What are varicose veins?
Symptoms of varicose veins
Pictures: Varicose Veins
Varicose Vein Treatments
 
How are varicose veins treated?
Self-Care Measures
Medical and Surgical Treatments
Sclerotherapy
Endovenous Techniques (radiofrequency and laser)
Surgical Ligation and Stripping
Ambulatory Phlebectomy
Endoscopic Vein Surgery
Can varicose veins return after treatment?
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What are varicose veins?
Varicose Veins are enlarged veins that can be flesh colored, dark purple or blue. They often look like cords and appear twisted and bulging. They are swollen and raised above the surface of the skin. Varicose veins are commonly found on the backs of the calves or on the inside of the leg. During pregnancy, varicose veins called hemorrhoids can form in the vagina or around the anus.
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Symptoms of varicose and spider veins include:

• Itching
• Swelling
• Muscle Cramps
• Tired, Sore, or Achy
• Feelings of Heaviness
• Tingling, Throbbing or Burning Pain
• Red Discoloration of the Skin around the Vein
• Brown Discoloration of the Skin around the Ankles

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Pictures: Varicose Veins
Varicose veins are twisted, enlarged veins near the skin surface, usually on the legs. When varicose veins occur elsewhere, they are usually called by other names, e.g., ‘varicocele’ in the scrotum, and hemorrhoids in the rectum.

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Available vein treatments include those listed below:
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Self-Care Measures
Self-care measures are a common option for treating varicose veins. If self-care measures are called for, your doctor may ask you to:

• Avoid excess amounts of standing when possible. Take frequent breaks during prolonged periods of standing.
• Elevate your legs when sitting, resting, or sleeping. Elevating your legs above the level of your heart is very important.
• Wear compression stockings. These are typically worn all day long. Doctors may prescribe special-strength stockings or over-the-counter support stockings, which may be available at pharmacies and medical supply stores.
• Exercise. Exercise gets the legs moving and improves muscle tone, which helps the circulation of blood through your veins.
• Lose weight. Taking off extra pounds may help with blood circulation and pressure on your veins.
• Avoid wearing tight clothes. Tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs, can make varicose veins worse.

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Medical and Surgical Treatments
Medical and surgical treatments are used to either remove varicose veins or close them. Removing or closing varicose veins usually doesn’t create circulation problems because the blood reroutes itself through other veins. These therapies range from approaches that don’t involve incisions or injections to those that are surgical procedures. It may be necessary to combine therapies, depending on your condition and lifestyle.

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Sclerotherapy
This is the most common treatment for both spider veins and varicose veins. The doctor injects a solution of liquid or foam into the vein that causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood and the vein turns into scar tissue. In a few weeks, the vein should fade. The same vein may need to be treated more than once.

This treatment is very effective if done the right way. Most patients can expect a 50% to 90% improvement. Sclerotherapy does not require anesthesia, and can be done in the doctor's office.

Microsclerotherapy uses special solutions and injection techniques that increase the success rate for removal of spider veins and other very small varicose veins. It involves injection of small amounts of a liquid or foam chemical using a very fine needle. The chemical causes scarring in the inner lining of the veins, causing them to close off.

• Temporary stinging or painful cramps where the injection was made
• Temporary red raised patches of skin where the injection was made
• Temporary small skin sores where the injection was made
• Temporary bruises where the injection was made
• Spots around the treated vein that usually disappear
• Brown lines around the treated vein that usually disappear
• Groups of fine red blood vessels around the treated vein that usually disappear

The treated vein can also become inflamed or develop lumps of clotted blood. This is not dangerous. Applying heat and taking aspirin or antibiotics can relieve inflammation. Lumps of coagulated blood can be drained.

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Endovenous Techniques (radiofrequency and laser)
These methods for treating the deeper varicose veins of the legs (the saphenous veins) have been a huge breakthrough. They have replaced surgery for the vast majority of patients with severe varicose veins. This technique is not very invasive and can be done in a doctor’s office. The patient is awake during the procedure, but the doctor numbs the area of the vein. The patient usually goes home on the same day.

The doctor puts a very small tube called a catheter into the vein. Once inside, the catheter sends out radiofrequency or laser energy that shrinks and seals the vein wall. Healthy veins around the closed vein restore the normal f low of blood. As this happens, symptoms from the varicose vein improve. Veins on the surface of the skin that are connected to the treated varicose vein will also usually shrink after treatment. When needed, these connected varicose veins can be treated with sclerotherapy or other techniques.

Possible side effect:

• Slight bruising.

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Surgical Ligation and Stripping
With this treatment, problematic veins are tied shut and completely removed from the leg. Removing the veins does not affect the circulation of blood in the leg. Veins deeper in the leg take care of the larger volumes of blood. Most varicose veins removed by surgery are surface veins and collect blood only from the skin. This surgery requires either local or general anesthesia and must be done in an operating room on an outpatient basis.

Possible side effects: Serious side effects or problems from this surgery are uncommon.

• With general anesthesia, a risk of heart and breathing problems.
• Bleeding and congestion of blood can be a problem. But the collected blood usually settles on its own and does not require any further treatment.
• Wound infection, inflammation, swelling and redness.
• Permanent scars.
• Damage of nerve tissue around the treated vein. It is hard to avoid harming small nerve branches when veins are removed. This damage can cause numbness, burning, or a change in sensation around the surgical scar.
• A deep vein blood clot. These clots can travel to the lungs and heart. Injections of heparin, a medicine that reduces blood clotting reduce the chance of these dangerous blood clots. But, heparin also can increase the normal amount of bleeding and bruising after surgery.
• Significant pain in the leg and recovery time of one to four weeks depending on the extent of surgery is typical after surgery.

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Ambulatory Phlebectomy
With this surgery, a special light source marks the location of the vein. Tiny cuts are made in the skin, and surgical hooks pull the vein out of the leg. This surgery requires local or regional anesthesia. The vein usually is removed in one treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment.

Possible Side Effects:

• Slight bruising
• Temporary numbness

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Endoscopic vein surgery
This procedure uses a tiny camera at the end of a thin tube to move through the varicose veins. A surgical instrument at the end of the camera is used to close the veins. Endoscopic vein surgery is currently only used in severe cases in which there are skin ulcers due to the varicose veins. Only small incisions are required for this procedure. People who have this surgery must have some kind of anesthesia including epidural, spinal, or general anesthesia. Patients can return to normal activity within a few weeks.

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Can varicose veins return even after treatment?
Current treatments for varicose veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop. The major reason for this is that there is no cure for weak vein valves. So with time, pressure gradually builds up in the leg veins. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.

The single most important thing a person can do to slow down the development of new varicose veins is to wear graduated compression support stockings as much as possible during the day.