The Other Blood Vessel Problem

Editor's Note: In our last issue of Keeping in Circulation, the article "Vain about Veins" gave a broad overview of varicose veins. It described what they are, symptoms, risk factors, causes, how they are diagnosed, and treatment options. Dr. Kingsley describes some exciting new advances in treatment options in this follow-up article.

Leg vein problems are fairly easily corrected, but have been overlooked by the U.S. medical profession for many years. Most patients have been told to wear compression hose, elevate their legs, and walk regularly to reduce vein pressure and leg pain. Some patients have been advised to undergo the vein stripping and ligation operation. The stripping surgery is fairly traumatic, requires at least two to three weeks for recovery, and has a fairly high failure rate over the long term. Consequently, there are large numbers of men and women in the U.S. who are suffering from leg vein problems and who have not been treated.

The good news is that these patients are now in luck! There have been significant advances in the treatment of leg vein problems just in the past five years. The new treatments are less invasive, less painful, give excellent cosmetic results, and allow patients to resume normal activities within a short time, usually just a few days. The procedures can be performed as outpatient care in the hospital or surgi-center, and can also be performed in qualified physicians' offices.

In order to permanently correct most leg vein problems, the offending saphenous vein must be removed from circulation. The saphenous veins are two major veins that begin near the ankle and either run along the inside of the calf and thigh, joining the deep femoral vein in the groin, or run up the back of the calf, joining the deep popliteal vein behind the knee. Removal of the saphenous vein is now done by the endovenous (inside the vein) radio-frequency or endovenous laser method. The simple idea is that a catheter or laser fiber is placed inside the abnormal vein using only a small catheter with ultrasound guidance. The catheter or fiber emits sufficient internal heat to destroy the vein, and the vein is permanently closed from circulation. Over several months the vein becomes a small fibrous cord which can no longer be seen with an ultrasound image. There is no further backwash of blood down the leg, vein pressure is relieved, leg pain resolves, and leg vein circulation is markedly improved. The large, bulging veins can be removed by a micro-phlebectomy technique, using only one millimeter punctures to access and to remove the veins.

Modern sclerotherapy, the injection of solutions into smaller veins including spider veins, shows such improved results that many patients can wear shorts for the first time in years. Two new solutions invented in Europe, foamed sotradecol or foamed polidoconol, and glycerin/lidocaine, slowly eliminate the unsightly skin veins until the appearance is often dramatically improved. Most patients see tremendous improvement within one year. Patients with ulcers on their legs and feet will often see complete healing within two to four months, and the ulcers will never re-occur.

For the first time in over 30 years, doctors who specialize in vein problems now have excellent treatment options to offer our patients. In addition, nearly all insurance programs, including Medicare, will cover the new treatments, with the exception of spider vein treatments, which are still considered cosmetic. As with all medical and surgical care, patients should carefully seek a qualified specialist who offers these procedures.

About the Author: John R. Kingsley, MD, FACS, RVT is a vascular surgeon based in Birmingham, Alabama. His practice at the Alabama Vascular & Vein Center emphasizes the diagnosis and treatment of patients with vein disorders, using the modern treatment methods described. He helped pioneer many of the treatments in use today, and is an instructor to physicians across the U.S. in his Vein Training and Education Institute.