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New Treatments for Varicose Veins

If you're "vein" or in pain, varicose veins are more easily treated now than in the past.

Diagnosis and Treatment

If you had a mother or grandmother treated for varicose veins and thought the treatment sounded worse than the disease, take heart. Times are changing. "We now use duplex ultrasound to look at the circulatory system of the leg," Weiss says. This means taking a sharp, two-dimensional picture instead of a doctor listening to blood flow in the leg with a Doppler device and trying to decide which veins are affected and where.

Duplex ultrasound is also a boon, says Sandy S. Tsao, MD, an instructor of dermatology at Harvard Medical School and assistant in dermatology at Massachusetts General Hospital in Boston. She says this is because knowing the condition of the exact vein affected can help the doctor determine which treatment to use.

In the old days, a flexible metal rod was inserted into the vein at the groin level, passed through the vein and taken out the other end, where a metal cap was screwed on. The rod was then pulled back through the leg, stripping the vein out through the groin incision. With the vein gone, the deeper circulatory systems took over and the wormy mass was not longer visible.

Stripping is hardly ever done anymore. "We have really widened the frontiers!" Tsao exclaims. Now, a thin catheter may be inserted into the affected vein and the whole inside of the vein, called the lumen, heated by radio waves, which shrinks the tough collagen in the vessel wall and causes it to collapse and re-absorb. Anesthesia mixed with fluid is injected first to make the procedure painless and, at the same time, press the blood out of the vein. Scarring is almost imperceptible, although there may be some bruising and the vein may take eight weeks to re-absorb.

Lasers are also used to send bursts of concentrated light into the vein, collapsing it. When the laser hits the skin, there is a tinge of discomfort, but the doctor quickly cools the skin off. Another, even newer technique is called foam sclerotherapy, Weiss explains. An agent, such as a detergent or emulsifier, is agitated with air, forming foam the consistency of watery shaving cream (a little air in veins is acceptable, unlike Hollywood would have you believe). The foam is then injected into the problematic vein, gradually causing the walls to swell and stick together, blocking off the vein. The deeper venous systems take over the blood flow.

Tsao, however, says she would prefer use of foam sclerotherapy for spider veins. Varicose veins she said are larger bore vessels and require more aggressive therapy.

Another, older, but still often used technique, is called ambulatory phlebectomy, in which the vein is extracted with a crochet-hook-like device. And it's quick. Once it's out, there's no waiting for the vein to re-absorb. "Some people still prefer this to waiting," Weiss says.

What are the chances of a blood clot? Doctors prefer to do these procedures on people with normal clotting capability. People taking warfarin and aspirin require special consideration.

As for the varicose veins returning, yes, there is a chance. "If you have the genetic susceptibility, smaller ones could form," Weiss says. "You should be relatively disease-free, though." And you can always do another procedure.

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