Management of varicose vein disease has historically been treated with stripping of the saphenous vein. While in the U.S., stripping has been replaced, 20 years ago, with endovenous ablation techniques, with micro-surgical procedures continuing to supplement these newer methods, and duplex guided (“ultrasound-guided”) foam sclerotherapy playing a major role.
Venous disorders are extremely common, affecting as much as 50% of the US population over the age of 50, with prevalence increasing with age and heredity playing a major etiological role. Venous disorders can be categorized as venous insufficiency, venous obstruction, and venous malformations. Symptoms can include none or all of the following symptoms: leg aching/pain, leg fatigue/heaviness, muscular cramps; lower leg, ankle, foot swelling, Itching, restless legs.
In the U.S. three methods are used to achieve venous ablation of diseased veins: endovenous thermal ablation using radiofrequency (RF) or laser energy, MOCA Clarivein, endovenous chemical ablation using (usually foamed) detergent agents such as Varisolve and newly FDA approved “ implantables” called Venaseal, a proprietary glue. As with traditional surgical ablation, it is necessary to treat any remaining portion of the great and/or small saphenous vein, and feeding tributaries additionally, typically with injection sclerotherapy of surface veins combined with “ambulatory micro-phlebectomy for bulging surface veins, usually no stitches needed.
RF and lasers destroy the vein wall with heat, while chemical destruction is accomplished by means of the detergent sclerosing agents: Asclera (polidocanol) or STS (Sodium Tetradechol Sulfate) for cosmetic veins and these solutions plus FDA approved Varisove Foam for medical vein RX. A detailed duplex ultrasound examination of the deep and superficial system is extremely important prior to making treatment decisions.
Activity is encouraged immediately, with limitation on weight lifting and travel for a brief period of time postoperatively. Graduated Compression Socks or Stockings are used after any ablation procedure. They have been improved immensely and come in at least 40- 60 different colors, styles, and textures for men and women.
Minimally invasive therapy has become prominent for quicker recovery and better cosmetic outcome, especially for what is usually a relatively benign disease.