By Robert K. Thompson, M.D.

Everyone seems to know the reason, whether it be fact or fiction, for their varicose veins: “I cross my legs a lot” (fiction); “I spend my day walking on concrete floors” (fiction); ”I wear high-heels every day” (maybe); ”I got them from my mother…or my children” (fact…fact). Unfortunately, few people seem to know that significant improvements have been made in the last decade in the treatment of this common medical problem.

Until recently, treatment of varicose veins was limited to a painful, bloody procedure called vein-stripping, which was exactly that: the large saphenous vein located on the inside of your thigh and calf, along with all its branches, was simply pulled out through multiple incisions throughout the leg. The procedure required general anesthesia, several days in the hospital at bed rest, and a week or more off work at home wearing a bulky compressive bandage with restricted activity. Even the smaller spider veins were treated with painful saline injections, often leaving behind unsightly spots and blisters. Recent advances in technology now enable doctors, trained specifically in the management of vein disease, to treat all stages of varicose and spider veins using minimally invasive outpatient procedures performed in specialized vein clinics.

Diseases of the venous system can be explained most simply as a defect in the hydraulic system our bodies use to transport used blood from our extremities back to the heart and lungs to be re-supplied with oxygen. The blood leaving our legs and feet must climb several feet uphill through our veins to our heart and lungs, using only the push of the heartbeat, contraction of the calf muscles, and a series of one-way valves inside the veins opening and closing with each beat, all working in concert to prevent the venous blood from falling back downhill. 

Gravity is a constant enemy of this process, in addition to excess weight, a pregnant uterus, prolonged standing, or an inherited weakness of the veins’ integrity. This constant downward pressure eventually overcomes the ability of the weak, thin-walled veins and valves to perform their task, resulting in an overstretched, enlarged, bulging network of veins in our legs…varicose veins. Complications of these stagnant blood-filled veins can include pain, bleeding, blood clots (phlebitis), skin thickening and discoloration, and in severe cases large open skin sores around the ankles called venous stasis ulcers.

The mainstay of prevention and conservative management of vein disease has been compression stockings, which help prevent overstretching of the veins by squeezing the leg in conjunction with calf muscle contraction, helping to propel the blood up the vein even in the presence of weakened veins. Newer fabrics and elastic materials have made today’s compression stockings much more effective, while at the same time provide a more comfortable uniform fit and color choice, thereby improving patient satisfaction and compliance.

Once vein disease has advanced to the more severe stages of pain, bleeding or ulceration, more aggressive intervention is medically indicated. The diseased vein segments must be removed, diverting the blood to stronger and healthier veins found deeper in the leg. LASER or radiofrequency ablation of the long, straight diseased saphenous vein segments, in combination with ambulatory phlebectomy of the short, tortuous segments has replaced vein-stripping with better long-term outcomes, significantly fewer complications, and a quick return to work or play.

With these new techniques, the diseased vein segment is identified with ultrasound, then surrounded by the infiltration of large amounts of dilute local anesthetic. A catheter is inserted into the vein through a tiny needle puncture, and intense heat generated by either laser light or radiofrequency energy is then passed through the catheter into the vein wall itself. The high temperature causes the vein to swell, collapse, and ultimately obliterate itself without having to be removed through any incisions in the skin. The local anesthesia infiltrated around the vein allows for a painless and bloodless procedure, and the patient is able to walk and drive home immediately afterwards, using only a compression stocking for a week.

Smaller, more tortuous veins can then be removed later with similar local anesthetic using small needle punctures and a vein “hook”, since their blood supply has already been removed by obliteration of the larger “feeder vein”. Spider veins, those unsightly thread-like veins on the skin surface can also now be treated  much more effectively with the injection of newer, less painful solutions developed and tested in Europe but now available to patients here in the U.S. These chemicals are injected directly into the spider vein cluster using a tiny needle, and contact between the solution and the vein wall causes the vein to swell and obliterate itself within a matter of days, providing an optimal cosmetic result.

So, no matter what the cause of your “very-gross veins”, the truth is that no one should have to suffer from the complications or cosmetic embarrassment of vein disease. Innovation in the treatment of venous disease over the last decade has revolutionized our ability to care for patients suffering from this common problem. Newer treatments have proven to be safer and more effective, and can now be performed in the comfort and privacy of a specialized vein clinic.

Dr. Thompson is a Vascular Surgeon with Peripheral Vascular Associates & Veintec Varicose Vein Clinics of San Antonio.

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