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Does the size of my varicose veins limit my treatment options?

This question was asked in Shallotte, North Carolina and has 11 answer(s) as of 11/26/2013.
Does it matter what size my varicose veins are? I want to get some removed from my legs and they are all really large. Are all of the same treatment options available to me? I would like to choose a procedure that is minimally invasive but is still gonna work for my big varicose veins.

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Doctors Answers (11)

The size doesn't matter in terms of treating your veins minimally invasive. With a combination of ultrasound guided radiofrequency, phlebectomy and sclerotherapy we are able to treat all sizes of veins.

Very large varicose veins are still easily treatable using conventional vein treatments including endovenous ablation (for the main trunks) and using micro-phlebectomy for those large veins bulging near the surface of the skin. In a micro-phlebectomy procedure, the varicose veins are removed through 1mm incisions along the side of the anesthetized vein allowing resumption of normal activities after the procedure. In addition to resolving the sore legs, it has excellent cosmetic improvements and the incisions are usually not visible after 1 month. Sclerotherapy of the large superficial veins should be avoided due to trapped blood and iron staining of the skin over the closed vein. Sclerotherapy is still excellent for treating the smaller veins.

Modern varicose vein treatments work well for all size veins, even large ones. Of course, treating the origin including any underlying "saphenous" vein reflux is important for a durable outcome.

Very large varicosities, are best removed by a minor surgical procedure known as "Microphlebectomy" after closure of the main axial vein with Radiofrequency and/or Laser energy. After removal and wound healing, any residual varicosities are likely to be much smaller; these can be closed with "Sclerotherapy and Compression". The results of this combined treatment are excellent.

The size of the vein can have some bearing on the treatment. First, any refluxing Saphenous vein should be treated with a laser ablation or RF. Next the branch varicosities should be treated with foam sclerotherapy or phlebectomy. Very large veins very close to the surface have slightly higher rate of hyperpigmentation if sclerotherapy is used to treat them, but still works well. It really comes down to the surgeon's preference and skills.

The size of the varicosities do not limit your treatment options at all. If they were very small and not causing any problems, we'd be more conservative. Large varicosities can be treated with minimal invasive procedures. You may require an endovenous ablation of the underlying vein that is causing your large varicose veins. I treat large bulging veins with a micro phlebectomy which is the surgical removal of varicose veins through tiny little holes that leave minimal to no scarring. This is done in the office with local anesthesia and is minimally invasive.

Generally the size does not matter the minimally invasive techniques are always useful.

Modern varicose vein treatments are minimally invasive. You do have several options for your veins. Please make an appointment and I will help you get a game plan together. If you are insured, most insurances do pay for the treatment of symptomatic vein disease.

Great question. Your first step will be to have a thorough evaluation including ultrasound examination by a surgeon who specializes in vein treatments. This will let you know how deep the issue is. Typically the varicose veins are a "pressure relief valve" for underlying saphenous incompetence. If this is present, this must be treated first and endovenous laser ablation is a minimally invasive treatment with little downtime. At the same time your surgeon can remove the varicose veins using microphlebectomy (small puncture and a small hook to "tease" the veins out in sections.) which leave few marks, maybe a small dot at most. Both of these procedures are minimally invasive and the long term results are excellent. If the veins are very large, the surgeon may opt to wait for a short time to see if the size decreases when the pressure is removed and deal with them later. This would be an additional procedure but with very little downtime.

The best and most effective is laser ablation where size of varicosities does not matter.

Usually not. Most veins are well treated with endovenous laser ablation because fluid is injected around the vein allowing it to come in contact with the laser fiber.

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