Can anything be done for varicose veins?

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Physician Article


Can anything be done for varicose veins?

Ashley H.  Stewart, MD, FACS By Ashley H.  Stewart, MD, FACS
8/06/15


My mother has a varicose vein. It bulges all the way down her leg, and she complains about her leg aching all the time. Since she’s my mother, she still thinks of me as a little kid—she doesn’t believe me when I say I can fix it. But I can. In 15 minutes.

Most of us remember that the only thing to do for varicose veins was to strip them. As revolting as that sounds, it looks about as bad as one imagines. So most people, just like my mother, carry on and live with the aching, cramps, itching, swelling and restless legs.

Have you ever thought, “Whatever did we do before (blank)?” I often think, “Whatever did we do before endovenous laser ablation?” It’s so easy! It works! Immediately!

Endovenous laser ablation is an outpatient procedure to destroy varicose veins. Varicose veins are malfunctioning veins. Veins are meant to be a one-way street back to the heart. Inside the vein are papery-thin, one-way valves. When those valves malfunction—due to genetics, pregnancy, injury, or weight gain—blood can flow freely up and down. Gravity causes it to pool in the legs.

The saphenous vein in the thigh is at particular risk of becoming a varicose vein. It is long and straight, so a heavy column of blood is sitting on those paper-thin valves. Once a valve malfunctions, the other valves have more weight to carry, so they tend to malfunction. Eventually, the veins in the lower part of the leg dilate under the pressure. The result is swollen, aching legs, often with ugly bulging veins. With time, the skin is sort of “tattooed” by pooled blood and it darkens. With more time, the skin and soft tissue are so damaged that chronic wounds form.

I think of a varicose saphenous vein like the trunk of a tree, with its branches coming off at the lower leg. If I destroy the trunk of that tree, the branches will die as well. That’s what I am doing with endovenous laser ablation. The saphenous vein is found with an ultrasound, then (after anesthetizing the skin) a needle is put into the vein. A tiny laser is then fed into the vein. That laser then heats up the vein from the inside, causing it to clot. Most people leave the office after the procedure and go out to lunch. There is some soreness, but nothing that can’t be taken care of with Tylenol. Symptoms improve dramatically in about 48 hours, and the appearance of the leg improves over the next several weeks.

I am often asked if one needs a saphenous vein. The answer is no—it is part of the “superficial system” of veins. The superficial system is supplemental to the veins you really need, which are the deep system. And you don’t need to save it for a heart operation. A diseased vein would not be used for that, because it would almost certainly clot off.

So there is something that can be done for varicose veins! Not only is it easy, safe, and effective--it's covered by most insurance plans and Medicare.

Would someone please call my mother and let her know?

Dr. Ashley Stewart is a general surgeon with West Georgia Surgery in LaGrange. She specializes in varicose vein treatment, breast surgery, peripheral vascular surgery, skin cancer surgery, colorectal surgery, thyroid surgery, pediatric surgery and chronic wound care, among others.