Treatment Options for Vein Disease
The human suffering caused by venous insufficiency (vein disease) is hardly a new phenomenon. The ancient Greek father of modern medicine, Hippocrates, first proposed compression wraps for twisted, painful varicose veins as an alternative to the crude and unsuccessful surgery used 2,400 thousand years ago. Ancient Egyptian writings dating back to 1550 B.C. advocated for herbal treatment of what they referred to as "serpentine windings."
Fortunately, today's vein treatment techniques are quick, minimally invasive, and allow patients to get back to their regular routine immediately with few restrictions.
We spoke to vein doctor Diana Wilsher, D.O., DABVLM, about these modern treatment options for diseased veins and asked her why one vein treatment method is chosen over another. Dr. Wilsher is the lead physician at Center for Vein Restoration's clinics in Canton, MI, and Dearborn, MI.
What is a vein treatment plan?
Dr. Wilsher explains that after a thorough history, physical, and diagnostic ultrasound is complete she puts together a plan of action to treat a patient's vein disease. The ultrasound exam reveals abnormalities in the patient's venous system (veins). It serves as a road map to deciding:
- Which veins are going to be treated
- In what order the doctor will treat the veins
- What treatment method is best used to treat the unhealthy vein
At the end of every treatment plan is a one-month follow-up appointment. During this important office visit, Dr. Wilsher and the patient review how the patient feels since vein treatment and compares it to how the patient felt before treatment.
Why would one vein treatment option be chosen over another?
"When we are looking at the ultrasound mapping of the patient, there are different veins that we can see," explains Dr. Wilsher. She adds that "depending on what veins we are treating; this mapping will dictate what treatment modality we use."
Veins examined during an ultrasound include the following:
- The great saphenous vein (GSV), which is the longest in the human body and extends from the top of the foot to the upper thigh/groin area
- The small saphenous vein, which is a superficial vein along the backside of the leg
- Accessory saphenous veins, which are the larger veins that branch out from the GSV
- Smaller tributary or varicose veins
What is the best treatment for malfunctioning leg veins?
Choosing the correct treatment modality depends on many factors, explains Dr. Wilsher, adding, "the treatments all work, but there are different reasons for using them."
One such reason is doctor preference. Physicians may like a particular treatment because they have experienced success and patient satisfaction using it.
Treatment methods for larger saphenous veins include:
Thermal methods use high levels of heat to close the vein. These include radiofrequency ablation and laser ablation. Because a local anesthetic is used during this procedure, patients who are anxious about needles or want a treatment that can be done quickly without this extra step may want choose a different treatment method.
The advantage of thermal treatment for vein disease is that the physician has a high degree of control over where the heat is applied. Because a straight, rigid fiber delivers the heat, this method best treats long, straight veins.
Sclerotherapy is an excellent option for treating veins that are twisted, asymmetric, and close to the skin. This minimally invasive procedure uses a medication called a sclerosant which displaces the blood in the vein, irritates the vein wall, and closes the diseased vein. This method is quick and requires no anesthetic.
The disadvantage of this procedure is that the physician does not have a high degree of control over where the medication goes, says Dr. Wilsher. Because the medication has a "shaving cream" consistency, it freely fills in the area. The benefit is that the medicine closes the vein efficiently and effectively.
Medical glue seals the damaged vein using this method, forcing blood to flow to nearby healthy veins. The procedure is quick, and no anesthesia is needed.
What is the best treatment for tortuous veins?
Dr. Wilsher defines tortuous veins as a vein that "is not in a straight line, but twists and turns." Because the tool used during radiofrequency and laser treatment requires "a straight shot to float up the vein," thermal methods are not the choice for tortuous veins. Sclerotherapy and adhesives are better treatment options for these asymmetric veins.
Why would a doctor choose to remove a varicose vein?
"We never remove a saphenous vein," declares Dr. Wilsher. Closure methods are always chosen for saphenous veins. Veins considered for removal are large, ropey-like varicose veins that can be seen just under the skin. While these bulging varicose veins can also be treated using a closure technique, patients who tell Dr. Wilsher that their varicose veins are "ugly, painful, and want them gone fast" are a good candidate for a vein removal technique called ambulatory phlebectomy. The cosmetic result is immediate, and patients are delighted afterward, says Dr. Wilsher.
During ambulatory phlebectomy, the skin is numbed. Tiny incisions are made through which the vein is removed. No stitches are needed; only a band-aid is used.
This is an excellent example of physician preference, adds Dr. Wilsher. When a patient describes being very bothered by the pain and aesthetics caused by a bulging vein, Dr. Wilsher will choose phlebectomy.
What should patients know when considering vein treatment?
Dr. Wilsher emphasizes that "patients experiencing aching, itchy, burning veins are experiencing are symptomatic and removing these veins are a matter of medical necessity. It is not just cosmetic." For this reason, vein treatment is covered by most insurance carriers.
"A common misunderstanding is that varicose veins are cosmetic treatment. It's not"
-Dr. Diana Wilsher
Another vein treatment fact that Dr. Wilsher wishes every patient knew is that rest after a vein is the opposite of what doctors recommend. Patients are encouraged to walk after treatment to promote good circulation and prevent clots from forming in the legs.
How to schedule a consultation with a vein treatment expert
Scheduling with the nation’s leader in vein care is easier than ever! Schedule a consultation online or call 1-800-FIX-LEGS to meet with a board-certified physician trained in all modern, state-of-the-art vein closure modalities. Visit centerforvein.com for more information.
The sooner you meet with a CVR physician, the sooner you can look and feel better!