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What are new non-surgical options for treating varicose veins?

I have varicose veins on my upper legs and am considering treatment options. I am really afraid of surgery, but thankfully it seems as if medical technology is advancing and there are new treatments that don’t require surgery? What are the newest non-surgical treatment options for treating varicose veins?


Doctors Answers (5)

Surgical stripping of varicose veins is obsolete, had a prolonged recovery period with extensive scaring and is rarely done any more. In-office procedures that treat the varicose vein by introducing a specialized catheter into the vein under ultrasound guidance allow the precise delivery of either Laser or RF energy to close the largest varicose veins. There is no cutting or suturing involved in these minimally invasive guided techniques. There is a procedure involving only injections, which takes about an hour and you can return to normal activities and work on the same day as your treatment. These new endovenous ablation treatments (EVLT, ELvS, etc.) do not require removal of the vein, but permanently closes the vein which will then gradually be absorbed by the body.

Radiofrequency, laser, and foam sclerotherapy are all options. I prefer foam sclerotherapy, laser, and then radiofrequency in that order. You can return to work the next day and in many cases the same day.

There is sclerotherapy if the veins are not large. Foam sclerotherapy for larger veins will be available in the next few months. Then there is laser or radio frequency ablation of the veins which use a small incision to place a device in the vein that heats it and seals it off. Another option is Clarivein. This uses a wire and solution to treat the vein. You should discuss the options with your physician

There are several ways to eliminate a problem "saphenous" vein without resorting to surgery. These procedures are all out-patient, FDA approved, cost less than surgery, leave no scars, have fewer risks, and no down time. The simplest is ultrasound-guided foam sclerotherapy, or "chemical ablation." It has been around for over 20 years and can provide an 80 percent long-term success rate. Thermal ablation has been available for over 10 years, requires a local anesthetic, and provides a 98 percent long-term success rate. Clarivein combines mechanical abrasion with sclerotherapy through a catheter, and although has high initial success, lacks long-term follow-up. Finally, the newest treatment is Varithena. It is a specially prepared injectable foam designed for fewer side effects. It was FDA approved last November, will be available this summer, and has a 90 percent success rate. Appropriate options for your case should be discussed following consultation and ultrasound mapping with your vein expert.

If your varicose veins are caused by failed valves in the saphenous veins below, this should be addressed first. While this is still a "procedure" it is minimally invasive and done under local anesthetic in an office setting. In the hands of an experience board certified surgeon, there is little down time and maximum benefit. The bulging veins can be removed through tiny punctures at the same time, again under local anesthetic, not stitches. You walk in and walk out. If there is no underlying insufficiency, the veins, if large, can be removed in the same way. IF the veins are smaller they can be treated with sclerotherapy injections, typically with several treatments. It is important that any "trapped blood" be released between treatments to decrease pigmentation over them and to speed up healing. Additionally we use compression hose after all of the treatments to maximize successful resolution.

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