Until recently the only way to treat varicose veins required patients to go through an invasive and often painful surgical procedure called “stripping,” which involves actually ripping the offending veins out of the leg and removing them. Ouch! So much for the “good old days.”
Thankfully, recent advances in technology have made varicose vein treatments pain- less and easy. Think “minimally invasive”— hooray! Dr. Gaurav K. Goswami, M.D., a board-certified physician with over 20 years of experience in vascular interventional radiology and surgery, was recently interviewed to talk about the vein treatments available and also how varicose veins can be prevented in the first place.
Dr. G: Varicose veins are the result of an underlying problem in your circulation. You see, there are valves in your veins that are supposed to keep your blood flowing upward from the legs to the heart and lungs for oxygenation. But in patients with varicose veins those valves no longer function properly. Instead, the blood flows backward and pools in the legs, causing the veins to bulge, elongate and become ropey. Those are varicose veins. The thin blue and red veins that appear just under the surface of the skin are called spider veins.
Dr. G: Absolutely! Varicose veins don’t always bulge or show but they do produce certain symptoms, including restless legs, painful heavy legs, skin itching and discoloration, night cramps, ankle swelling or leg ulcers. These symptoms may not be life threatening but they can make you very uncomfortable and limit the quality of your life.
Dr. G: Yes. As men age, gain weight or become inactive, their blood flow can become compromised resulting in varicose veins. Heredity is also a risk factor.
Dr. G: Left untreated, they will only progress and worsen over time. The more the blood stagnates in the leg veins, the less oxygenated that blood will be. That can lead to various medical problems such as worsening leg pain, itching, skin discol- oration, bleeding and ulcer formation if left untreated.
Dr. G: In the initial consultation, I perform a clinical examination and do an ultrasound to evaluate the entire vein structure. The superficial and the deep veins connect to each other, so treating only superficial veins without evaluating the deeper veins can cause the patient future problems. Once both the surface veins and the deeper veins have been evaluated, a proper course of treatment can be planned.
Dr. G: Well, with the new technology I hesitate even to call it surgery anymore. No fasting or general anesthesia is re- quired. I simply apply a local anesthetic and then, guided by ultrasound, I insert a thin heat probe (laser or radiofrequency based) into the varicose vein and seal it closed. The technical term for the proce- dure is endovenous (or vein) ablation. As a result, the treated vein shrinks and the pooling of blood is eliminated. The symp- toms almost immediately disappear, and over the next few weeks there is a grad- ual improvement in appearance. No sur- gery, no stitches, no heavy bandages. The treatments have become a lot simpler and much less invasive!
Dr. G: I typically treat smaller spider veins with simple injections (sclerotherapy) that make the blood ves- sels shrink. However, if the spider veins are in the pa- tient’s nose or ears, I use a heat process called VeinGogh to treat them.
Dr. G: Right after the procedure. You walk in. You walk out. I tell my patients that they can bring their shopping list and hit the mall right after treatment!
Dr. G: Yes. I measure your legs for a perfect fitting of therapeutic stockings to wear off and on for about a week to ten days after the procedure.
Dr. G: Move. Keep the blood flowing. Prolonged sitting for your job or on long car or plane trips is unhealthy. One should never sit or stand in the same position for over an hour without moving around. Pro- longed immersion of the legs in hot tubs can also aggravate varicose veins. But even with the healthiest habits, you may need a little bit of medical help. Leg veins are working to carry blood against gravity and with advancing age, abnormal veins can develop.