Treatment of Varicose Veins of the Leg

  • Definition

    This procedure involves the removal or destruction varicose veins that are just under the skin.
    There are different methods to remove veins, such as:
    • Sclerotherapy—injects the varicose veins with a chemical to shrink the veins
    • Radiofrequency ablation—collapses and seals varicose veins using radiofrequency energy
    • Vein stripping
    • A surgical procedure called phlebectomy
    Varicose Veins
    Nucleus images
    Copyright © Nucleus Medical Media, Inc.
  • 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

    Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
    • Recurrence of varicose veins
    • Bleeding
    • Infection
    • Skin discoloration at the surgical site
    • A blood clot, known as deep vein thrombosis
    Factors that may increase the risk of complications include:
  • What to Expect

    Prior to Procedure
    Your doctor will:
    • Evaluate your deep and superficial vein systems and decide which veins will be removed or destroyed
    • 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 medications. You may be asked to stop taking some medications up to one week before the procedure, like:
      • Anti-inflammatory drugs
      • Blood thinners
      • Antiplatelets
    • 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. Anesthesia may be:
    • General —blocks pain and keeps you asleep through the surgery
    • Epidural —numbs the area from the chest down to the legs
    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 great saphenous vein. The doctor will view the vein using an ultrasound, then puncture the vein near the knee. A catheter 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 is 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 medication.
    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 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

    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 medications 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
    If you think you have an emergency, call for medical help right away.
  • RESOURCES

    American College of Phlebology http://www.phlebology.org

    American Society of Plastic Surgeons http://www.plasticsurgery.org

    CANADIAN RESOURCES

    Canadian Society for Aesthetic Plastic Surgery http://www.csaps.ca

    Canadian Society for Vascular Surgery http://canadianvascular.ca

    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.

    Varicose veins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 29, 2013. Accessed August 8, 2013.

    Varicose veins. VascularWeb website. Available at: http://www.vascularweb.org/vascularhealth/pages/varicose-veins.aspx. Updated January 2012. Accessed August 8, 2013.

    Varicose veins and spider veins fact sheet. US Office on Women's Health. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm. Updated June 2, 2010. Accessed August 8, 2013.

    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.

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