Varicose Vein Treatment

Treatment for Varicose Veins

Radiofrequency vs Laser Treatment: Which is Safer for Varicose Veins Disease?

Many adults have vein disease, with estimates ranging from 40% to 80%. More than 30% of adults in the United States have chronic venous insufficiency and varicose veins. Patients have a variety of procedures to choose from, including invasive and non-invasive treatments. While several treatments are available, laser therapy and radiofrequency technology are the most popular minimally invasive procedures.

Understanding Varicose Veins

To understand how radio frequency treatments (RF) and laser therapy work on varicose veins, you should first understand how this disease develops. Veins play a crucial role in returning blood to the heart, and when they are damaged, this blood return process is disrupted, leading to varicose veins. Severe varicose veins are not only a cosmetic concern but can also threaten your overall health.

What are Varicose Veins?

Varicose veins are large, swollen veins lying under the surface of your skin. Essentially, they are veins that have swelled and moved toward your skin’s surface, making them much easier to see and feel than normal veins. They’re usually relatively easy to identify: large, bulging, throbbing, and dark blue or purple in color.

Doctors diagnose varicose veins through the following symptoms:

• Burning or itching around the veins
• Skin color changes
• Swollen legs
• Aching legs
• Heaviness in the legs and feet
• Leg cramps at night

When you have these symptoms, your healthcare provider will thoroughly examine your family history, physical activity levels and lifestyle to confirm the diagnosis. Your provider may also order a duplex ultrasound imaging test, a noninvasive procedure that uses sound waves to assess blood flow in your legs' blood vessels and confirm the diagnosis.

How You Develop Varicose Veins

Most patients have a family history of varicose veins because many family lines have a genetic predisposition to this condition. Overall health and wellness are also factors. You may be at a higher risk of developing them if you are older, have given birth, or are significantly overweight.

Weak or damaged valves in blood vessels cause varicose veins. Your leg veins carry blood back toward the heart and have one-way valves preventing blood flow from going down your legs. When these one-way valves don’t operate properly, they fail to stop blood from flowing backward, leading to abnormal blood flow and difficulty returning to the heart. When these one-way valves malfunction due to damage or simple weakness, blood begins to flow backward, pool, and increase pressure. This condition is called reflux and causes the veins to swell, which, in turn, produces varicose veins. Damage to the vein walls or valves allows some blood to flow in the wrong direction.

As the damage progresses, the veins grow larger and become distorted. Varicose veins can form whenever blood pressure increases in affected areas. Factors include age, pregnancy, obesity, sitting or standing for long periods, and a sedentary lifestyle.

Exposed veins are not a significant health risk, but they can develop into more serious problems. Untreated varicose veins can become dangerous because pooling blood due to faulty valves can produce blood clots. This, in turn, can limit blood flow to the heart and overall circulation. Other potential health risks include:

• Ulcers
• Skin changes
• Swollen limbs

More severe complications include venous reflux and deep vein thrombosis (DVT). Venous reflux can produce significant circulatory problems, while DVT can produce severe clots that result in pulmonary embolism or travel to the heart and cause heart attacks or even death.

Sometimes, varicose veins are the first sign of chronic venous disease, usually characterized by brawny skin discoloration, typically on the ankles and calves. Pooling blood leaks into the tissue of the lower leg and ankle, resulting in darkening and hardening of the skin and possibly causing skin ulcers that are difficult to heal.

VENOUS REFLUX DISEASE IS PROGRESSIVE — SYMPTOMS CAN WORSEN OVER TIME IF LEFT UNTREATED.

Effective Varicose Veins Treatment

Once you have varicose veins diagnosed, your doctor will recommend an appropriate course of treatment. Many of these treatments, including radiofrequency and laser ablation, are clinically proven effective in treating varicose veins. Many providers initially recommend conservative approaches, such as compression stockings and lifestyle changes, but if you have severe varicose veins, you will need a recognized procedure to alleviate the condition. Although surgery to remove severe varicose veins used to be standard, less invasive procedures like radiofrequency treatments and laser ablation are safer and more effective.

Radiofrequency Therapy Options

The Federal Food and Drug Administration (FDA) approved RF treatment for varicose veins in 1999. Catheters used in radiofrequency treatments have a built-in heating element at the tip that uses thermal energy to destroy the lining of the vein walls. The procedure causes the vein to collapse, with scar tissue closing the vein. After the procedure, blood flows are redirected to nearby healthy veins. RF is typically performed in your doctor’s office with a nursing assistant and a trained ultrasound technician.

