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December 2011 Vascular Newsletter >>
Minimally Invasive Surgery for Varicose Veins
Catheter-based laser or radiofrequency ablation is an effective, minimally invasive treatment for patients with severe varicose veins due to venous reflux disease and/or venous hypertension.
Background and Pathophysiology
Varicose veins are a common condition that, in Western countries, can affect up to 73% of adult women and up to 56% of adult men (1).
Varicose veins are often caused by venous reflux, a disorder resulting from damaged or failed valves—usually in the superficial veins of the leg.
In patients with normal veins, valves push blood inward and upward through the body. But in patients with venous reflux, blood flows backwards and pools in the leg.
Over time, this pressure prevents the valves in the veins from working properly. Veins become visibly dilated and are recognized as varicose veins.
Symptoms and Complications
In addition to visible varicose veins, patients with venous reflux often present with such symptoms as:
• leg heaviness;
Left untreated, severe venous reflux can sometimes lead to disabling morbidities, such as chronic leg ulceration. Some patients develop superficial thrombophlebitis.
Treatment with Endovenous Ablation
Endovenous ablation is a minimally invasive way to treat severe varicose veins. It’s performed in the outpatient setting, usually under sedation and local anesthesia. It’s also combined with phlebectomy and may be performed with general anesthesia as an outpatient procedure.
In the procedure, a surgeon positions an ultrasound-guided catheter through a very small (5 mm) incision into the vein. The catheter delivers laser or radiofrequency energy to the inner lining of the blood vessel, heating it and causing it to shrink and collapse. When the vein completely closes, blood is re-routed through other healthy veins.
Recovery is fast: patients usually return to routine activities within 48 hours, and return to exercise within two weeks. Long-term complications are rare, and the consequences of prolonged venous stasis are markedly reduced.
Most patients will have bruising and lumpy areas where the veins were treated; these are absorbed by the body. Some patients will also have areas of tingling or numbness, but these also usually resolve.
Approximately 2% of patients have a blood clot in the adjacent deep veins, which require treatment with blood thinners.
All patients undergo follow-up ultrasound to search for blood clots. Some patients develop new varicose veins in the treated or contralateral leg.
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1. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005 Mar;15(3):175-84.