Mild varicose veins often do not need treatment.  However,
some people may choose treatment for cosmetic reasons or
because the condition causes uncomfortable symptoms.

Removing or treating varicose veins does not cause
circulationproblems because veins can re-route themselves
around a blockage.

Treatments for varicose veins include:

Injection Therapy

Endoluminal Ablation "CLOSURE"

Laser Therapy

Microsurgery

Varicose Ulcer Treatments with Endoscopic Techniques or Microsurgery

Compression Stockings

Injection Therapy

A type of injection therapy, called sclerotherapy, may be used to close off damaged veins without the need for surgical removal. Sclerotherapy is usually performed in a doctor's office and works like this:

• Using a fine needle, the doctor gently injects an irritating chemical (the sclerosing agent) into the varicose vein.  A foamed solution can bind the vessel walls with less volume.
• To minimize discomfort, the doctor may mix a local anesthetic with the sclerosing agent.
• The sclerosing agent creates scar tissue inside the vein, which blocks off the flow of blood to that vein, shutting it down permanently.
  

After the procedure:

• There may be some discomfort and redness of the skin at the injection sites.
• Your doctor will apply a compression bandage to the area. You will need to wear this bandage for about three days.
• Walking is an important follow-up activity.
• Most people are able to return to work and daily chores within 24 hours, if not immediately.
  
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Endoluminal Ablation "CLOSURE^®" Procedure

"Radical change is occurring in the treatment of large
veins in the lower legs."

The VNUS^® Closure procedure, an alternative treatment option to traditional vein stripping surgery, brings state-of-the-art technology to an age-old disease. 

The Closure procedure is performed on an outpatient basis.  Using ultrasound, your physician will position the Closure catheter into the diseased vein, through a small opening in the skin.  The tiny catheter delivers radiofrequency (RF) energy to the vein wall.  As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close.  Once the diseased vein is closed, blood is re-routed to other healthy veins. 

Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. Your doctor may encourage you to walk, and to refrain from extended standing and strenuous activities for a period of time. 

 
Patients who undergo the Closure procedure typically resume normal activities within a day.

Highlights of the Closure^® procedure

• Relief of symptoms
• Resume normal activity within a day
• Outpatient procedure
• Local or general anesthesia
• Good cosmetic outcome with minimal to no scarring, bruising or swelling

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Laser Therapy

Newer lasers have been developed for endoluminal collapse of the larger or greater saphenous vein.  Like “Closure” a laser generates heat to seal the inside of the greater saphenous vein.  The procedure is limited to the upper thigh portion of the saphenous vein primarily and lower leg veins will need to be treated by other methods which insurance may not cover.  Results are variable depending on the size of the veins and long-term success looks promising.

Several laser and pulsed light procedures have been approved in the last few years by the federal Food and Drug Administration (FDA) for the treatment of varicose veins. Treatments using lasers or pulsed light beams have been especially successful in the treatment of smaller spider veins, especially on the face and the upper body. 

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Microsurgery

Surgical treatment of varicose veins may be required to alleviate pain, bleeding or put a halt to recurrent bouts of phlebitis (blood clots in superficial veins).

Surgery is especially beneficial when the large veins of the legs, cluster veins, and in the case where ulcerations are involved.

There are three main types of minor surgical procedures used to treat varicose veins:

1. TRIVEX or Transilluminated Powered Phlebectomy - extraction of cluster veins
   
   
2. ATRAMATIC VEIN STRIPPING – inverted large vein removal
   
   
3. SEP Subfascial Endoscopic Perforator Ligation
   
   
   

Trivex
Large dense superficial cluster of veins in the lower leg and calf can effectively be removed from the legs with tiny incisions utilizing this technology.  The patient receives tumescent anesthesia and a spinal or general anesthetic and a light is passed under the skin to identify the cluster branches.  The small shaver is utilized to extract the vessels through these small incisions.  This process typically does a better job of removing secondary veins than hock phlebectomy is much less time.

Side effects are induration in the soft tissue that may take months to resolve but the cosmetic effects are good.


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Atraumatic Vein Stripping
Varicose veins can be removed by a procedure known as atraumatic vein stripping. Vein stripping is the only option for permanently removing the saphenous veins (the largest surface veins in the legs) that serve as the major channels for blood among the superficial veins in the leg.

A person undergoing this procedure may receive either general anesthesia (to be asleep for the procedure) or an epidural (a local anesthetic injection into the back that numbs the lower half of the body).

• The surgeon makes two small incisions-one in the groin and the other near the knee typically.
• The surgeon then ligates (ties off) the saphenous vein and its branches at the groin incision to prevent recurrence.
• The surgeon then passes a flexible wire through the vein.  The vein is extracted by pulling the wire and removing the vein in an inverted fashion to avoid damage to surrounding tissues. 

The bandages and any stitches used will be removed in two days, during a follow-up visit to the surgeon's office.

Most people are able to return to work within one to two days of the operation.

Subfascial Endoscopic Perforator Ligation
Patients with brown discoloration around their lower ankle and gaiter region of the leg particularly if they have open sores or infections are likely to have poorly functioning veins in the superficial calf that lead to the deep system in that area.  These vessels can be treated by interrupting them with a small camera placed under the skin and clipping the connections between the deep and superficial veins.  This process reduces the pressure in the skin and allows the ulcers to heal without making and incision through the area.

It may take several weeks or months for complete healing, and sometimes much longer. Sometimes vein stripping or sophisticated camera surgery or Subfascial Endoscopic Perforator Ligation is required to achieve healing. 

To help prevent recurrences, wear elastic stocking support and immediately treat any skin injuries to the leg.  


Compression Stockings

Compression stockings improve circulation by putting pressure on the outer leg and squeezing the blood into the deeper veins, thus improving the flow of blood back to the heart using the muscle pumps in the foot and leg. Hence, there is less swelling, tiredness, and achy feeling. Elastic hose will not, however, cure varicose veins. Rather, they only help control symptoms.

 
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