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What is your experience with new therapies for treating venous diseases?

I recently read about a new therapy being promoted by a large healthcare products company. What new treatment for varicose veins has been highly effective in your experience?

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Doctors Answers (5)

The major advancements in the treatment of varicose veins include endovenous thermal ablation techniques to permanently close the large refluxing varicose (saphenous vein) trunks. This is now a minimally invasive office procedure using either fiber optic guided lasers or radio frequency (RF) energy, with immediate return to normal activities. Another advancement over previous procedures is the micro-phlebectomy which is used to remove prominent superficial varicose veins through 1mm slits along the side of the vein. The vein is removed by this minimally invasive technique in the office with excellent cosmetic improvement and does not require sutures. Both of these techniques have made vein stripping obsolete and both are extremely effective.

Great question. "New therapies" are mostly in experimental and testing phases. The current standard of care is endovenous ablation of affected saphenous veins with concurrent or separate setting microphlebectomy to remove the bulging surface veins. In my practice I try to do this in one setting for the patient's convenience and reduced expense. Smaller varicosities and reticular veins can be injected using sclerotherapy (foamed and non-foamed). How these different modalities are performed varies from physician to physician. In the future they are working on vein "glues" which will seal the saphenous veins, foam sclerotherapy injection devices for the same purpose and other similar extensions of current procedures. All treatments for varicose veins today can be safely performed in office under local anesthetic. There is no need for surgery centers, anesthesia, or hospitals. They are all minimally invasive, walk in, walk out surgeries. This reduces the time away from work/home for the patients, reduces the cost of the procedures for both patients and insurance and is very effective and comfortable. We look forward to new procedures once they are tested, FDA-approved and safe with appropriate training of surgeons.

Endovenous Laser ablation (EVLA) and FOAM Sclerotherapy are my favorite closure techniques.

Available since 2002, the most effective treatment for saphenous-derived varicose veins is thermal ablation by laser or radiofrequency with a 95% success rate. Clarivein, a combination injection/mechanical abrasion technique, has been available since last year, with somewhat lower rates of acceptance and success. Finally, Varithena microfoam injections will become available next month with an 85-90% success rate. All these methods are very successful. Still being studied with promising initial results are (cyanoacrylate) superglue and steam ablation.

Your question is too broad to answer. There are many venous diseases and there are many techniques for treating them. It is most important to see an experienced and well-trained physician who can evaluate your problem and assess the options for treatment, and who can discuss with you the relative merits of each of the options for your particular needs.

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