VIVAA offers two related treatments. One is Venefit, an endovenous ablation procedure to cauterize and close affected veins. The other is VenaSeal by Medtronic.

Venefit

This minimally invasive treatment, performed under local anesthesia, leaves little to no scarring. We insert a specialized catheter guided by an ultrasound transducer into the affected vein through a small incision.

Our doctor will then shrink the vein walls around the catheter. In just a few minutes, a large portion of a vein can be effectively treated. Many patients sleep through the treatment and report minimal to no marks on their skin afterward.

Those treated via Venefit also said they experienced fewer complications, pain, and bruising in the treated area than with other treatments. The published success rate of RF is between 95 and 98%.

Comparative studies indicate radiofrequency energy treatments have the lowest rates of adverse events and complications. Patients also report greater symptom improvement and quality of life in the year after treatment. Pain is the most common side effect, followed by bruising and thrombophlebitis. Venefit requires minimal recovery time and allows you to return quickly to your routine.

VenaSeal

We also use the VenaSeal system to close problem veins safely with a proprietary medical adhesive. Most insurance plans cover this procedure.

The VenaSeal™ closure system provides relief for patients suffering from chronic venous insufficiency. It uses a proprietary medical adhesive to close the diseased vein permanently.

VenaSeal vein treatment offers:

• Rapid return to normal activities
• Minimized pain, tenderness, and skin discoloration
• Significant improvements in the quality of life

During the VenaSeal procedure, we insert a catheter under ultrasound guidance into the diseased vein to deliver the adhesive under local anesthesia. The adhesive seals the diseased vein along with light external pressure to ensure the vein walls adhere together. Once the catheter is removed, a small bandage is applied to the access site. VenaSeal has a high success rate of up to 98.9%.

*Photo courtesy of Dr. Sidhu, This picture shows results of Venefit the procedure treatment only. Cosmetic improvements may occur sooner with adjunctive procedures.

Patient Review
"Dr. Sidhu and the VIVAA staff treated me for a number of large varicose veins. They gave me thorough explanations of the procedure and its impact at my advance consultation and also explained how they would file with my insurance company. I received the utmost care. Dr. Sidhu is an excellent diagnostician as well as a high-quality surgeon. I am very critical about the medical care I receive. I couldn’t be hap
Albert Marilee Young

Laser Treatments 

The first notable laser treatments using pulsed dye lasers were developed in the late 1980s. Newer lasers used for this purpose, such as the Nd:YAG laser, are non-ablative, meaning they penetrate the skin without removing the outermost layers. Researchers have developed newer, safer versions using longer wavelengths that deliver better, safer results. The key to laser therapies involves utilizing wavelengths that are better absorbed by blood vessels. Newer lasers used for this purpose, such as the Nd:YAG laser, are less invasive and have a low risk of side effects.

How Laser Treatments Work

Laser treatments for varicose veins deliver high-intensity light to the top layer of the skin, which is absorbed by the blood in the veins. This causes the veins to heat up and collapse, with the treated vein eventually absorbed by the body.

As another minimally invasive procedure performed in a doctor’s office, treatment usually takes less than an hour. Your doctor will choose the wavelength type and duration by evaluating the size and type of vein to be treated. Deeper veins require longer wavelengths to penetrate deeper tissue. Smaller veins disappear almost immediately, while larger ones take time to disappear.

Laser Ablation

Smaller varicose veins on the surface of the skin can receive laser treatments via a small hand-held device used to direct the laser onto the skin. Laser energy will cause the vessel to collapse and eventually fade away.

Endovenous Laser Therapy (EVLT)

This laser treatment is used to treat larger varicose veins deeper below the skin’s surface. Ultrasound technology is also used to map the locations for effective treatment. A catheter placed inside the veins inserts a laser fiber. This fiber uses radial energy to target specific areas and close vein walls. Deeper veins require longer wavelengths to penetrate the deepest layers of tissue.

Safety remains a top priority with laser treatments. By targeting treatment, your doctor can help reduce the chance of damaging healthy tissue. Local anesthesia reduces pain and discomfort during appointments, while over-the-counter medications can relieve post-procedure discomfort.

Although EVLT is generally safe, some minor side effects can occur. Typical side effects include temporary bruising or soreness. Some patients experience headaches and dizziness. Rare adverse side effects involve leg numbness, nerve damage, or skin burns. EVLT has a high success rate, ranging from 95% to 100% at six months.

