Varicose Vein Ablation

Reducing and destroying unsighlty, problem veins

Insurance covers varicose vein ablation because of the considerable discomfort this condition can cause, and because of the condition's link to more chronic and serious
venous conditions.

Interventional radiologists now offer the latest and most advanced option for removing unsightly varicose veins. These veins, once they appear, are permanent unless they are treated. The condition is extremely common: Tens of millions of people in this country are affected by this form of venous disease.

These enlarged veins, which may be discolored blue or purplish, most often appear on the side or back of the calf. They occur here because this is the area where the circulatory system's job of returning blood is most difficult, due to gravity, distance, pressure, and other factors. The veins also become visible because they are located close to the surface of the skin.

In addition to cosmetic concerns that patients experience, varicose veins can cause physical symptoms too. These veins do not usually cause medical problems; however, in severe cases, they can noticeably affect circulation in the legs, pooling a significant amount of blood, decreasing return of blood to the circulatory system, and compromising the supply blood to leg muscle. The condition is referred to as venous insufficiency or venous stasis disease. The result in the legs can be achiness, heaviness, tiredness, swelling, itchiness, easy fatigability, and cramping –– and in severe cases, leg ulceration. In rare cases, blood clots can form in these veins. In addition, not all patients who have varicose veins or symptoms of varicose veins have visible varicose veins. Individuals may have functional symptoms only.

Examining Valve Function
To evaluate patients for these symptoms, radiologists may use ultrasound to examine the leg veins. This test shows whether blood that should be moving out of the leg veins is flowing back or refluxing in these areas. This reflux occurs as a result of failure of the one-way valves in the legs that are supposed to keep the blood from flowing back as it is pushed out of the legs by circulatory pressure and the pumping action caused by movement of these limbs. Some people lose enough elasticity in their veins and have enough incompetency of the valves to cause malfunction of these veins and the venous pooling condition. The pressure caused by this venous insufficiency directly causes the thick, bulging, elongated appearance of varicose veins. Ultrasound will allow your specialist to assess the shape of the veins, the valve function, and the blood flow.

Age is the primary risk factor for the condition, but women are also somewhat more likely than men to have visible varicose veins. Any family history of varicose veins is another factor, as is having had multiple pregnancies.

Laser Therapy Available
Whether treatment is appropriate and which treatment is best depends in the size of the varicose veins, their position, their level of cosmetic concern, functional symptoms they produce and other factors. Radiologists offer the procedures of choice for most patients today who seek definitive treatment for varicose veins, especially when the condition involves larger or deeper veins. These specialists provide treatment via several options, all of which serve to ablate (destroy) the problem veins from inside so that they no longer affect the appearance or function of the legs or other areas in which they occur. Once ablated, the veins atrophy and disappear. To accomplish these venous- or varicose-closure techniques –– also referred to as endovenous ablation –– interventionalists can use one of a number of different approaches:

•radiofrequency ablation. The specialists may use radiofrequency (RF) energy delivered through the end of a catheter. RF tools transmit radiowave energy at high levels through small areas of tissue. The tissue absorbs the energy, converting it to heat. This heat destroys the cells exposed to it. Specialists can, thus, place the tip of RF delivery devices in and around abnormal blood vessels to destroy them.

• laser treatment. Interventionalists may use laser energy delivered through the end of a catheter. Catheter tools with laser-fiber tips transmit laser light to small areas of tissue. The tissue absorbs the energy, converting it to heat. This heat destroys the cells exposed to it. Specialists can, thus, laser abnormal blood vessels to destroy them.

• sclerotherapy. The radiologists can also use chemical scarring or sclerotherapy, in which they direct a thin tube to the vein and inject alcohol or other substance that causes the veins to scar and close. The scar tissue is absorbed by the body over time.

Additional Treatments & Prevention

Other options in addressing varicose veins include:•Phlebectomy or avulsion. Vascular surgeons may use this minimally invasive, outpatient procedure to remove varicose veins that do not involve or affect the saphenous vein. The surgeon simply removes the vein through a series of holes in the skin. There is little recovery time needed from this procedure.•External laser therapy. Small or medium-sized varicose veins can often be reduced by exposing them to surface treatments of laser light or other intense, pulsed-light energy.•Injection sclerotherapy. Like interventional, ultrasound-guided sclerotherapy, this treatment takes advantage of a chemical solution to shrink the vein. In this case, though, the physician simply uses a fine needle to inject the solution into the vein, rather than treating it from the inside using catheters.•Endoscopic repair. If a patient has severe symptoms such as sores or ulcers, the vascular surgeon may use a small scope to find and repair defects in the veins.

Specialists make these recommendations for preventing occurrence or reoccurrence of varicose veins:• Don't make a habit of sitting with your legs crossed at the knees.• Stay at a healthy weight. - Avoid high heels, which restrict circulation in the lower legs.• Limit the wearing of restrictive clothing that can inhibit blood flow in the upper and lower legs.• Try not to sit or stand, especially in a fixed position, for extended periods of time.• Take opportunities to stretch and move your legs, or elevate them, when you can.

Patients receive local anesthetic and moderate sedation for procedures to treat varicose veins. The interventional radiologist accesses the venous system of the legs through a small incision (normally just above or below the knee) that allows the specialist to introduce a catheter into, normally, the greater saphenous vein in the thigh. (Reflux in the greater saphenous vein is the most common basis for varicose veins.) Using ultrasound to visualize the vein and catheter and to guide the procedure, the interventionalist advances the catheter to the varicosed area and then treats it, to cause the vein to collapse and seal shut. This outpatient procedure takes less than an hour.

Veins Shrink and Disappear
Eventually, the body reabsorbs the venous tissue that is destroyed, as other veins take over and empty blood from the legs, re-establishing normal flow and blood-return back to the heart. The treatment is a quick, outpatient procedure, and many patients begin to feel relief immediately. The patient's legs are wrapped for a day to aid healing, and the patient may return to normal activity within a day or two, although patients must avoid long periods of sitting or bed rest and must not lift heavy objects. Patients should remain moderately active with their legs (normally through walking) during the day to improve healing during this time. They also wear compression stockings to reduce bruising, tenderness, and the slight possibility of blood clots.

Patients will undergo a follow-up ultrasound evaluation with the radiologists to determine if the procedure successfully treated the targeted area. While varicose vein ablation is effective well over 90 percent of the time in closing the targeted veins, small expanded branches of vein may be persistent and visible in the skin and require a minor phlebectomy (see below)or sclerotherapy procedure to remove them.

May Involve Series of Treatments
Patients may chose to have one leg treated with varicose ablation and then return some weeks later to have the other leg treated. Satisfaction is very high with both with the cosmetic and functional results of these interventional steps. The appearance of the legs is improved, and patients who have severe symptoms are often able to return with greater comfort to activities that were painful or difficult previously.

Interventional vein ablation allows many patients to avoid surgery for varicose veins. In the past, these surgical procedures were the only option for the condition. Patients underwent vein ligation or stripping, operations in which the surgeon ties off problem veins or removes them, through the skin. Recovery from these procedures is painful and extended, and the rate of recurrence of varicose veins after these procedures is high.

In comparison to these surgical solutions, specialists are finding the endovenous interventional techniques to be more effective and to have fewer complications –– and to be followed by far fewer recurrences. Patients also experience notably less pain in healing. In addition, because the opening required for the radiologic catheter is small, the newer procedures leave behind virtually no scarring on the surface of the leg. These procedures have replaced surgery for the vast majority of patients with severe varicose veins.

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