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.
Before considering any type of leg vein treatment, the American Academy of Dermatology advises patients to talk to their dermatologist about their experience with the procedure and their credentials, ask to see before and after photos of previous patients, and discuss expected results and the risks of the procedure.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 14,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the AAD at 1-888-462-DERM (3376).
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