Treatments for Leg Veins Stand the Test of Time
/For the approximately 30 percent of the U.S. population affected by
venous disease, covering up their varicose and spider veins with
clothing or cosmetics can be a real pain. But the physical pain caused
by this common medical condition is what drives most patients to seek
treatment.
Speaking at ACADEMY ’04, the American Academy of Dermatology’s
summer scientific session in New York, dermatologist Mitchel P. Goldman, M.D., an associate clinical professor of dermatology at the
University of California, San Diego, discussed the latest minimally
invasive treatment options available for patients with varicose and
spider veins.
Varicose veins are abnormally swollen or enlarged blood vessels
caused by a weakening in the vein’s wall, which often leads to pain and
swelling in the leg. Varicose veins occur from the backward flow of
blood in the legs caused by damaged or diseased valves in the veins.
Spider veins, on the other hand, are dilated small blood vessels
located close to the surface of the skin that have a red or bluish
color. Although they can appear anywhere on the body, spider veins
typically occur on the legs and face.
“Treatment of leg veins first should be directed to the cause of
the veins and not necessarily to the veins themselves,” said Dr.
Goldman. “In my practice, patients undergo a duplex ultrasound to
determine the optimal method of treating the veins.
Today, there are more non-invasive options than ever in treating
varicose and spider veins – with less chance of recurrence and less
downtime needed for healing compared to the traditional invasive
procedures.”
Sclerosing Solutions (Sclerotherapy)
Sclerotherapy is a procedure used to treat spider and varicose
veins that involves the injection of special solutions, known as
sclerosing solutions, into the unwanted veins. The solution works by
irritating the lining of the blood vessel, causing it to swell and
stick together and the blood to thicken. Over a period of weeks, the
blood vessel turns into scar tissue that is absorbed – eventually
becoming barely noticeable or invisible.
In his study published in the January 2003 issue of Dermatologic
Surgery, Dr. Goldman compared the safety and efficacy of using a
glycerin solution versus a traditional sclerosing solution known as
sodium tetradecyl sulfate (STS). Thirteen patients with spider veins
were treated with both sclerosing solutions – one leg with the glycerin
solution and one leg with STS.
“What we found in this study was that the glycerin solution was
more effective than STS in clearing the spider veins quicker and with
less pain and fewer side effects,” explained Dr. Goldman. “In our
follow-up of these patients after two to six months, we found that the
legs treated with the glycerin solution had far greater clearance of
spider veins by a margin of seven to one than the legs treated with
STS, and side effects were fewer as well.”
Dr. Goldman also studied the use of a foaming sclerosing solution
to treat large varicose veins. Published in the January 2004 issue of
Dermatologic Surgery, the study analyzed the efficacy of an
ultrasound-guided foam sclerotherapy in treating 100 randomly chosen
legs with varicose veins. While 31 percent of the legs with varicose
veins required a second treatment to completely resolve the condition,
after three months following the initial treatment, 100 percent of the
patients studied felt that their legs were successfully treated with
this procedure.
“What we found in our three-to five-year follow-up using this
technique is that patients were highly satisfied with their results and
reported an improvement in their overall quality of life,” said Dr.
Goldman. “Since the procedure is non-invasive and produces few side
effects, foam sclerotherapy is an excellent long-term treatment option
for patients suffering from varicose veins.”
Novel Laser Treatment
In the past, the only option for dermatologists when treating
patients with varicose veins – particularly for those whose condition
involved the main vein trunk in the legs known as the Great Saphenous
Vein (GSV) – was surgery with stripping of the defective vein. This
invasive procedure performed under general anesthesia involved making
an incision in the skin and either tying off or removing the blood
vessel. Common side effects of this procedure include scarring, loss of
skin sensation in the legs and a prolonged recovery time. Now, a
variety of minimally invasive techniques using the safer tumescent
anesthesia – in which the patient is awake but numbed during the
procedure – are being used successfully.
In a study pending publication, 24 patients requiring repair or
closure of the GSV for varicose veins were treated with a 1320
nanometer (nm) intravascular laser. Dr.
Goldman determined that this novel wavelength was actually safer
than lower wavelengths previously used because it did not interact with
a patient’s red blood cells, which has been shown to cause damage to
the vein wall. With this higher-wavelength technique, the veins are
slowly heated by the laser’s energy and coagulated (or clotted),
causing them to close up without the explosive rupture that can occur
with lower wavelengths.
“During our 18-month follow-up of patients treated with the 1320nm
intravascular laser, all patients demonstrated complete closure of the
Great Saphenous Vein with no complications or side effects,” reported
Dr. Goldman. “In fact, the treated vein was not identifiable six months
after treatment, and there was no recurrence of any varicose veins at
any time during our follow-up. These results demonstrate that this
procedure is extremely effective as a long-term solution in treating
varicose veins.”
While dermatologists can treat existing leg veins, they cannot
prevent the body from forming new ones. Dr. Goldman recommends that
patients with a tendency to develop leg veins should avoid standing for
long periods, avoid wearing high-healed shoes, wear graduated
compression stockings and exercise regularly (walking is best) to tone
the calf muscles, which helps propel the blood back to the heart and
avoid pooling in the lower legs.
