Varicose veins are enlarged, twisted and distorted vessels which affect half of people age 50 and older, and 15 to 25% of all adults in North America
Although any vein may become varicose, leg veins are most commonly affected. This is because people spend much of their time sitting or standing which increases the pressure in the veins in the lower body.
Varicose veins are produced as a result of defective venous valves within leg that fail to close properly. This causes blood to flow backwards (reflux) towards the feet and pool in the lower legs (especially when sitting or standing). This causes the veins to distend and bulge out and, over time varicose veins may develop.
Risk factors for varicose veins include: age, family history, female gender and pregnancy. Other contributing factors include hormone replacement therapy, birth control pills, obesity or sedentary lifestyles, and professions that require prolonged standing or sitting.
Varicose veins are not only of cosmetic concern but can also be associated with swelling, aching, tenderness as well as a tired or heavy feeling in the legs which often worsens as the day progresses. As time goes on, chronic skin thickening, discoloration and even ulceration may occur.
Varicose Vein Treatment Options:
Lifestyle Modification Treatment options include lifestyle changes in which patients are instructed to elevate their legs whenever possible. In addition, compression stockings are worn throughout the day. While this approach is cheap and non-invasive, compression stockings can be uncomfortable and unsightly to wear for the rest of one’s life. In addition, the underlying problem is not corrected and no cosmetic improvement can be expected.
The mainstay of therapy for varicose veins in the past has been surgical ligation and stripping of the long saphenous vein (LSV). This involves making an incision at the groin. The LSV is tied off and cut. A second incision is then made at the knee and a special instrument is inserted and advanced up the vein to the groin. The vein is tied to the instrument and the remainder of the vein is then averted (pulled inside out), stripped and removed through the knee incision. Additional incisions may be required up the leg to tie off branching veins. The advantages of surgery include that it is covered by provincial health insurance and the fact that the procedure has been around for years and is reasonably effective. The disadvantages include that it produces fairly extensive tissue trauma, multiple scars, may require general anaesthesia and is associated with higher complication rates and longer recovery times that minimally invasive therapies.
Minimally Invasive Therapies Endovenous Laser Therapy (EVLT®):
EVLT® is a new, minimally invasive image-guided technique designed to replace surgical vein stripping. A catheter bearing a laser fiber is inserted under ultrasound guidance into the long saphenous vein through a small puncture at the level of the knee. The catheter is then advanced (also under ultrasound guidance) up the leg to the top of the long saphenous vein. The laser is activated resulting in obliteration of the saphenous vein. The catheter is then slowly withdrawn and the vein is ablated along its entire length. Foam sclerosant may be added through the catheter as required to treat large side branches. Results to date suggest a cure rate of over 90%
Direct Injection of Liquid Sclerosants: Useful for spider veins. Not appropriate for large varicose veins. May be used as an adjuvant therapy to other forms of varicose vein treatment. Sclerosants (including saline solution) are injected into clusters of spider veins, causing obliteration by destruction of the vein wall.
Direct Injection of Foam: Useful for branch veins but not the large saphenous vein. The foam replaces the blood in the vessel causing phlebitis or clotting, thereby destroying the vein. This method is very useful as a supplemental therapy, often administered along with Endovenous Laser Therapy (EVLT®)