Varicose Veins Treatments and Surgery

Thousands of people every year consider getting treatment for varicose
veins and spider veins. Advertisements for treating venous disease
often tout "unique," "permanent," "painless," or "absolutely safe"
methods making it difficult to decide on the best treatment. If you
are considering this procedure, the following information may help.
Remember, though, this cannot substitute for a consultation with a
properly-trained physician.

What are varicose veins?

Veins can become enlarged with pools of blood when they fail to
circulate the blood properly. These visible and bulging veins, called
varicose veins, are often associated with symptoms such as tired, heavy,
or aching limbs. In severe cases, varicose veins can rupture, or open
sores (called "ulcers") can form on the skin. Varicose veins are most
common in the legs and thighs.

Spider Veins

What are spider veins?

Small "spider veins" also can appear on the skin's surface. These may
look like short, fine lines, "starburst" clusters, or a web-like maze.
Spider veins are most common in the thighs, ankles, and feet. They may
also appear on the face.

Who gets varicose and spider veins?

Varicose and spider veins can occur in men or women of any age but most
frequently affect women of childbearing years and older. Family history
of the problem and aging increase one's tendency to develop varicose and
spider veins.

What causes varicose and spider veins?

The causes of varicose and spider veins are not entirely understood. In
some instances, the absence or weakness of valves in the veins, which
prevent the backward flow of blood away from the heart, may cause the
poor circulation. In other cases, weaknesses in the vein walls may
cause the pooling of the blood. Less commonly, varicose veins are
caused by such diseases as phlebitis or congenital abnormalities of the
veins. Venous disease is generally progressive and cannot be prevented
entirely. However, in some cases, wearing support hosiery and
maintaining normal weight and regular exercise may be beneficial.

Is treatment always necessary?

No. Varicose and spider veins may be primarily a cosmetic problem.
Severe cases of varicose veins, especially those involving ulcers,
typically require treatment. Check with a doctor if you are uncertain.

What procedures are available to treat varicose and spider veins?

Varicose veins are frequently treated by eliminating the "bad" veins.
This forces the blood to flow through the remaining healthy veins.
Various methods can be used to eliminate the problem veins, including,
most commonly, surgery or sclerotherapy. Less commonly, laser or
electro-cautery treatments have been used to treat the smallest spider
veins, especially on the face. Surgery to treat varicose veins, commonly
referred to as "stripping," is usually done under local or partial
anesthesia, such as an "epidural."

Here, the problematic veins are "stripped" out by passing a flexible
device through the vein and removing it through an incision near the
groin. Smaller tributaries of these veins also are stripped with this
device or removed through a series of small incisions. Those veins that
connect to the deeper veins are then tied off. This stripping method
has been used since the 1950's.

Spider veins cannot be removed through surgery. Sometimes, they
disappear when the larger varicose veins feeding the spider veins are
removed. Remaining spider veins also can be treated with
"sclerotherapy." "Sclerotherapy" uses a fine needle to inject a solution
directly into the vein. This solution irritates the lining of the vein,
causing it to swell and the blood to clot. The vein turns into scar
tissue that fades from view. Some doctors treat both varicose and spider
veins with sclerotherapy. Today, the substances most commonly used in
the United States are hypertonic saline or Sotradecol (sodium tetradecyl
sulfate). Polidocanol (aethoxyskerol) is undergoing FDA testing but has
not yet been approved in the U.S. for sclerotherapy.

During sclerotherapy, after the solution is injected, the vein's
surrounding tissue is generally wrapped in compression bandages for
several days, causing the vein walls to stick together. Patients whose
legs have been treated are put on walking regimens, which forces the
blood to flow into other veins and prevents blood clots. This method
and variations of it have been used since the 1920's. In most cases,
more than one treatment session will be required.

Do these procedures hurt?

For all of these procedures, the amount of pain an individual feels will
vary, depending on the person's general tolerance for pain, how
extensive the treatments are, which parts of the body are treated,
whether complications arise, and other factors. Because surgery is
performed under anesthesia, you will not feel pain during the procedure.
After the anesthesia wears off, you will likely experience pain near the
incisions.

