

Will It Hurt?

You will have pain and discomfort with the procedure. Stripping is more painful. Ask your doctor about pain medicine.

Post-procedure Care

When you return home, do the following to help ensure a smooth recovery:

  • If you had vein stripping, keep your legs elevated while you are resting. This will help to minimize pressure on your veins.
  • If you had sclerotherapy or ablation, resume normal activity within a few hours.
  • Wear an elastic bandage (eg, ACE bandage) for the first 24-48 hours, or as instructed by your doctor.
  • Be sure to follow your doctor's instructions. You may need to have another ultrasound done.

Call Your Doctor    TOP

After arriving home, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
  • Pain that you cannot control with the medicines you have been given
  • Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
  • Cough, shortness of breath, or chest pain
  • Leg swelling

In case of an emergency, call for medical help right away.

RESOURCES:

American College of Phlebology
http://www.phlebology.org/index.php
Society for Vascular Surgery
http://www.vascularweb.org/

CANADIAN RESOURCES:

Health Canada
http://www.hc-sc.gc.ca/index_e.html/
Varicose Veins
http://www.evlt.ca/index.html

References:

Merchant RF, Pichot O, Closure Study Group. Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency. J Vasc Surg . 2005; 42(3):502-509.
Rakel R, Bope E, Conn Howard. Conn's Current Therapy 2005 . 57th ed. Philadelphia, PA: Elsevier Saunders; 2005.
Teruya TH. New approaches for the treatment of varicose veins. Surgical Clinics of North America . 2004;84(5):1397-1417.
6/2/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/ : Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed September 2012 by Michael J. Fucci, DO
Last Updated: 09/24/2012