What are Varicose Veins?
Varicose (enlarged) veins are a common condition that affects more than 30% of adults in the U.S. Veins are blood vessels that return very low-pressure unoxygenated blood back to the heart. Varicose veins are caused and worsened by a problem called chronic venous insufficiency. When these vessels are exposed to increased pressure over time from chronic venous insufficiency, their walls become weakened. The veins then enlarge, twist and bulge causing further blood to pool and enlarging the veins even more.
Varicose veins are most often found in the legs and can appear as blue or dark purple lines, sometimes as big as ropes. For some people the condition is solely a cosmetic concern, but in many cases these veins also cause pain and swelling. Rarely, varicose veins can be associated with a more serious vascular disease like deep vein thrombosis (DVT). Typical varicose vein symptoms include throbbing pain in the legs, stiffness after sitting or standing for prolonged periods, leg cramps, swelling, and occasionally bleeding.
Risk factors include:
- Female sex
- Family history
- Obesity
- Older age
- Limited movement
- Pregnancy
Ablation Treatment for Varicose Veins
There are a range of treatments for varicose veins. For mild cases, wearing compression socks or increasing leg elevation can help alleviate or even eliminate the symptoms. However, once the varicose veins cause ongoing pain, local clotting, and even bleeding, more permanent intervention may be necessary.
One of the most effective, durable treatments is a minimally invasive procedure called endovenous ablation. Ablation, or closing the vein, can be accomplished either with heat (thermal) or chemicals injected locally. Thermal ablation uses a laser or radiofrequency waves to seal off the affected vein. Both thermal and chemical ablation are accomplished using small needles and allow the blood to be rerouted through adjacent, healthy veins. The treated varicose veins then shrink and become less visible over time.
Endovenous ablation is an outpatient office-based treatment. Patients can return home the same day and resume normal activity in the next one to two weeks. Ablation treatment has a faster recovery time than operations that surgically remove the varicose veins. The ablation procedure is also very low risk, with a less than 1% occurrence of major adverse events.
Use of Vascular Ultrasound in Varicose Vein Treatment
Vascular ultrasound technology is used to diagnose varicose veins and venous insufficiency, to perform ablation when indicated, and to evaluate the ablation procedure in the recovery period. Vascular ultrasound uses harmless, high-frequency soundwaves to create images of veins and blood flowing through them. These images reveal if the veins are enlarged and where they are located, whether blood is pooling in the veins and flowing in the proper direction, and if the vein valves are functioning normally.
In short, vascular ultrasound helps determine whether the veins are abnormal and if they are, where ablation should be directed. Varicose vein ablation is performed by a vascular surgeon, with the assistance of a Registered Vascular Technologist (RVT) who performs the vascular ultrasound exam.
During the procedure, vascular ultrasound is first used to find the affected vein. Then, local anesthesia is applied to the leg where the surgeon will make a small incision, typically below the knee or at the ankle. For thermal ablation, a thin tube called a catheter is inserted and guided into the vein, and a device to deliver the treatment is guided through the catheter. Local anesthesia is also applied around the vein to numb it. Chemical ablation is performed through similar catheters. The procedure lasts a couple of minutes and once complete, the devices are removed, the small incision is covered with a bandage, and the leg is wrapped.
The healing process typically takes one to two weeks. During this time, the patient will need another vascular ultrasound exam to confirm the vein is closed. While patients heal, they will need to avoid swimming and flying and may be asked to wear compression socks. The procedure itself is painless due to local anesthesia. Afterward, there may be some soreness and bruising. Pain can typically be managed with over-the-counter medications.
Guest Contributor: Jordan Galerkin
Sources:
- Chronic Venous Insufficiency. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/chronic-venous-insufficiency
- Endovenous Thermal Ablation. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/16965-endovenous-thermal-ablation
- Varicose Veins Radiofrequency Ablation Therapy. Chokkalingam Mani B, Delgado GA. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556120/#_NBK556120_pubdet_
- Varicose Veins. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/varicose-veins/symptoms-causes/syc-20350643
