WOMEN'S HEALTH

Dr. Thomas Foster

Varicose Veins: Over 70 Percent of Women Develop Condition

VARICOSE VEINS are defined as one or more markedly dilated, twisted vessels directly under the skin of the legs.  It is estimated that up to 72 percent of females and 42 percent of adult males will develop varicose veins by the age of 60.  The risk factors include a family history of varicose veins, obesity, standing professions, and multiple pregnancies.  Varicose veins are usually symptomatic, variably producing leg pain, fatigue, itching, throbbing and restless foot.  If progressive, advanced stages lead to leg and ankle swelling (estimated USA prevalence: six million), skin changes (one million), and eventually, venous stasis skin ulcers (500,000), which often do not heal without aggressive, prolonged therapy.

Many people find that elevating their legs or wearing medical grade compression stockings improve their symptoms.  Until recently, the only definitive treatment for varicose veins was surgical vein stripping.  This turned out to be only 50 percent effective, and was associated with a high complication rate.

New Techniques

WITH RECENT ADVANCES in technology, it is now possible to treat varicose veins in the physician’s office using only local anesthetic. The procedure generally takes only one to two hours, and the patient is encouraged to walk immediately after.

With recent advances in the technology of duplex ultrasound coupled with advances in minimally invasive endovascular surgery techniques, it is now possible to precisely deliver thermal energy to treat the vein responsible for the varicose veins through a three millimeter skin incision near the knee and threading a long thin plastic tube called a catheter through the vein to the groin.  This is performed in the physician’s office, using only local anesthetic, with no IVs required.  The procedure is performed under real time ultrasound guidance and generally takes one to two hours.  The patient is encouraged to walk immediately after the procedure.

How New Procedure Works
The veins of the legs are divided into two parallel systems: the deep and the superficial (under the skin) veins. The superficial veins are low pressure vessels that are passive, thin walled reservoirs and are very distensible, enabling pooling of large amounts of blood.

The normal passage of blood upward from the feet and legs back to the heart (against gravity) is accomplished by a combination of valves in series inside the vein and muscular pumping. Varicose veins will form when the venous valves fail to perform their function of closing after the muscles have pumped the blood upward toward the heart, resulting in reversal of flow and large amounts of blood pooling in the web of superficial leg veins.  This is what constitutes the varicose veins.

The saphenous vein is the major superficial vein in the leg, extending from the groin to the inner ankle, on the inside of the leg just deep to the skin.  In the vast majority of cases, closing the saphenous vein will eliminate the source of all incompetent valves responsible for the varicose veins and result in a complete cure.  As long as the deep venous system is healthy, blood from the legs will return to the heart in a normal fashion, and the saphenous vein can be safely closed.  Endovascular closure of the saphenous vein is accomplished by the application of LASER or RF (radiofrequency) energy to the inside of the saphenous vein.  Though both modalities will result in 95 percent success, RF energy may be more advantageous to accomplish venous closure.

LASER generates energy inside the vein to literally boil the blood and cause thermal injury to the inner vein wall.  RF generates energy inside the vein, causing resistive heating, collagen contraction of the vein wall, and fibrous obliteration of the vein.  The difference between the two modalities is that LASER energy is delivered at a constant rate, whereas RF energy is variably delivered by a computer controlled by direct real time feedback obtained from electrode measurements inside the vein being treated.  The RF generator constantly adjusts its energy level to deliver much lower amounts than LASER to accomplish the same end result: closure of the vein.

Lower Complication Rates
The advantage to the patient is that RF treatment results in much lower complication rates, including less bruising, pain and skin burning when compared to LASER.  RF closure is also supported by the largest collection of published data, with up to five year follow up.  Both modalities boast 95 percent effectiveness, but RF has documented durability out to five years.

Most insurance companies will now pay for varicose vein therapy, including RF closure, if the reasons are other than cosmetic.  The physician must not only perform a history and physical examination, but also must document venous insufficiency by the results of a noninvasive ultrasound scan.  The patient must have significant symptoms and/or signs, and must have used medical grade compression stockings for one to two months without relief of their symptoms.

The most significant benefit of varicose vein therapy is not only relief of symptoms and improved cosmetic appearance, but also avoidance of the long term complications of venous insufficiency, especially debilitating leg and ankle swelling, as well as skin changes, including dreaded venous stasis skin ulcers.

The understanding and treatment of varicose veins of the legs has progressed considerably over the last decade.  Those suffering from the symptoms of varicose veins should be aware that a highly effective, minimally invasive treatment is available.

Dr. Foster is a Vascular and Interventional Radiologist, President of Harbor City Medical Imaging, P.A., and is director of Medical Imaging at Wuesthoff Medical Center in Melbourne.  He holds a Bachelors degree in Biomedical Engineering from the University of Southern California and Masters and Medical degrees from Ohio State University.  Dr. Foster received fellowship training in Vascular and Interventional Radiology at the Cleveland Clinic and is board certified. Dr. Foster has presented original research on several occasions for the Society of Vascular and Interventional Radiology and has served as President of the Brevard County Medical Society. For more information, CLICK HERE.

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