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Why are there so many ways to treat varicose veins?

There seem to be a lot of treatment options for varicose veins. Why are there so many ways to treat varicose veins? Does the treatment choice depend on the location of the vein on the body?


Doctors Answers (4)

Varicose veins can differ depending of the size, location, tortuosity (degree of twisting) and degree of venous reflux in the vein. Many of the options to treat veins can be similar in actual practice. Endovenous thermal ablation (ETA) includes the laser fiber-optic procedures (EVLT, ELVS, etc.) and the radio frequency (Venus Closure) procedure which all use a specialized catheter to introduce precise pin-point heating at the tip of the device located inside of the anesthetized vein. They all produce sufficient heating to safely destroy the thin inner lining of the varicose vein resulting in vein spasm and closing of the varicose vein. There are times that the varicose vein is highly visible and directly below the skin, so physical removal of that section is preferred with a micro-phlebectomy for the best cosmetic result. Primary varicose vein trunks such as the Greater Saphenous Vein (GSV) and Small Saphenous Vein (SSV) are best treated with one of the ETA procedures described above. Smaller branch varicose veins can be closed (once the main trunk has been treated) by several methods, including injection sclerotherapy with liquid or foam either with or without ultrasound guidance. Vein treatments are individualized so discuss your treatment options after getting an duplex ultrasound evaluation of your veins.

Firstly there must be a diagnosis of the actual underlying cause if any. This can be saphenous reflux. If present, the most common treatment is endovenous ablation with microphlebectomy of the larger varicose veins. This is the most common standard of care and done in an office setting under local anesthesia. Walk in and walk out. If no reflux is present, varicose veins are considered "non-truncal." Again larger veins are best removed using microphlebectomy (tiny incisions through which the veins are removed, no stitches). If smaller theses can be injected using sclerotherapy (injection solutions which collapse and destroy the veins). So these are the most basic treatments, three in all, which can be used to treat varicose veins. There are some experimental procedures being tested, but none of which are yet in mainstream treatment. The important thing is a thorough evaluation by an experienced vascular trained surgeon who specializes in treating varicose veins; this includes ultrasound examination. He/she will be able to tailor your treatment to your particular problem.

Free market is the best answer I have for you. Innovators have brought a variety of treatment tools for the medical world to utilize. Size of the vein and shape of the vein also dictates the best equipment to use.

The size, shape and location of the veins determine which treatments may be options. It takes an experienced physician to make good judgments about which techniques or combinations of techniques to use for a given patient.

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