New Laser Treatment for Varicose Veins
For more information about vein ablation, please call:
- Harborview Medical Center at 206-731-6862
- UW Medical Center at 206-598-6209
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Overview
Varicose veins. Those are the twisted, enlarged purple vessels that bulge out from the skin. What many people do not realize is that they are more than an unattractive nuisance. Varicose veins can cause severe pain, heaviness, swelling, bleeding, and wounds that won't heal. Varicose veins are not a normal part of aging, they can be a sign of serious underlying vein disease.
Large varicose veins can be a sign of serious underlying disease.
This left side of this cartoon shows normal blood flow with functioning vein valves. Blood can only flow toward the heart (green arrows). When the valves fail, as in the picture on the right, blood can flow backwards (red arrows), causing veins to swell and become painful.
What causes varicose veins?
When blood flows from the legs to the heart, it has to travel against gravity. This process works because a series of small one-way valves keep the blood from flowing backwards. Every time you move a muscle in your leg, it squeezes blood through nearby veins, and the valves direct it toward the heart. When the valves fail, blood can travel backwards, a process known as reflux. (Imagine a one-way street with all the traffic signs removed.) Refluxing blood pools in the legs, raising the pressure in the veins and causing them to enlarge. As this process continues, varicose veins appear.
The vessel most often responsible for the reversal of blood flow is called the saphenous vein, which runs along the inner thigh. If your varicose veins are caused by reflux in the saphenous vein, the only sure way to permanently eliminate them is to remove the saphenous vein or block the backward flow. There are several treatment options for varicose veins, as well as a new, minimally invasive way of blocking saphenous vein reflux.
Treatment Options
There are several options for treating varicose veins, and the type of treatment used in a particular situation depends upon the size of the veins and their cause. You will need to discuss your own case with a health-care provider to determine the treatment that's right for you. The following is an overview of the options:
- Stockings
The simplest treatment for varicose veins is to wear compression stockings -- very tight socks that compress the veins and help the valves function better. They also squeeze excess fluid out of the legs, reducing swelling. While compression stockings are rather expensive and can be quite uncomfortable, they are very effective.
- Sclerotherapy
Specific veins can be eliminated by injecting them with a chemical called a sclerosant. Sclerosing agents cause a chemical injury to the vein, sealing it closed. This technique is extremely effective for small veins (often called "spider veins"), but large varicose veins treated with sclerotherapy generally come back. This treatment is not useful for treating the saphenous vein, which is the root cause of varicose veins in many cases.
- Surface laser
Like sclerotherapy, surface laser is very effective in treating spider veins, but is not useful for larger varicose veins or the saphenous vein.
- Phlebectomy
This is a surgical procedure in which visible veins are removed through a series of small incisions under anesthesia. Like sclerotherapy, phlebectomy targets specific varicose veins. Unlike sclerotherapy, this procedure can be used for very large veins. Phlebectomy is similar to vein stripping (below), but treats only surface veins, not the saphenous vein that caused them in the first place.
- Vein stripping
When varicose veins are caused by saphenous vein reflux, as they usually are, any treatment that leaves the saphenous vein intact will probably only give a temporary result. In other words, a permanent fix requires that the saphenous vein be removed or its backward flow blocked. In the past, saphenous vein reflux was treated by surgically removing the entire vessel under general anesthesia, a procedure called "stripping." The surgeon makes incisions in the groin and near the knee. The saphenous vein is pulled from one incision through to the other, completely removing it. This is the "gold standard" treatment, but is a major procedure.
- Endovascular laser ablation
Endovascular laser ablation (ELA) is an exciting new technique for treating saphenous vein reflux without a major operation. Using laser energy, ELA heats the vein from the inside, sealing it closed. Like vein stripping, vein ablation with laser eliminates reflux through the saphenous vein and can therefore be considered a permanent fix. Unlike stripping, this new procedure does not require general anesthesia: it is done through a skin puncture so small it doesn't even require a stitch. This procedure is discussed in detail below.
Endovenous Laser Ablation
Endovenous laser ablation (ELA) is an exciting new technique for treating saphenous vein reflux without a major operation. Like vein stripping, ELA eliminates reflux through the saphenous vein and is considered a permanent fix. Unlike stripping, this new procedure does not require general anesthesia: it is done through a skin puncture so small it doesn't even require a stitch.
How does it work?
The word "endovenous" means
inside the vein. An endovenous procedure is one that is done from the
inside, rather than from the outside. ELA uses the same type of laser
energy we've all seen in penlights and pointers. When this energy is
delivered to the inside of the vein, it heats the vessel wall and seals
it closed.
ELA Step-by-step
After the skin is numbed with
local medications, a tiny laser fiber (the size of a piece of
spaghetti) is introduced into the saphenous vein near the knee. It is
guided through the vein to the groin using an ultrasound machine (you
can't feel this). The vein is then surrounded with a small amount of
fluid, again using ultrasound guidance and a small needle. The laser is
turned on and pulled back through the vein, treating the entire length
of the abnormal vessel in approximately three minutes. That's it!
Immediately afterwards, the patient gets a band-aid on his or her knee
and walks out of the procedure room. There is no need for anesthesia,
no hospital stay, no visible scar, and very little discomfort during
the short recovery period.
Is it painful?
Placement of the fluid around the
vein requires us to use a needle placed through the skin. However, the
skin is first treated with a local numbing cream, so this is not
particularly painful. The fiber inside the vein is completely painless,
as is the laser treatment itself. During recovery, which takes about
two weeks, you may have some bruising and cramping. This is usually
mild and responds well to over-the-counter medications like ibuprofen
or Tylenol. Most people are able to return to work immediately.
Don't I need my vein?
In a normal leg, the
saphenous vein carries less than 20 percent of the blood going to the
heart. When it starts flowing backwards, the saphenous vein carries no
blood to the heart. In fact, by carrying blood the wrong way, it
actually makes other veins work harder. Closing the saphenous vein
actually makes blood return better, not worse.
What if I need a vein for bypass surgery?
Most
surgeons will not use a refluxing saphenous vein for bypass. The vein
is enlarged and scarred, and generally makes a poor choice for use as a
bypass graft.
Will it work for me?
If you have large, painful
varicose veins, swollen legs, or leg wounds that are slow to heal, you
may very well be a candidate for vein ablation. In order to know for
sure, you will need to have an ultrasound examination of your veins.
This is an important step in evaluating vein disease, and will be
useful no matter what kind of vein treatment you have.
Does it treat spider veins?
If your symptoms are
limited to small spider veins, ELA may be more than you need. However,
if your spider veins are caused by saphenous vein reflux, and the
saphenous vein is not treated, the spider veins will likely come back.
Again, ultrasound examination is a very useful study in deciding the
best course of therapy.
Who does the procedure?
ELA is performed by
specially trained physicians in the University of Washington Center for
Endovascular Therapy. These physicians cover both University of
Washington Medical Center and Harborview Medical Centers and offer an
identical commitment to patients at both facilities.
Will my insurance cover it?
Almost all insurance
companies will cover vein treatments that are medically necessary. That
is, those conditions that cause pain, bleeding, non-healing wounds, or
that significantly impact the patient's quality of life. Some insurance
companies will only cover surgical vein stripping, but many will also
cover laser ablation. If vein ablation is right for you, we can work
with you to evaluate your coverage.
What do I do next?
If you are interested in
being evaluated for venous disease, and specifically for endovenous
laser ablation, please call the endovascular service at either UW
Medical Center (206-598-6209) or Harborview Medical Center
(206-731-6862). Our telephone staff will discuss your symptoms with you
and help to direct you to the appropriate clinic.
