Varicose veins, the unsightly and often painful condition, affects one out of two people above age 50, according to the National Institutes of Health.
Dr. Robert A. Weiss, a dermatologic surgeon at the Maryland Laser, Skin and Vein Institute and past president of the American Society for Dermatologic Surgery, says newer, less-invasive treatments exist now, such as endovenous laser therapy, that have replaced "the old, barbaric procedure of stripping." He answered some questions about the condition.
QUESTION: What are varicose veins?
ANSWER: Varicose veins are basically enlargement of veins that are superficial or close to the surface of skin, so they're visible. When blood flows backwards … [the veins] become enlarged.
Q: What causes them?
A: Genetics is high on the list [of contributing factors]. If you're genetically susceptible, they can be provoked by having a standing occupation, pregnancy or low-fiber diets.
Q: Can they be prevented?
A: At earliest sign, such as seeing a tiny vein or getting fatigued, achy legs or swelling of ankles, people should wear support hose. Pregnant women who are genetically susceptible should be wearing hose and those with standing occupations such as hairdresser, nurse or teacher.
Q: Why should they be treated?
A: The fundamental reason for treatment is to eliminate reverse flow and reduce pressure in the leg. When the valves malfunction, blood flows backwards into the leg instead of out of the leg. By eliminating faulty veins, blood returning to the heart from the leg is shifted back to the working veins with good valves. We have tremendous venous capacity in our legs and leg muscles.
Q: How are they treated?
A: The laser fiber is inserted into the vein via a small needle puncture under Duplex ultrasound guidance. Once the fiber is seen to be properly and safely positioned, very dilute local anesthetic is placed, again under ultrasound guidance to make sure that the vein is compressed so that it is around the laser fiber. The anesthetic also lowers the temperature around the vein and prevents the patient from feeling anything. Once full circumference tumescent (dilute local) anesthetic is achieved, an auto pullback mechanism is engaged and the laser is turned on. A precise amount of energy is released, causing the vein to heat contract thus sealing the vein as the laser fiber is pulled back.
Q: What are the complications?
A: Nothing worse than a little bruise. In the literature, there were … very low incidents of loss of sensation in a quarter-sized area. Also, four to five skin burns. Deep venous thrombosis occurred in less than 1 percent because patients were under general anesthesia, which is not recommended.