For sclerotherapy, the degree of pain will also depend on the size of
the needle used and which solution is injected. Most people find
hypertonic saline to be the most painful solution and experience a
burning and cramping sensation for several minutes when it is injected.
Some doctors mix a mild local anesthetic in with the saline solution to
minimize the pain.

What types of doctors provide treatments for varicose and spider veins?

Doctors providing surgical treatment include general and vascular
surgeons. Sclerotherapy is often performed by dermatologists. Some
general, vascular, and plastic surgeons also perform sclerotherapy
treatments. You may want to consult more than one doctor before
deciding on a method of treatment. Be sure to ask doctors about their
experience in performing the procedure you want.

What are the side effects of these treatments?

Carefully question doctors about the safety and side effects for each
type of treatment. Thoroughly review any "informed consent" forms your
doctor gives you explaining the risks of a procedure.

For surgical removal of veins, the side effects are those for any
surgery performed under anesthesia, including nausea, vomiting, and the
risk of wound infection. Surgery also results in scarring where small
incisions are made and may occasionally cause blood clots.

For sclerotherapy, the side effects can depend on the substance used for
the injection. People with allergies may want to be cautious. For
example, Sotradecol may cause allergic reactions, occasionally severe.
Hypertonic saline solution is unlikely to cause allergic reactions.
Either substance may burn the skin (if the needle is not properly
inserted) or permanently mark or "stain" the skin. (These brownish
marks are caused by the scattering of blood cells throughout the tissue
after the vein has been injected and may fade over time).

Occasionally, sclerotherapy can lead to blood clots. Laser and
electro-cautery treatments can cause scarring and changes in the color
of the skin.

How long do results last?

Many factors will affect the rate at which treated veins recur. These
include the diagnosis, the method used and its suitability for treating
a particular condition, and the skill of the physician. Sometimes the
body forms a new vein in place of the one removed by a surgeon. An
injected vein that was not completely destroyed by sclerotherapy may
reopen, or a new vein may appear in the same location as a previous one.
Many studies have found that varicose veins are more likely to recur
following sclerotherapy than following surgery. However, no treatment
method has been scientifically established as free from recurrences.
For all types of procedures, recurrence rates increase with time. Also,
because venous disease is typically progressive, no treatment can
prevent the appearance of new varicose or spider veins in the future.

Is one treatment better than another?

The method you select for treating venous disease should be based on
your physician's diagnosis, the size of the veins to be treated, your
treatment history, your age, your history of allergies, and your ability
to tolerate surgery and anesthesia, among other factors. As noted
above, small spider veins cannot be surgically removed and can only be
treated with sclerotherapy. On the other hand, larger varicose veins
may, according to many studies, be more likely to recur if treated with
sclerotherapy.

Be wary of claims touting "major breakthroughs," "permanent results,"
"unique treatments," "brand-new," "painless," or "absolutely safe"
methods. Always ask for specific documentation for claims made about
particular recurrence rates or fewer health risks or cosmetic side
effects.

How expensive is the procedure?

Sclerotherapy can cost anywhere from a few hundred dollars to several
thousand dollars, depending on the number of injections and treatment
sessions required and the area of the country where the procedure is
performed. Surgery can cost approximately $600 - $2,000 per leg for the
surgeon's fee, plus charges for anesthesia and hospitalization. Most
vein surgery can be performed on an out-patient basis. Costs can vary
depending on how many veins must be removed and the area of the country
where the procedure is performed.

You may want to check to see if the procedure is covered under your
medical insurance. Many policies do not cover costs for elective
cosmetic surgery.

For More Information

If you need to resolve a problem with a doctor regarding treatment for
varicose veins, you may want to contact your county medical society,
state medical board, or local consumer protection agency. You also may
want to report any concerns about advertising claims to the Federal
Trade Commission (FTC).

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