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Surgical techniques to treat the cause (leaking veins) include ligation (tying off of a vein) and stripping (removal of a long segment of vein by pulling it out with special instruments). These operations have been the standard of care for more than 100 years. However, surgery has not been very popular among the patients, since it is typically done under general anesthesia, requires hospital stay for several days and may have some adverse effects such as skin scars, paresthesia (numbness) and clot in the deep veins. In 2002, a revolutionary method called "endovenous laser" (EVL) was introduced to treat the cause of the varicose veins. In EVL, a tiny laser fiber is placed via a catheter into the leaking veins. Under local anesthesia, laser energy is given, and the leaking vein is closed. Once closed, the vein gets thinner by time and become invisible even with the ultrasound machine. EVL has been so rapidly accepted by both physicians and patients that it has largely replaced surgery in centers where it can be performed. Unlike surgical operation, EVL is done under local anesthesia with the patient fully awake. Since it is done through a small nick in the skin, there is no sutures and incision scars. The patient stands up and starts walking immediately after the procedure, and returns to daily life right away. Use of local anesthesia and immediate walking of the patient prevent complications such as paresthesia (numbness), skin burn and thrombosis (blood clot) in the deep veins.
After the leaking veins are treated with EVL, or other methods, the symptoms like heaviness, fatigue, pain, cramps and itching decrease or disappear, because the blood no longer returns to legs and accumulates in the veins. _
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After EVL, varicose veins also become thinner and further intervention may not be needed. However, in most cases, varicose veins are also treated in the same session, to further improve cosmesis and to prevent recurrence. This treatment is also done under local anesthesia with either sclerotherapy or miniphlebectomy. In sclerotherapy, a liquid medication that shrinks the vessels is injected into the varicose veins through a tiny needle under ultrasound guidance. The effect of sclerotherapy can be further increased if the liquid is mixed with air and turned into foam (foam sclerotherapy). This method is advantageous because the foam is readily seen on ultrasound and since the foam is lighter than blood, it can be directed into target veins by putting the leg into different positions.
EVL and foam sclerotherapy are the most effective and least invasive ways of treating varicose veins. Using the keywords "endogenous laser" and "foam sclerotherapy", you can search internet and obtain more information about these revolutionary treatments.
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