Diverse treatment options exist for various vascular disorders. Arteries are the pipes that carry oxygen-rich blood to the legs, and veins are the pipes that carry oxygen-depleted blood back to the heart.
Interestingly, vein problems are treated quite differently to problems affecting the arteries. The most common vein procedures work by redirecting venous blood from poorly-functioning veins into healthy leg veins, which allows venous blood to more efficiently return to the heart. Artery procedures typically involve opening up narrowed (or blocked) arteries allowing oxygen-rich blood to more easily get to the feet and legs. Selecting the ideal treatment option is best determined by a vascular specialist.
First-line therapy for patients with symptomatic varicose veins and venous insufficiency often consists of simple, non-invasive management strategies.
Compression hose come in a variety of lengths and strengths that can be tailored to the needs of an individual patient. Compression hose minimizes swelling of the veins and decreases leakage of fluid from the veins into the adjacent tissues. Compression hose can help control leg swelling and can provide symptom relief for many patients.
Leg elevation is another simple, non-invasive way of reducing pressure in the veins. Leg elevation often partially alleviates the discomfort of venous insufficiency. Unfortunately, prolonged periods of leg elevation are not practical for active people. Furthermore, reduction in movement and mobility (when elevating the leg) poses challenges for maintaining weight control and cardiovascular health.
Although difficult to achieve, obtaining/maintaining an ideal body weight tends to lessen symptoms in patients with venous insufficiency.
Venous ablation refers to minimally-invasive procedures designed to deliberately block-off, or close problematic veins. These procedures leverage the concept that “blocking off” a vein simulates having the vein tied-off or “stripped”, but avoids the need for large surgical incisions.
“Closing” problematic veins reduces pressure within vein branches in lower parts of the leg. Commonly treated veins include the great saphenous vein (located on the inner thigh & inner calf) and the small saphenous vein (located on the back part of the calf).
Ablation procedures can be safely and effectively performed via tiny access sites in the lower part of the leg, using a local anesthetic. The width of the skin puncture site is typically only 3-4mm in diameter and is typically too small to require any form of suture repair.
Widely utilized methods of venous ablation include radio-frequency ablation and laser ablation. Recently the FDA has also approved devices that rotate within the vein (causing deliberate injury to the vein wall), and devices that release glue-like material into the vein (facilitating closure of the vein).
In 2015 the FDA approved the release of a “non-thermal” ablation procedure called VenaSeal™ for the treatment of incompetent superficial veins in the legs. This procedure involves using a proprietary medical adhesive to close the diseased vein. Clinical studies have demonstrated that the procedure is both safe and effective.
The VenaSeal procedure eliminates the risk of heat-induced nerve injury, avoids the requirement for injection of local anesthetic (tumescent anesthesia) along the length of the target vein, and allows immediate return to normal activity (back to work/exercise the next day). The ability to immediately return to full activity is compelling for active people and professionals who are interested in minimizing “down-time”.
VenaSeal therapy is immediately available to patients with superficial venous insufficiency and has been successfully performed on multiple patients at Vascular Solutions.
Varithena microfoam is an FDA approved product that allows leg veins to be treated by injecting a liquid “microfoam” into the target vein.
The microfoam seals the diseased vein closed, which results in diversion of venous blood to remaining healthy leg veins. The procedure is quick to perform, highly effective, and can treat veins of various diameter. Because this procedure is “non-thermal” and can treat veins that have multiple twists & turns, Varithena microfoam is the optimal treatment modality in many situations.
Phlebectomy is a medical word used to describe the surgical removal of a vein. Often used interchangeably with the terms “micro-phlebectomy”, “stab-phlebectomy”, or “ambulatory-phlebectomy” these procedures involve tiny stab incisions (typically measuring 3-5mm in length) over the site of a superficial vein (varicosity).
The target vein is hooked (or directly grasped) and then pulled out through the stab incision. If multiple veins are present then multiple incisions may be required.
Venous blood that was previously flowing through the varicose vein auto-diverts to remaining veins in the leg. Phlebectomy procedures can be safely performed in an office-based (or outpatient) based setting using local anesthesia.
Sclerotherapy involves the injection of a medication into a vein (or cluster of veins). The goal of therapy is to deliberately cause blockage of the vein via chemical injury to the internal lining of the vein.
A variety of medications can be used for injection sclerotherapy. Some of the most commonly utilized agents are hypertonic saline, sodium tetradecyl sulfate – STS (Sotradecol), and polidocanol (Asclera).
Sclerotherapy sessions are office-based, walk-in walk-out procedures that typically take 20-30 minutes. Sclerotherapy procedures can be used to improve the cosmetic appearance of spider veins ( <1mm in diameter), reticular veins (1-3mm in diameter), and varicose veins (>3mm in diameter).
Occasionally leg swelling may be related to narrowing or constriction of an upstream vein. In the pelvic region, this constriction is often related to external compression of the vein by adjacent structures in the pelvis. In some circumstances, there may be an option for inserting a metallic stent(s) into the vein to relieve this area of constriction.
Various procedures are available to help improve the blood flow to the lower legs and feet in patients with peripheral arterial disease (PAD).
The optimal procedure is guided by the severity of symptoms, the location of the plaque, and the extent of plaque accumulation within the leg arteries.
Many patients with narrowings (or blockages) of the leg arteries may be candidates for balloon angioplasty (temporary insertion of a medical balloon), stenting (insertion of a metallic scaffold to buttress open the artery) or atherectomy (procedures designed to shave/scrape/remove plaque from the internal wall of the artery).