Varicose Veins and Spider Veins

Other treatments for venous reflux disease

Vein Stripping
The traditional therapy used to treat venous reflux in the saphenous vein is surgical stripping and ligation. This procedure is performed by surgeons and often involves general anesthesia in an outpatient hospital setting. Vein stripping and ligation begins with an incision in the groin region to expose the saphenous vein; once identified the surgeon "ligates" or ties off the saphenous vein and small veins in the area with sutures. A second incision is made either just below the knee or at the ankle for the same purpose. Once both ends of the vein are free, a thin wire-like instrument called the stripping tool is threaded through the vein from the groin to the second incision. The stripping tool is tied to the vein and the vein is pulled out, or stripped, and removed from the leg. Some common side effects from vein stripping and ligation surgery may include temporary pain or discomfort, bruising, hematoma, numbness, and less frequently wound infection.³

To read the story of a patient who has received both the vein stripping and Closure procedure, click here.

Endovenous Laser (EVL)
The EVL is an outpatient procedure performed under local or regional anesthesia. In the EVL technique, a bare laser fiber is inserted into the diseased vein through a small opening and delivers pulsed laser light which heats the vein to over 1000ºC.⁶ A recent medical study found that the laser acts by indirect heat damage of the vein wall through laser induced steam bubbles.⁷ Another recent report, using EVL in an animal model, showed that the laser energy perforates the vessel thereby interrupting flow. The report recommends a thorough histologic investigation and in conclusion states that "further study of this laser procedure for the treatment of varicose veins is clearly warranted before the endovenous laser ablation technique can be fully advocated in patients".⁶ Typical side effects experienced by majority of patients after treatment include bruising and tenderness.⁶

To read the story of a patient who underwent both the endovenous laser treatment and Closure procedure click here.

Adjunctive procedures to treat spider veins and visible varicose veins
Whereas the Closure procedure (and other alternative treatments) are used to treat the underlying condition of venous reflux, adjunctive procedures are often used to treat visible spider and varicose veins. Spider veins are small, thin veins that lie close to the surface of the skin.

Sclerotherapy
Sclerotherapy is often performed to destroy small, visible spider veins and varicose veins near the skin surface. A sclerosing solution is injected into the spider veins to damage the interior of the vein. The injections are followed by compression wrapping of the leg to help the damaged vein seal closed. Sclerotherapy treatment often requires multiple injections per visit to the doctor and several visits may be necessary before the veins disappear. Common side effects may include skin discoloration and tenderness.

Phlebectomy
Medium-sized and larger varicose veins can be removed by a procedure called stab avulsion or phlebectomy. This procedure can be performed using local or general anesthesia. Small stab incisions are made in the skin to allow a tool to be placed through the skin to hook the vein and pull it out through the skin incision. The vein is then pulled until it breaks, causing the varicose vein to be removed in pieces. This process is repeated until all targeted varicose veins have been eliminated. Common side effects may include pain, bruising, hematoma, and bleeding.

1. Procedures performed at regional ACP Meeting, June 2001.
2. Data on File - VNUS Medical Technologies, Inc.
3. Mackay DC, et al. The Early Morbidity of Varicose Vein Surgery, Journal of the Royal Naval Medical Service, 1995; 81: 47-51.
4. Morrison N. Presented at the Union Internationale de Phlebologie, Rome, September 2001.
5. Weiss RA, et al. Controlled Radiofrequency Endovenous Occlusion Using a Unique Radiofrequency Catheter Under Duplex Guidance to Eliminate Saphenous Varicose Vein Reflux: A 2-Year Follow-up, Dermatologic Surgery, Jan 2002; 28:1: 38-42
6. Weiss RA. Comparison of Endovenous Radiofrequency Versus 810 nm Diode Laser Occlusion of Large Veins in an Animal Model, Dermatologic Surgery, Jan 2002; 28:1: 56-61
7. Proebstle TM, et al. Endovenous Treatment of the Greater Saphenous Vein with a 940 nm Diode Laser: Thrombotic Occlusion after Endoluminal Thermal Damage by Laser Generated Steam Bubbles, J Vasc Surg 2002; 35: 729-736.
8. Merchant RF, DePalma RG, Kabnick LS. Endovascular obliteration of saphenous reflux: A multicenter study. J Vasc Surg 2002;35:1190-6
9. Jones L, et al. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomized trial of stripping the long saphenous vein, Eur J Vasc Endovasc Surg, 1996; 12: 442-445
10. Lurie, F, et al.Prospective randomized study of endovenous radiofrequency obliteration (Closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study), J Vasc Surg 2003; 38(2):207-14
11. Morrison N. Abstract presentation at the American College of Phlebology 16th Annual Congress, Ft. Lauderdale, Florida, November 2002