Interventional Radiology
Lower extremity veins, equipped with one-way valves, are responsible for returning blood from the legs back to the heart. If lower extremity valves malfunction and become incompetent, blood fails to flow efficiently and veins become enlarged. These enlarged, dilated veins are referred to as varicose veins.
Leg pain is frequently related to varicose veins. Symptoms, often made worse by prolonged standing, include feelings of fatigue, heaviness, aching, burning, throbbing, itching, and cramping. Swelling of the legs is also a common complaint. Severe varicose veins may lead to inflammation or even ulceration of the lower extremity.
Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, non-invasive ultrasound is an excellent method of determining venous incompetency.
What Causes Varicose Veins?
Heredity is the number one contributing factor causing varicose veins. In addition, women are more likely to suffer from abnormal leg veins. Up to 50% of American women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone may all contribute to venous disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume, which in turn causes vein enlargement. In addition, the enlarged uterus causes increased pressure on the venous system. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, occupations requiring long-periods of standing, obesity and leg injury.
How & When are Veins Treated?
The most commonly asked questions are: do veins require treatment and what treatment is best? Veins that cause pain or other symptoms are prime candidates for treatment. There are two general treatment options: conservative management, such as compression stockings, and "corrective" methods such as surgery (vein stripping) and laser therapy. Less invasive and safer non-surgical procedures, such as endovenous laser therapy (EVLT) are quickly replacing the traditional surgical technique of venous stripping.
What is Endovenous Laser Therapy?
Schematic of endovenous laser treatment (Photo courtesy of Diomed, Inc.)
EVLT is a treatment alternative to surgical vein stripping. A small laser fiber is inserted through a needle stick in the skin, into the damaged vein. Heat generated by the laser is delivered inside the vein, which causes the vein to collapse and close down.
The procedure is done in-office under local anesthesia. Following the procedure a compression stocking is placed on the treated leg. Patients are required to walk for 30 minutes immediately following the procedure. Patients may resume normal daily activities immediately following the procedure except for strenuous activities such as running or aerobics. It is not unusual to feel tenderness or tightness at the site of treatment and this is usually treated with non-steroidal anti-inflammatory agents such as Motrin. Compression stockings are worn for 2 weeks post-procedure.
What Results Can I Expect?
EVLT for the treatment of varicose veins has an initial technical success rate of 98%. Because EVLT is a newer procedure, long-term results are not available. However, in one study evaluating over 3,000 treated varicose veins, 97% of veins remained closed at 28 months. (Photo courtesy of Diomed, Inc.)
To schedule an examination call 215-955-6440.