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How Are Varicose Veins Treated?
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 circulation problems because veins can re-route themselves around a blockage.
Treatments for varicose veins include:
1. Compression stockings
2. Injection Therapy
3. Surgery
4. Laser Therapy
5. Closure Technique
6. Treatment of Ulcers
Dr. White and his staff may recommend that you wear compression stockings-also called support hose-to reduce symptoms. These are elasticized stockings worn from the toes to the knee or sometimes to the top of the leg.
Compression stockings improve circulation by putting pressure on the leg muscles that squeeze the veins, thus improving the flow of blood back to the heart. Hence, there is less swelling, tiredness, and achy feeling. Elastic hose will not, however, cure varicose veins. Rather, they only help control symptoms.
How-To Information:
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Put the stockings on as soon as you get out of bed, before gravity gets a chance to cause pooling of blood in varicose veins. Keep the stockings on all day. Take them off when you are lying down, with your legs raised above the level of the heart. |
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You can buy compression stockings in most drug stores but our office will have the best prices. For women who suffer from varicose veins during pregnancy, special prescription vascular-compression pantyhose are available. |
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Elastic stockings for women are available in a variety of colors and degrees of sheerness. For men, calf-high support hose come in different colors and are made to look like dress socks. |
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Support hose must be replaced when they begin to lose their compressive power, about every three to four months. |
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Need To Know:
People with varicose veins should not attempt to wrap their legs with elastic bandages. If bandages are applied too tightly, they may act like a tourniquet, cutting off blood flow to the region.
2. 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 our office and works like this:
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Using a fine needle, the doctor gently injects an irritating chemical (the sclerosing agent) into the varicose vein. |
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To minimize discomfort, we may mix a local anesthetic with the sclerosing agent. |
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The sclerosing agent creates scar tissue inside the vein, which blocks off the flow of blood to that vein, shutting it down permanently. |
Need To Know:
Injection treatment is especially useful for treating small varicose veins below the knee. It may also be useful in treating some cases of spider veins.
Sclerotherapy is not suitable for:
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Large varicose veins |
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Varicose veins extending up to the groin |
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People who are obese |
After the procedure:
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There may be some discomfort and redness of the skin at the injection sites. |
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After sclerotherapy we will apply a compression bandage to the area. You will need to wear this bandage for about 3-6 weeks. |
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Walking is an important follow-up activity. |
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Most people are able to return to work and daily chores within 24 hours, if not immediately. |
Possible Complications of Sclerotherapy
Sclerotherapy is mostly successful, but not always. Individual varicose veins may occur again and require treatment. Other complications include:
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Blood may leak from the treated veins into the surrounding tissue, which produces brownish discoloration on the skin around the treated veins. This discoloration will eventually fade in four to six months, although sometimes it takes as long as a year. In some cases, the discoloration is permanent. |
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In rare cases, a small, depressed scar may appear after treatment, or a blood clot may develop in a treated vein. |
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The procedure may leave a fine network of smaller varicose veins at the site where the larger vein was treated. |
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Some saline chemical solutions used in the procedure contain high concentrations of salt, which can temporarily raise blood pressure. |
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Solutions have caused allergic reactions in some people, but these are rare. |
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An ulcer at the site of the injection may occur in a very small number of individuals who undergo sclerotherapy. This superficial ulceration should heal with time; but, may cause some scarring at the site of injection. |
3. Surgery
Surgical treatment of varicose veins may be required to alleviate pain and to put a halt to recurrent bouts of phlebitis.
Surgery is especially beneficial when the large veins of the legs are involved. Surgery may also be chosen for cosmetic reasons.
There are two main types of surgical procedures used to treat varicose veins:
• Ambulatory phlebectomy
• Vein stripping
3a. Ambulatory Phlebectomy
Larger varicose veins can be treated with a surgical procedure known as ambulatory phlebectomy. In this procedure, a surgeon makes a series of tiny puncture holes along the vein and then takes out small segments of the vein.
The tiny incisions require no stitches. Most people experience very little pain after the operation and are able to walk immediately following surgery.
Nice To Know:
Ambulatory phlebectomy can be preformed in one 45-minute session under local anesthesia in a physician's office or an outpatient center. The surgery rarely leaves significant scarring.
3b. Vein Stripping
Varicose veins can be removed by an operation known as vein stripping. Vein stripping is the only option for 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).
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The surgeon makes two small incisions-one in the groin and the other near the ankle. |
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The surgeon then ligates (ties off) the saphenous vein and its branches at the groin incision. |
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The surgeon then passes a flexible wire through the vein from the ankle incision. A number of small incisions in the skin are sometimes needed along the vein to guide the wire along the length of the entire vein. |
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When the wire reaches the groin incision, the surgeon pulls the wire out, bringing the entire vein with it ("strips the vein out"). |
Recovery
Many patients are able to leave the hospital on the same day as the surgery--or at the most, the day following surgery.
It usually takes two to six weeks to recover from the operation. During that time, your physician may ask you to:
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Keep the leg or legs bandaged for several weeks following surgery. |
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Take several short walks, starting with five minutes each time, and slowly increasing the time and distance covered each day. |
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Lie down frequently and keep your leg elevated above your heart. |
The bandages and any stitches used will be removed by the end of the first week, during a follow-up visit to the surgeon's office.
Most people are able to return to work within one to two weeks of the operation.
Nice To Know:
Some physicians believe that the saphenous vein should never be removed, because it is the primary source of veins used for heart bypass operations. However, other surgeons feel that if the saphenous vein is thoroughly damaged, as in more severe varicose veins, it is usually not suitable for use in bypass surgery.
Possible Complications of Vein Stripping
The principal complications following vein stripping include:
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Occasionally, the procedure can damage superficial nerves along the stripped vein, causing a patchy area of numbness in the leg. The nerves usually recover, however, and sensation returns. |
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In some instances, it can result in such complications as infection, which will require antibiotic treatment, and bleeding, which can be treated usually by firm pressure. |
Nice To Know:
About 85 percent of patients experience long-term relief of varicose veins following vein stripping.
4. Laser Therapy
Several laser and pulsed light procedures have been approved 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.
Even though there are promising new lasers in development, as of now this procedure is of limited value for the treatment of large varicose veins in the legs.
5. EVLA Closure Technique
A procedure to treat varicose veins called the Closure technique was approved by the Food and Drug Administration (FDA) in March 1999.
The EVLA Closure technique involves inserting a small tube called a catheter into the defective vein through a small skin puncture. The Closure catheter delivers radiofrequency energy to the vein wall, causing the vein to shrink and seal shut. Once the diseased vein is closed, neighboring healthy veins take over to restore normal outflow of venous blood from the legs. As normal blood flow returns, symptoms typically are reduced.
The Closure technique is a minimally invasive procedure. It can be performed in a doctor's office and allows the person to resume normal activity immediately after the treatment. Bruising, which is a common side effect of any invasive procedure, is minimal.
6. Treatment of Ulcers
Treatment of a varicose vein ulcer consists of warm wet dressings, bandaging, exercise, and elevation of the affected leg.
It may take several weeks or months for complete healing, and sometimes much longer. Sometimes plastic surgery is required to cover the ulcers with full thickness skin grafts or even thicker flaps of skin taken from elsewhere on the body.
To help prevent recurrences, wear elastic stocking support and immediately treat any skin injuries to the leg.
Advanced Surgical Concepts,
where Christian Compassion meets
Advanced Surgical Care.
For a consultation or further information
please call 423-648-4011.
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