Modern options for removing varicose veins

As a general surgeon treating veins, I see a lot of people who want their varicose veins to disappear. Sometimes they ask: If my veins are removed, where will all the blood go?

Where the blood goes is the problem. The blood in varicose veins is not flowing properly. It's trapped in slow-moving, ever-widening canals down your calves. If these "canals" are removed, then blood can get back to traveling in the faster moving "highways" that healthy veins are meant to be.

Some folks come in for varicose treatment with the misconception that their legs will look like a model's. Although I can promise you significant improvement in how your legs feel and look, I can't promise you the world. Women who want their legs to look the same as when they were 20 years old will be extremely disappointed. However, today's techniques are much more aesthetically pleasing than those in your grandmother's day.

Varicose veins result from "vein insufficiency," which occurs when the one-way valves in the surface veins fail. Blood from our legs needs to flow a long way upward to the heart. When valves fail, blood abnormally flows backward, forward, or just pools.

Why do valves become faulty? Many times it is an unlucky gene. Other causes include injury from trauma or clots that damage the valves. I see a number of athletic individuals who recall being hit repeatedly by softballs, basketballs or physical contact when they were younger. They're now seeing the results of the damage.

Very often pregnancy invites the development of varicose veins. Hormonal changes, higher blood volume and the weight of the baby combine to provide a "perfect storm," causing valves to fail and allowing varicose veins to develop. After delivery, many women will see their veins return to normal. For others, however, the beginning of their vein issues can be traced back to their childbearing years.

So what treatments are available? Compression stockings are often offered as a first line of treatment. The stockings may improve how your legs feel, but unfortunately, many people find the tight stockings more uncomfortable than the varicose veins themselves.

Common methods to treat varicose veins include:

Sclerotherapy: Used for spider veins or smaller varicose veins. This treatment involves injecting the veins with a compound that causes the vessels to seal themselves off and disappear. This often requires several treatments.

Microphlebectomy: Used for larger varicose veins. In this procedure, a small nick is made in the skin and the vein is "teased" out. It can frequently be performed in an office setting and the results are immediate. 

Ablation: Refers to the elimination of a main surface vein that is feeding varicose veins. In past years, this vein was removed by "stripping" it out. Today, we "ablate" the vein with a catheter that is heated either by radiofrequency, which acts much like a microwave, or laser, which uses a hot light to seal the vein. Both have similar results.

Currently, insurance companies may cover vein treatment if a patient has such symptoms as clots, bleeding or non-healing sores on their legs. Insurance may also cover those who have consistent pain that prevents them from working efficiently. Sclerotherapy is not covered but is usually affordable.

We know that varicose veins don't threaten life or limb, but they sure can threaten self-image. Today, many options are available to improve how your legs look and feel.

Dr. Jon Oberg is a board-certified general surgeon at Tanner Clinic in Layton.