Larger varicose veins – and the underlying causes of varicose veins – require different treatment approaches than the smaller veins. In order to control the backward flow of blood in the large veins, the source of the visible varicose veins (varicosities) must be sealed shut or removed.
In the past, such veins were surgically removed through an invasive procedure known as 'vein stripping.' Today, stripping has been replaced by a far less invasive procedure, endovenous ablation, which seals the veins shut from within the vessel. The Director of the Vascular Surgery Vein Program has been instrumental in the development of endovenous ablation techniques over the last 10 years, helping to advance many of these technologies and to teach surgeons around the world how to perform them. Our center does not perform the older 'stripping' technique.
During endovenous ablation, an energy source is directed into the great or small saphenous veins in the leg. No incisions are necessary, as only a needle stick is required. The treatment seals the veins shut from within, eliminating the source of the varicose problems.
Treating the Underlying Cause
Visible varicose veins are often caused by veins slightly deeper below the surface of the skin. These veins cannot be seen but can be visualized with ultrasound studies. The treatments for varicose veins may entail treating the underlying abnormal feeding vein first, or sometimes in conjunction with treatment of the visible varicose veins. The principle is to treat the underlying cause of the patient's symptoms and visible veins.
Endovenous ablation techniques such as laser (the use of pulses of light to collapse and seal the vein shut), radiofrequency (the use of heat energy to collapse and seal the vein shut;), Mechanochemical ablation (Clarivein™) (the use of chemical and mechanical energy), and other new procedures treat the underlying abnormal feeding vein. Techniques such as Trivex or phlebectomy directly treat the visible varicose veins. All treatments are determined by what is seen on the ultrasound studies and what the patient wishes to accomplish. Endovenous ablation treatments are performed under local anesthesia, sometimes with sedation. Following the procedure, a bandage or compression hose is placed on the treated leg. Patients are able to walk immediately after the procedure and most are able to return to work the next day. Complications are rare, occurring in less than 1% of all patients.