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The Latest Varicose Vein Treatments
By Gilly S. Munavalli, MD, MHS
Charlotte HEALTH&FITNESS magazine, January 2006
More than half of the adult population ultimately develops a weakness
in the circulatory system, which leads to varicose and spider veins.
So... next question – what to do about it?
No one knows the exact reason why the valves that push the blood through the veins break down, but genetics plays the strongest role. Hormones also are thought to be involved. Varicosity often appears during pregnancy and menopause, and women taking birth control pills or hormone replacement therapy are more prone to it. Varicosity develops in twice as many women as men.
In addition to being unsightly, varicose veins can cause leg fatigue, swelling, aching and sometimes throbbing. People should consult with a physician if they experience discomfort. Lack of treatment can result in constantly swollen legs, an itchy rash and, because circulation becomes compromised, ulcers on the inner side of the ankle, especially in older adults.
TYPES OF VARICOSE VEINS
 The vast majority of people with varicose veins have it either in a major interior leg vein called the greater saphenous vein (GSV) or in veins connected to this major vein. The GSV is the longest vein in the body (cardiac surgeons harvest healthy GSV's for use in by-pass surgery). The GSV has many smaller veins emanating from it (much like branches from a tree trunk) that can become varicose, but to mend them without considering the major vein would be like repairing a wet patch on the wall while ignoring the leaky pipe that is causing it. Anyone with varicosity in the family should be aware of the potential problem in the greater saphenous vein. About 20% to 30% of the people who have varicosity on the inner and front of the leg will eventually have a problem with this vein.
Other varicosity issues involve veins that are not related to the greater saphenous vein, as well as the smaller veins that are just under the skin that form spider veins.
TREATMENT OPTIONS
Treatment for varicosity has improved considerably, making a difficult surgery called vein stripping, which required the patient to undergo general anesthesia, almost unheard of now. The norm today are endovenous procedures -- those done within the vein itself -- that actually collapse the vein from the inside out.
In endovenous procedures, the doctor numbs the skin using a local anesthetic and inserts a laser fiber. When activated, this create a gradual heat buildup, by heating the water in the vein wall. The collapse of the vein causes it to close permanently, forcing the blood to reroute itself into adjacent healthy veins. The success rate at two years stands at 95%, judging by the procedures we've done. This new FDA approved technology is called CTEV, which stands for Cool Touch Endovenous Laser ablation. Dr Munavalli, of the Goslen Aesthetic and Skin Care Center, is the only physician in Charlotte with this laser, and has been performing this procedure for over 2 years.
 For some patients, treatment involves closing off just the greater saphenous vein, which ends the varicosity problem. Others, though, will need further treatment for adjacent veins. And, of course, many patients have varicosity that is unrelated to the GSV.
For patients with varicosity unrelated to the GSV, ambulatory phlebectomy is advised, in which the doctor makes small needle holes in the skin and pulls the vein out with a hook. The small needle holes are at the top and bottom of the vein. Pulling the vein out in this way breaks the connections among the veins, thus freeing them for removal. This procedure leaves virtually no scars, because the needle holes heal up completely.
 For varicose veins just under the skin – including spider veins – Dr. Munavalli advises using sclerotherapy, which involves injecting a solution into the vein to seal it off. (Laser is effective for facial spider veins but not for those on the legs because of their variance in size and depth.) Dr Munavalli has replaced saline solution previously used for this, which caused pain, with a type of glycerin solution that does not sting and is more effective. Sclerotherapy requires two to four sessions to collapse the vein, and it can take several months for the vein fully to disappear. Because treating spider veins usually is considered a cosmetic procedure, insurance often does not cover it, although painful,bulging veins are typically covered by insurance. Costs run from $250 to $450 per session for sclerotherapy.
RISKS
Risks associated with all of these procedures are very low. Most involve the possibility of temporary bruising and bleeding or discoloration. Since the procedures are done with local anesthetic, there is minimal pain, although endovenous laser procedures can cause more discomfort.
WHO AND WHERE
Should you need or desire treatment for varicosity, either a dermatologist or a phlebologist (MD specializing in treating vein diseases) performs these procedures. In most areas there are groups of doctors who specialize in vein treatment -- often in vein treatment centers.
All of these procedures are outpatient, done either in the doctor's office, a surgicenter or outpatient surgery center.
PREVENTION
In the meantime, preventive measures include wearing support hose, avoiding standing in one position for long periods of time and, when working at a desk, standing up to walk around periodically. The old wive's tale that crossing legs leads to varicose veins is just that – an old wive's tale. Long, frequent, brisk walks also are helpful as a way to keep the leg veins healthier. Eating lots of fruits and vegetables helps too, thanks to their phytochemicals.
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