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Laser Treatment for Varicose Veins
A Minimally Invasive Non-Surgical Therapy
Background
Venous insufficiency is an abnormal condition of the veins with decreased blood return from the leg veins up to the heart causing pooling of blood in the legs leading to varicose veins. Veins in the legs have to carry blood upwards, towards the heart against gravity. Normally, one-way valves in veins prevent blood from flowing downward into the veins of the legs with gravity.
Varicose veins have ineffective valves, which cause the veins to dilate and enlarge under pressure. The veins become elongated, rope-like, bulging, and thickened.
Chronic venous diseases affect half of the U.S. population – 50-55% of women and 40-45% of men. Of these, 25% of women and 15% of men will have visible varicose veins. Risk factors include age, family history, female gender and pregnancy. Multiple pregnancies are one of the most common factors accelerating the worsening of varicose veins.
Symptoms
Common complaints of patients with varicose veins include aching pain, cramps, leg fatigue, and heaviness, which worsen with prolonged standing and as the day progresses. Many people may need to sit down and elevate their legs to relieve their symptoms.
If left untreated, nearly 50% of patients with varicose veins will develop chronic venous insufficiency characterized by lower-extremity swelling, skin discoloration, and ulceration.
What causes varicose veins?
Greater saphenous vein reflux is the most common underlying cause of significant varicose veins. The Greater Saphenous Vein (GSV) runs along the inner calf and thigh and empties into the femoral vein in the groin region. Malfunctioning valves in the GSV lead to blood flowing downward with gravity. The GSV dilates and blood flows into other veins in the leg, which become enlarged, bulging, rope-like varicose veins.
Diagnosis and Treatment
Varicose veins are diagnosed by physical examination. Ultrasound evaluation is required to evaluate the veins of the leg and determine if the valves of the veins are malfunctioning and GSV reflux is present. If GSV reflux is present, therapies that remove or obliterate the GSV will lead to dramatic improvement or disappearance of varicose veins in the leg.
Traditional treatment for GSV reflux has been surgery where the vein is tied off and “stripped” or removed. The stripping surgery is associated with significant pain, bruising and a prolonged recovery time. Less invasive surgical treatments such as tying off the GSV in the groin alone or in combination with other treatments including sclerotherapy have been attempted. Traditional surgical treatments for varicose veins have high recurrence rates of 10 – 25%.
The newest, most advanced treatment for varicose veins caused by GSV reflux is Endovascular Laser Venous System (ELVS). Endovascular laser treatment of the greater saphenous vein received approval from the FDA in January of 2002.
ELVS Procedure
The procedure is approximately one hour long and does not require hospitalization. Under local anesthesia, the greater saphenous vein is entered with ultrasound guidance and a thin plastic tube less than 2 millimeters in diameter is inserted. The laser fiber is used to deliver heat energy along the entire length of the GSV. This causes occlusion (closure) of the entire length of the abnormal vein, eliminating the most common cause of varicose veins.
After the local anesthesia is applied for initial vein entry, the procedure is virtually pain-free. After the procedure, a compression stocking is worn for one week. Normal activities can be resumed immediately after leaving the clinic. Patients may experience soreness and tightness or a pulling sensation in the inner thigh for 7-10 days. This is easily managed with anti-inflammatory medication.
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| BEFORE: Reflux in the GSV in the upper thigh is transmitted to the veins below the knee and is causing the varicose veins seen here in this patient. | AFTER: Following laser treatment of the Greater Saphenous Vein, the varicose vein in the lower leg was significantly improved and required no further therapy. |
Results
Two-year results from medical studies show a 93-95% success rate for the laser treatment. This is a much higher success rate than surgical ligation or stripping.
In the largest study to date with results available in nearly 500 legs treated with endovascular laser, a recurrence rate of less than 7% at 2-year follow-up was demonstrated. These results are superior to those reported for the other options available for treatment of GSV reflux, including surgery, ultrasound-guided sclerotherapy, and radiofrequency ablation.
Insurance Coverage
Many insurance companies are starting to offer coverage for this highly effective outpatient therapy for varicose veins. Patients can have the procedure done and return to work the same day. Contact our office today by calling 281-880-6947 to schedule an appointment. We will evaluate your varicose veins and quickly determine if you are a candidate for the laser treatment. If you are a candidate, we will contact your insurance provider to obtain coverage for the procedure.
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