Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in veins keep blood flowing toward the heart—against the force of gravity. When the valves do not perform their function, blood can flow backwards or reflux. This reflux results in what is known as venous insufficiency, a very common condition that results in the pooling of blood in the veins.
Prevalence of Varicose Veins and Venous Insufficiency
Chronic venous disorders of the legs are among the most common conditions affecting people. Varicose veins affect one out of two people age 50 and older, and 15 to 25 percent of all adults.
Risk factors include increasing age, a family history of varicose veins, jobs that require long periods of continuous sitting or standing and obesity. In women, pregnancy—especially multiple pregnancies—is one of the most common factors accelerating the progression of venous insufficiency.
Symptoms caused by venous insufficiency and varicose veins are related to the increased pressure within the veins. Symptoms include aching, throbbing, fatigue and heaviness—all of which worsen as the day goes on. Many people find that they need to sit down in the afternoon and elevate their legs to relieve these symptoms. People who have venous insufficiency can have symptoms even without visible varicose veins. Less commonly, in severe cases, venous insufficiency can injure the skin near the ankle resulting in dark pigmentation and scarring. Unfortunately, 1 percent of adults over age 60 develop chronic wounds from venous disease known as ulcers.
Diagnosis and Assessment
An interventional radiologist, a doctor specially trained in the diagnosis and minimally invasive treatment of all types of venous disorders, can assess your clinical situation through a thorough history,a clinical examination and, in many cases, a duplex ultrasound examination of your venous system.
Varicose Vein Treatments
Minimally Invasive Vein Ablation Treatment
Endovenous (or vein) ablation is a minimally invasive outpatient treatment for venous insufficiency that is performed using ultrasound guidance. After applying local anesthetic to the skin over the vein, an interventional radiologist inserts a thin tube known as a catheter, about the size of a strand of spaghetti, into the abnormal saphenous vein. Through this catheter, laser or radiofrequency energy is applied to the inside of the vein to seal it closed.
Reflux within one of the saphenous veins can lead to pooling in its tributaries (branches), causing visible varicose veins to develop and more blood for the surrounding normal veins to send back toward the heart. By closing the abnormal vein, the varicose veins—which are close to the skin—shrink and improve in appearance. In addition, once the diseased vein is closed, the surrounding healthy veins are no longer burdened by the leaking blood flow. Other healthy veins take over to carry blood from the leg, re-establishing normal flow.
Benefits of Vein Ablation Treatment
- The treatment takes less than an hour and provides immediate relief of symptoms.
- Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
- No scars or stitches - because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.
- High success rate and low recurrence rate compared to surgery.
- The success rate ranges for vein ablation ranges from 93-97 percent.
Before Vein Ablation, photo courtesy of Dr. Robert Min
After Vein Ablation, photo courtesy of Dr. Robert Min
Almost all insurance carriers cover a consultation with an interventional radiologist to assess a patient with a venous disorder. Venous insufficiency treatments are covered benefits in most plans, based on medical necessity. If you require treatment, your interventional radiologist can interact with your insurance company to assess your coverage.
Surgical Treatment of Veins
Traditionally, surgical ligation—with or without vein stripping—was the treatment for varicose veins. This procedure can be more painful and often have a longer recovery time than endovenous ablation. In addition, it is associated with a higher rate of recurrence.
Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.
Additional Treatments for Varicose Veins
Microphlebectomy and injection sclerotherapy are other treatments for varicose veins. These procedures may be done alone or in conjunction with vein ablation.
Microphlebectomy is a minimally invasive technique to remove bulging varicose veins. The abnormal vein is removed through a tiny nick using a special set of tools. This outpatient procedure is done under local anesthesia. Injection sclerotherapy is used to treat varicose as well as spider veins. An extremely fine needle is used to inject the abnormal vein with a solution that eventually shrinks the vein.
Recovery is rapid after both microphlebectomy and injection sclerotherapy.