What If I Opt Not to Get Treatment?

When you don’t get your varicose veins treated, you can develop venous reflux disease. Untreated varicose veins can lead to complications such as open sores, which may not heal properly and can result in infections. Damaged leg veins don’t close properly and become progressively worse over time, leading to venous reflux disease. When left untreated, patients can experience severe complications like blood clots and pulmonary embolism, which can be life-threatening.

Can I Prevent Varicose Veins?

Although varicose veins are primarily inherited, you may be able to delay the onset and progression of this condition. While laser and radiofrequency treatments are often grouped into one category, they serve different purposes and should not be confused. Preventative measures include:

• Maintaining a healthy weight
• Strengthening calf muscles through exercise
• Elevating the feet while sitting
• Wearing compression stockings or support hose

You should also avoid clothing that constricts your waist, groin, or legs. Not wearing shoes with high heels or crossing your legs while sitting may also help prevent varicose veins from developing. Quitting smoking is also a good idea, as smoking damages your veins and may cause varicose veins to develop more quickly.

Choosing VIVAA for Varicose Veins Treatment

The healthcare professionals in our Seattle-area practice will thoroughly evaluate your medical history and note health problems to determine the best course of treatment for your varicose veins. Our extensive experience in vein disease helps minimize risk factors associated with vein procedures. If you’re considering radiofrequency therapy to relieve symptoms of varicose veins, contact our office by calling 425-250-9999 or completing our online Request an Appointment form.

Q & A about Varicose Veins (by Dr. Sidhu from RealSelf)

What happens when an ultrasound doesn’t show insufficiency but indicates varicose veins? How should this situation be treated?

Q: My saphenous veins in either leg are not affected, but I still have a lot of various veins. How should this problem be treated if the large vessels are okay but the tributary veins are not?

A: Several possibilities could be responsible for your situation. You may have mild reflux that’s insignificant, or reflux could be absent, yet you have reticular and spider veins. The best way to determine your course of treatment is to have a vascular specialist evaluate your veins. If no reflux is present, you would most likely have sclerotherapy for the bulging veins.

A young woman in her 20s who wants to have children.

Q: I have venous reflux and wonder if I should have treatment on my veins before having children?

A: This is a common question among women of childbearing age. We see women frequently at our practice who wonder if they should have their veins treated before becoming pregnant. The severity of the bulging veins, as well as the degree of reflux, are factors for recommending treatment before pregnancy. Reflux alone is not a prime reason to have treatment.

However, one solution is to control your veins with compression stockings. For many people, it is difficult to regularly follow a daily schedule of wearing them, so compression therapy ultimately fails.

Phlebitis during pregnancy is a potential problem, along with the genuine possibility of your varicose veins getting worse. I thoroughly discuss these issues with my patients if they don’t want to worry about their veins during pregnancy. This is a critical issue with first-time mothers. If you can tolerate compression, then we can treat you conservatively unless you begin to experience severe problems. However, your varicose veins will worsen without compression or some form of treatment.

I have a single varicose vein in one leg. I'm 32, and I don't eat horribly.

Q: I am male, 32, and very fit. I have recently quit using marijuana products. I have high blood pressure from stress. In the last two months, I have noticed the great saphenous vein of my left leg is pronounced enough for me to notice it. It appears to be the beginning of the formation of a varicose vein. I say "beginning" because it's nearly not noticeable until you look at my other leg for comparison. What can I do to heal this condition completely? Is it possible that I have a blood clot? Help!

A: Varicose veins are very common in young, healthy, active people. The best way is to get a consultation with a vascular specialist and discuss all your concerns and, if needed, do an ultrasound to look at the valve function and then plan treatment accordingly. At least compression is advised to prevent this from getting worse.

Large blue veins visible throughout legs and hips?

Q: During the last six months, I have had large, noticeably blue veins spread rapidly over my thighs and hips. A doctor I consulted said the ultrasound performed on me indicated that they were not varicose veins and that the reason for seeing these was that I was pale. However, I know many people who have skin lighter than mine, and they don’t have them. I don’t think it’s genetic, as my parents don’t have these veins, either. Is this normal? I feel awful and wonder if there is a treatment to lessen their appearance. I’m only 21.

A: Looking at the photos, they are not reticular, but the only way to know for sure is via examination. If another ultrasound shows no reflux, your insurance company will consider this a cosmetic problem. If they bother you, we can quickly fix the problem without downtime.