Tonie Reincke, Medical Director, Reincke Vein Center
Patient Treatment Options for Leg Vein Disease
Leg vein disease is common and frequently underdiagnosed or misdiagnosed. It includes varicose veins, chronic venous insufficiency, and often associated symptoms such as swelling, itching, heavy legs and bulging veins. Characterized by dilated veins with valves that no longer close and allow backward blood flow. If left untreated, advanced skin changes and even open wounds may occur. With advanced technology, treatments options now range from conservative management to minimally invasive, office-based procedures.
Initial management of leg vein disease typically involves conservative measures. Most physicians will start patients on a trial utilizing medical grade compression hose in an attempt to reduce inflammation and swelling. Additionally, daily walking, weight management, and education regarding healthy food choices prove to be an effective adjunct in conservative therapy. Avoiding prolonged standing and sitting as well as leg elevation prove effective in temporarily reducing symptoms.
Herbal supplements may be considered as part of conservative management. Arnica and flavonoids have shown promise in decreasing swelling and venous symptoms. However, they are not usually implemented as solo treatments.
If symptoms persist despite conservative measures, minimally invasive procedures may be considered. The procedures are efficient, have little or no discomfort, and have no down time.
Catheter-based treatments to heat and close dilated veins (thermal ablations) are the standard of care. An ultrasound allows the physician to target the vein to be sealed. After topical numbing, the catheter is inserted into the vein under ultrasound guidance. Deeper numbing is then instilled around the vein to protect the adjacent vasculature, nerves, and skin from the heat of the catheter. The catheter is removed and a pressure dressing is applied. The procedure is performed in less than 30 minutes and patients resume their normal activities immediately.
In conjunction with heat ablations, FDA approved sclerotherapy will frequently be used to close branching veins. This procedure involves utilizing ultrasound to select refluxing veins that may be tortuous or too small to insert a catheter into. Once access is established in the vein, a foam or liquid is precisely injected to destroy the lining of the vein and facilitate closure.
Large, bulging varicose veins may need to be removed via a phlebectomy. This involves adequate local numbing and small incisions through which a tiny surgical hook is inserted to gently tease out the vein. Compression bandages are applied and the patient is instructed to limited strenuous activities for 24 hours.
In conclusion, treatment options for leg vein disease range from conservative management to minimally invasive procedures. A thorough history and physical examination by a specialist will target diseased veins and tailor treatments to address both underlying venous reflux and patient symptoms. Most patients have improved quality of life after treatments.
