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Treatment of Varicose Veins of the Leg

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by Nath RL
 

Definition

There are different methods to remove veins, such as:
  • Sclerotherapy—injects the varicose veins with a chemical to shrink the veins
  • Radiofrequency ablation—collapses and seals varicose veins using radiofrequency energy
  • Vein stripping
  • A surgical procedure called phlebectomy
Varicose Veins
Nucleus images
Copyright © Nucleus Medical Media, Inc.
 

What to Expect

Prior to Procedure

Your doctor will:
  • Evaluate your deep and superficial vein systems and decide which veins will be removed or destroyed
  • Do an ultrasound—a test that uses sound waves to examine the veins in your legs
Leading up to the procedure, you may be advised to:
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure, like:
    • Anti-inflammatory drugs
    • Blood thinners
    • Antiplatelets
  • Wear special support stockings.
  • If you have a stasis ulcer, wear Unna boots. This is a type of cast that will aid in healing the ulcer.

Anesthesia

The anesthesia depends on the type of procedure that you are having. Anesthesia may be:
  • General —blocks pain and keeps you asleep through the surgery
  • Epidural —numbs the area from the chest down to the legs

Description of the Procedure

Sclerotherapy
With this procedure, the doctor will inject a chemical into each of the damaged veins. This chemical will scar the vein so that it will no longer be able to carry blood. This will be a short, simple office procedure.
Radiofrequency or Laser Ablation
This is done on one of the largest superficial veins, called the great saphenous vein. The doctor will view the vein using an ultrasound, then puncture the vein near the knee. A catheter will be threaded up to the groin. The space between the vein and the skin will be filled with a special solution. This solution will provide local anesthesia. The catheter will then be attached to a radiofrequency generator or a laser. Heat or light energy will seal the vein closed so that there is no longer any backflow of blood.
Vein Stripping
The doctor will remove the veins by threading a long wire into them. Each vein will be tied to this wire and then stripped out. This will leave the smaller side branches broken off and in place. This procedure is usually not used on the saphenous vein.
Phlebectomy
This surgery is used to remove larger veins that cannot be injected. The doctor will make many small incisions to access each varicose vein. The vein will either be tied off or removed.

After the Procedure

If the doctor does vein stripping, you will have many loose vein ends in your leg. Your leg will be tightly wrapped. This is to prevent blood from leaking out of the veins.

How Long Will It Take?

  • Sclerotherapy—short office visit
  • Radiofrequency or laser ablation—1 hour
  • Vein stripping—1-1½ hours
  • Phlebectomy—2-4 hours

Will It Hurt?

You will have pain and discomfort with the procedure. Stripping is more painful. Ask your doctor about pain medication.

Post-procedure Care

When you return home, do the following to help ensure a smooth recovery:
  • If you had vein stripping, keep your legs elevated while you are resting. This will help to minimize pressure on your veins.
  • If you had sclerotherapy or ablation, resume normal activity within a few hours.
  • Wear an elastic bandage for the first 24-48 hours, or as instructed by your doctor.
  • Be sure to follow your doctor's instructions. You may need to have another ultrasound done.
 

RESOURCES

American College of Phlebology
http://www.phlebology.org

American Society of Plastic Surgeons
http://www.plasticsurgery.org

 

CANADIAN RESOURCES

Canadian Society for Aesthetic Plastic Surgery
http://www.csaps.ca

Canadian Society for Vascular Surgery
http://canadianvascular.ca

 

References


Merchant RF, Pichot O, Closure Study Group. Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency. J Vasc Surg. 2005; 42(3):502-509.


Varicose veins. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated July 29, 2013. Accessed August 8, 2013.


Varicose veins. VascularWeb website. Available at: http://www.vascularweb.org/vascularhealth/pages/varicose-veins.aspx. Updated January 2012. Accessed August 8, 2013.


Varicose veins and spider veins fact sheet. US Office on Women's Health. Available at: http://www.womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.cfm. Updated June 2, 2010. Accessed August 8, 2013.


6/2/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.

 

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