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Treatment of Varicose Veins of the Leg
This procedure involves the removal or destruction of varicose veins that are just under the skin.
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
- Adhesive sealing—seals the affected veins that are close to the skin using an adhesive
- Vein stripping
- A surgical procedure called phlebectomy
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Reasons for Procedure
Veins have one-way valves to channel blood back to the heart. Varicose veins develop when the valves of the veins become damaged. This causes blood to pool in the veins, enlarging them and often making the veins just beneath the skin visible. The skin can also turn dark purple or brown because of increased pressure.
Treatment may be done for cosmetic and health reasons. In some cases, the areas of discolored skin may break down and form open sores, called stasis ulcers. Clots can also form in the pooled blood. When the valves are functioning poorly, your leg may burn, ache, or throb.
Treatment for this condition can involve either destroying or removing the damaged veins.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Recurrence of varicose veins
- Skin discoloration at the surgical site
- A blood clot, known as deep vein thrombosis
Smoking may increase the risk of complications
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 1 week before the procedure.
- 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.
The anesthesia depends on the type of procedure that you are having. Anesthesia may be:
Description of the Procedure
With this procedure, a chemical will be injected 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.
A catheter is inserted into the damaged vein. An ultrasound is used to view the placement of the catheter. An adhesive is injected into the catheter to seal the vein.
Radiofrequency or Laser Ablation
This is done on one of the largest superficial veins, called the great saphenous vein. The vein will be viewed using an ultrasound. Then, the vein will be punctured 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.
The veins will be removed 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.
This surgery is used to remove larger veins that cannot be injected. Many small incisions will be made to access each varicose vein. The vein will either be tied off or removed.
After the Procedure
If vein stripping is done, 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
- Adhesive sealing—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.
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.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or any discharge from the incision site
- Pain that you cannot control with the medications you have been given
- Pain, burning, urgency or frequency of urination, or persistent bleeding in the urine
- Cough, shortness of breath, or chest pain
- Leg swelling
If you think you have an emergency, call for emergency medical services right away.
American College of Phlebology
American Society of Plastic Surgeons
Canadian Society for Aesthetic Plastic Surgery
Canadian Society for Vascular Surgery
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. VascularWeb website. Available at: http://www.vascularweb.org/vascularhealth/pages/varicose-veins.aspx. Updated January 2012. Accessed June 29, 2015.
Varicose veins and spider veins fact sheet. US Office on Women's Health. Available at: http://womenshealth.gov/publications/our-publications/fact-sheet/varicose-spider-veins.html. Updated July 16, 2012. Accessed June 29, 2015.
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.
3/16/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: US Food and Drug Administration. FDA approves closure system to permanently treat varicose veins. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm435082.htm. Published February 20, 2015. Accessed March 16, 2015.
- Reviewer: Michael J. Fucci, DO
- Review Date: 06/2015
- Update Date: 03/16/2015