Varicose Veins

What is venous insufficiency?

Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins.

Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don't close properly, they allow blood to flow backward, a condition called reflux.

What are varicose veins?

Veins that have lost their valve effectiveness become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux.

A common cause of varicose veins in the legs is reflux in the thigh vein called the great saphenous, which leads to pooling in the visible varicose veins below.

What are the symptoms of varicose veins or venous insufficiency?

Symptoms caused by venous insufficiency and varicose veins include:

  • Aching pain, easily tired legs and leg heaviness, all of which worsen as the day goes on. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms.
  • In more severe cases, venous insufficiency and reflux can cause darkening of the skin and wounds that may be very difficult to treat. One percent of adults over age 60 have chronic wounds known as ulcers.

People who have venous insufficiency can have symptoms even without visible varicose veins. The symptoms are caused by pressure on nerves by dilated veins.

How common is venous disease and varicose veins?

Chronic venous disease of the legs is one of the most common conditions affecting people.

Approximately half of the U.S. population has venous disease:

  • 50 to 55 percent of women
  • 40 to 45 percent of men

Of these, 20 to 25 percent of the women and 10 to 15 percent of men will have visible varicose veins.

Varicose veins affect one out of two people age 50 and older, and 15 to 25 percent of all adults.

People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins, as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.

Who is at risk for varicose veins?

Risk factors include age, family history, female gender and pregnancy.

In women, pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of varicose veins.

How is venous insufficiency diagnosed?

Your interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, will use duplex ultrasound to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency.

The doctor will map the great saphenous vein and examine the deep and superficial venous systems to determine whether the veins are open and to pinpoint any reflux.

This will help your interventional radiologist to determine if you are a candidate for a minimally invasive treatment known as vein ablation.

What is the vein ablation treatment?

This minimally invasive treatment is an outpatient procedure performed using imaging for guidance.

After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh. Then laser or radiofrequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed.

Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance.

Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.

What are the benefits of vein ablation?

The treatment takes less than an hour and provides immediate relief of symptoms. You can return to normal activity immediately with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers. There is no scar, because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.

Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures, on average 10 to 25 percent.

How successful is the vein ablation?

The two-year data show a 93 to 95 percent success rate. This is a much higher efficacy rate than surgical ligation or stripping.

Reprinted with permission of the Society of Interventional Radiology (c) 2004, 2008; All rights reserved.

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