Venous insufficiency is a condition in which veins lose the capacity to maintain blood flow in the correct direction. Arteries usually bring blood to the legs and arms. Veins return blood back to the heart. Veins normally have valves that prevents blood from traveling backwards and therefore facilitate blood travelling back toward the heart. When these valves lose their function, blood no longer moves normally towards the heart and starts to pool in the veins of the legs. This is referred to as venous insufficiency. When legs have venous insufficiency, symptoms or findings may include leg swelling, development of varicose veins, spider veins and skin changes. Extreme cases of venous insufficiency can lead to ulcers of the skin.
The Greater (long) Saphenous vein and Lesser (short) Saphenous vein when developing insufficiency can cause varicose veins, spider veins and swelling and discomfort in the legs. People may feel as though their legs are heavier as the day progresses. Standing for an extended period can cause discomfort and swelling but is often alleviated by elevating the legs. Some people as a result of venous insufficiency, may experience restless leg syndrome. Traditionally vein stripping has been used as a treatment for venous insufficiency, but technology has advanced in recent years that have made alternate options more appealing.
Endovenous ablation is a newer and more effective treatment compared to venous stripping and has become available in the last several years for the treatment of venous insufficiency. Veins such as the long saphenous, short saphenous and the anterior accessory vein of the thigh are amenable to treatment using endovenous ablation.
Endovenous ablation can be done with radiofrequency ablation (RFA) technology or a laser. Both techniques are effective in treating or ablating these veins as an outpatient procedure with a 96% (laser) to 97% (RFA) success rate in closure of a vein immediately following the procedure. It is more effective and successful than venous stripping. Long-term studies (10 year follow-up), have shown RFA it to be far superior to venous stripping in regards to recurrence with a less than 4% recurrence rate compared to a greater than 30% recurrence rate using venous stripping.
There are additional other advantages to endovascular venous ablation. It is done as an outpatient procedure and is commonly done in a clinic setting rather than in a hospital. One can return to full activities with no delay. With radiofrequency ablation 90% of patients can return to full activity within 24 hours and with endovenous laser approximately 70% return to normal activity within 24 hours. These procedure can be done with no general or spinal anesthetic. The procedure of endovascular ablation can usually be completed within an hour. Risk factors are relatively very low. Sedation is unnecessary. With RFA , bruising occurs in less than 5% of patients following the procedure.
It is important to understand that endovenous ablation alone usually does not eradicate existing varicose veins or spider veins. Endovenous ablation of veins such as the greater saphenous, lesser saphenous veins or anterior accessory vein of the thigh might however, be an important step to the successful treatment of varicose veins and spider veins.
Varicose veins and smaller veins can be treated successfully with microphlobectomy or sclerotherapy. As mentioned previously, it is valuable to know if underlying venous insufficiency is present because if it is not treated, additional spider veins or varicose veins can occur or recur.
Much smaller veins such a small spider veins can be treated with relatively good success using laser or ohmic thermolysis. Spider veins or telangiectasia are most commonly seen on extremities or on the face.
Medium to large spider veins in legs usually require sclerotherapy or a combination of ohmic thermolysis or laser and sclerotherapy. Depending on location and size it is a good idea to first assess and treat any underlying insufficient veins. These veins may not be so visible to the eye but may be seen with ultrasound or a vein light which may be contributing to the visible spider veins forming. These can be eliminated with microphlebectomy or sclerotherapy and sometimes with laser if larger in size.
Microphlebectomy, sclerotherapy and ohmic thermolysis or laser can be used to treat varicose veins and spider veins during the same session as endovascular ablation or alternatively during subsequent visits. It is not uncommon however to require several visits/procedures over a month or two to successfully treat veins effectively. There are cases also where it is highly advised to treat varicose veins during the same visit of endovascular ablation to prevent thrombophlebitis (clotting and subsequent inflammation and pain) of a varicose vein.
Complete treatment of veins may necessitate as many as 6 visits a few weeks apart. Most issues can be treated in 2 to 4 visits. To see the final results can take a few weeks to a few months. It is important not to be discouraged with the initial appearance after treatment. It is normal for it to look worse immediately following treatment. The cosmetic appearance improves within a few weeks.