Varicose Veins

Symptomatic veins primarily include varicose veins and the underlying "feeding" veins (great and small saphenous veins) that may be the true cause of the visible varicose veins and leg symptoms. Varicose veins are veins below the surface of the skin that become abnormally swollen and large. Varicose veins are commonly bluish dilated, swollen veins that protrude from the surface of the skin. They frequently have a tortuous or worm-like appearance.

What causes varicose veins?

When functioning normally, the veins bring blood from the extremities back to the heart. Valves in the vein must close properly so that blood travels in the right direction. If the valves become weak or damaged and fail to close properly, the blood moves backwards down the leg (called venous reflux), causing an abnormally high volume and pressure of blood to build up in the veins. The veins cannot withstand the pressure of that additional blood, so they expand and begin to dilate and protrude. When they bulge against the skin surface, they are called varicose veins.

Treatments for Varicose Veins

Vein treatments are designed to treat visible varicose veins and to treat abnormal veins that may not be visible, but which may be the underlying source of the visible veins and symptoms. If varicose veins are the only problem, treatment usually involves collapsing or removing the visible varicose veins through one of the minimally-invasive methods offered at our program.

All vein procedures at the Vascular Surgery Vein Program are minimally invasive. Most involve no incisions, or at most, a quarter inch incision. All procedures are performed with local anesthesia or sedation. Procedure time is usually 20-30 minutes. Patients can walk immediately after the procedure and can resume all activity, including exercise, after one or two days.

Together with their physicians, patients may choose among several types of procedures, each of which uses a different form of energy to treat the veins: chemical energy (sclerotherapy), mechanical energy, microwave energy, radiofrequency, or laser energy are all highly effective, minimally invasive options. In some cases, a tiny vacuum is used that performs a "lipo-suction" of the visible veins. All are extremely safe. In surveys, 95% of patients would recommend these procedures to others.

At the Vascular Surgery Vein Program we no longer perform 'stripping' of veins, an invasive procedure to remove varicose veins that has been replaced by minimally invasive technologies.

Endovenous Ablation for Varicose Veins

Larger varicose veins – and the underlying causes of varicose veins – require different treatment approaches than the smaller veins. In order to control the backward flow of blood in the large veins, the source of the visible varicose veins (varicosities) must be sealed shut or removed.

In the past, such veins were surgically removed through an invasive procedure known as 'vein stripping.' Today, stripping has been replaced by a far less invasive procedure, endovenous ablation, which seals the veins shut from within the vessel. The Director of the Vascular Surgery Vein Program has been instrumental in the development of endovenous ablation techniques over the last 10 years, helping to advance many of these technologies and to teach surgeons around the world how to perform them. Our center does not perform the older 'stripping' technique.

During endovenous ablation, an energy source is directed into the great or small saphenous veins in the leg. No incisions are necessary, as only a needle stick is required. The treatment seals the veins shut from within, eliminating the source of the varicose problems.

Treating the Underlying Cause

Visible varicose veins are often caused by veins slightly deeper below the surface of the skin. These veins cannot be seen but can be visualized with ultrasound studies. The treatments for varicose veins may entail treating the underlying abnormal feeding vein first, or sometimes in conjunction with treatment of the visible varicose veins. The principle is to treat the underlying cause of the patient's symptoms and visible veins.

Endovenous ablation techniques such as laser (the use of pulses of light to collapse and seal the vein shut), radiofrequency (the use of heat energy to collapse and seal the vein shut;), Mechanochemical ablation (Clarivein™) (the use of chemical and mechanical energy), and other new procedures treat the underlying abnormal feeding vein. Techniques such as Trivex or phlebectomy directly treat the visible varicose veins. All treatments are determined by what is seen on the ultrasound studies and what the patient wishes to accomplish. Endovenous ablation treatments are performed under local anesthesia, sometimes with sedation. Following the procedure, a bandage or compression hose is placed on the treated leg. Patients are able to walk immediately after the procedure and most are able to return to work the next day. Complications are rare, occurring in less than 1% of all patients.

Frequently Asked Questions about Varicose Veins

How will the blood in my veins get back to my heart after all of the abnormal veins are removed or destroyed?

The veins that are treated are abnormally functioning veins which have been identified by the ultrasound study (see previous section about diagnosis.) The backward flow of blood in the malfunctioning varicose veins and the underlying feeding veins (great and small saphenous) impairs the normal venous return flow of blood to the heart. Removal of these areas of abnormal circulation actually improves circulation of blood in the treated limb by keeping the blood in the normally functioning veins. The combination of treating the abnormal veins and returning blood to the normal veins improves limb circulation and reduces symptoms in the limb.

Is it a problem to leave varicose veins untreated?

Untreated varicose veins may remain only a mild or moderate problem, or they may progress. Some people with varicose veins will experience continued symptoms of pain, fatigue and swelling of the legs or ankles. In other people, more advanced medical problems may develop, including:

  • discoloration of the skin (hyperpigmentation),
  • hardening of the skin and fat (lipodermosclerosis),
  • venous leg ulcers,
  • spontaneous bleeding,
  • inflammation of the vein (superficial thrombophlebitis)
  • potentially life-threatening condition called deep vein thrombosis.