Varicose veins are twisted, enlarged, and painful veins that fill with blood. They usually develop in the legs and are raised above the surface of the skin. They are not life-threatening, but can cause discomfort and may be unsightly.
Traditionally, a surgery known as “vein stripping” was performed to remove the veins. This procedure involves small incisions and physically pulling the veins out of the body. However, more recent technologies have been developed to remove varicose veins using non-or-minimally-invasive procedures. The term noninvasive means that the procedure is nonsurgical and does not involve tools or equipment that cut the skin or that physically enter the body. Minimally invasive procedures are performed through tiny incisions in the skin as opposed to a large opening.
There are several different minimal or non-invasive procedures available for treating varicose veins. These include:
Sclerotherapy is a procedure that is designed to destroy the varicose veins by injecting them with a solution called a sclerosant. The sclerosant scars the vein and causes it to collapse, which forces blood to reroute to healthier veins. Your body eventually destroys the veins and they disappear over time. The sclerosant solution normally used during sclerotherapy is known as sodium tetradecyl sulfate (STS). This type of procedure is typically used to treat small varicose veins located closer to the surface of the skin, called “spider veins,” and to improve the aesthetic of the leg.
A procedure called foam sclerotherapy involves making the sclerosant into a foam prior to injecting it into the vein. This process is used for larger veins. This is because the foam can cover a larger surface area than liquid.
In this procedure, radio waves are applied to the vein wall. Radio waves, also called radiofrequency energy, are a form of electromagnetic energy. A doctor will use an ultrasound to see inside the leg. A wire catheter is passed along the vein and radiofrequency energy is applied to the wall of the vein. According to the National Institutes of Health, this catheter will passed up through the vein, typically from the knee to the groin. Your doctor will inject a special solution into the vein to numb it during this procedure (NIH, 2011).
The vein wall will heat up, thicken, and contract. The vein will eventually be reabsorbed by the body and disappear. It may take a few weeks or months to see the full results of this procedure.
Endovenous Laser Ablation
Laser ablation is similar to radiofrequency ablation, except it uses laser energy rather than radiofrequency energy. Laser fiber is inserted into the catheter, moved to the necessary location, and laser energy causes the vessel to close by heating it. The vein will eventually shrink and be reabsorbed by the body over time. Radiofrequency and laser therapy are often used to treat the deeper veins of the leg.
Not all varicose veins require treatment from a doctor. Conservative treatment—including exercise, weight loss, elevating the legs while sitting, and wearing compression stockings—may be tried initially. Noninvasive treatment may be recommended by a doctor if:
- self-care treatment is not successful
- the appearance of the leg is causing distress
- there is any pain or cramping
- blood clots form frequently (phlebitis)
- ulcers or sores form
- the fatty tissue under the skin hardens due to blood pressure from the vein (lipodermatosclerosis)
Noninvasive treatment for varicose veins is typically performed in a doctor’s office using local anesthetic.
Before the Procedure
Be sure to tell your doctor if you are pregnant, have any allergies, and/or you are taking any medications, including any herbal supplements. A doctor may have you stop taking aspirin, blood thinners, or any other medications that make it hard for the blood to clot a few days before the procedure.
During the Procedure
You will be awake during the entire procedure. A doctor will use ultrasound to visualize the vein. The image will appear on a monitor that looks like a television screen. An area of your leg will be cleaned and numbed with a local anesthetic. You will feel a sharp prick when the anesthetic is injected and may feel slight pressure when the catheter is inserted or minor stinging if a sclerosant solution is injected into the vein. If lasers are used, you will be required to wear protective glasses during the procedure. The closure of the vein, whether with radiofrequency or laser, should not be painful.
After the Procedure
Your legs may be wrapped with bandages to control swelling and bleeding. These bandages may need to be worn for several days. You should plan on having a friend or relative drive you home after the procedure. You may be advised to avoid strenuous exercise for a week or two following the procedure, but you should still remain active. Acetaminophen (Tylenol) may be recommended for any discomfort, but you should avoid any pain relievers that may disrupt blood clotting, such as aspirin or ibuprofen.
Additionally, your doctor may have you avoid hot baths or whirlpools following this procedure. Cool showers or sponge baths with mild soap and lukewarm water are recommended.
The noninvasive treatments are generally very safe. However, as with all medical procedures, there are some risks. All of the procedures carry a risk of allergic reactions to the anesthesia, bleeding, bruising, scarring or infection.
Risks of sclerotherapy may include:
- blood clots
- air bubbles
- small skin sores
- mild inflammation or swelling
- leaking of the solution into the surrounding tissues
Radiofrequency and Laser Ablation
Risks of radiofrequency and laser ablation include:
- damage to the vessel
- blood clots
- hematoma (collection of blood outside the blood vessels)
- skin burns
- sensation of tingling or prickling on the skin
- nerve injury
Typically a patient can resume normal activities within a day or two after receiving treatment. Compression stockings will need to be worn during the day for a week following treatment.
In general, the noninvasive procedures are very successful and the risks of experiencing complications are low. The appearance of the legs is typically greatly improved. In most cases, there are no signs of scarring or bruising. There is a small risk that the varicose veins will return later on. Wearing compression stockings can reduce the risk that the veins will return.