Why Do Varicose Veins Form

The veins in our legs return blood to the heart as part of normal circulation.  The machinery for this process is quite remarkable given the challenges of bringing blood up from the floor against gravity.  To do this, veins have tiny valves that work like a ladder to keep blood moving toward your heart.

If the valves become dilated or damaged due to venous insufficiency, blood flow becomes impaired and the veins swell from the pooling of blood.   Swollen veins visible on the surface develop as spider veins and varicose veins.

Symptoms of Varicose Veins

Varicose vein symptoms can be present with both visible and non-visible veins on the surface of the skin.  Suggestions of vein disease include:

  • Swelling in your ankles and feet
  • Painful or heavy legs particularly at the end of the day
  • Charley horse or muscle cramps at nighttime
  • Discolored patches of skin particularly at the ankles or anterior shin region
  • Corona phlebectatica
  • Stasis dermatitis due to chronic inflammation from leg swelling

What Are Effective Varicose Vein Treatments

Modern vein treatments are far removed from the days past where large veins were surgically removed in a procedure known as “vein stripping.”  Today, the most effective treatments are minimally-invasive and performed directly within the office.  The most common forms of treatment are:

  • Vein Ablation: The gold standard of vein treatment involves catheter based delivery of heat energy to collapse the target vein.  Two different technologies are available but have similar results: Endovenous Radiofrequency Vein Ablation and Endovenous Laser Ablation (EVLA).  With vein ablation, surgical incisions are not necessary and the procedure can be completed with just simple, local anesthetic.
  • Foam Sclerotherapy: The FDA has approved Varithena for treatment of both truncal vein disease and large varicose veins. Varithena is a low-nitrogen, polidocanol foam dispensed from a proprietary canister device effective.  Varithena is injected as a microfoam without tumescent anesthesia.
  • Phlebectomy: Using tiny incisions, large and bulky veins can be directly removed using local anesthetic.
  • VenaSeal: The latest innovation in vein medicine involves catheter based delivery of a medical adhesive to the target vein. The diseased veins are fused closed and blood is shunted to healthier veins to improve venous circulation in the legs.

How Effective are Varicose Vein Treatments

Vein ablation is now the most frequently used therapy and is  the gold standard of treatment for venous insufficiency.  Most importantly, vein ablation has been associated with improved quality of life measures at 5 years and recurrence rates in comparison to traditional stripping procedures.  A meta-analysis on the different treatments for saphenous varicose veins demonstrated a success rate at 93% at 5 years of follow-up. As expected, vein ablation also demonstrated decreased time for recovery and less post-operative pain.

VenaSeal received approval after demonstrating non-inferiority to vein ablation on 5 year follow up. The effectiveness was found to be greater than 90% in the VeClose study.

Similarly, placebo-controlled trials have demonstrated the safety and effectiveness of Varithena.

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