Varicose Vein Treatments? Any Cures?

As a board-certified vein specialists and vascular surgeon, I would like to respectfully disagree with some of the other physician panel responses to this question.

There is definitely a "cure" for most patients who develop varicose veins and this has been proven in multiple well-done medical studies performed by vein specialists.

To explain, you must first understand why varicose veins develop.  Almost everyone with true varicose vein disease develops the problem due to faulty and weak vein valves within one of the superficial veins which provide venous flow to the skin of the legs.  The most common vein to fail is the great saphenous vein (also known as the greater saphenous vein).  If this is not the culprit, then it is usually the small saphenous vein or a perforator vein in the leg that fails.  The varicose veins that you can see at the skin surface are actually branches of this failed vein (similar to a tree: the failed vein is the trunk and what you see at the surface are the branches coming off of the failed trunk).  Since the faulty trunk or source vein will lead to progressive vein disease, with larger and more numerous branches growing from it over time, the goal of therapy is to rid the body of this faulty trunk.

It is well known that if you remove or destroy the faulty trunk vein in the leg, the the varicose vein problem in the leg will usually be permanently cured.  If you only treat the surface branches but leave the faulty trunk in place, new branch varicose veins will continue to grow and you will develop recurrent varicose veins.  On a weekly basis I see patients treated by other doctors in the past who present to me with recurrent varicose veins after their prior treatment(s) . . . and it is usually because the faulty trunk was never treated.  This typically happens because the previous treating doctors were not vein specialists and did not know the importance of running a simple diagnostic test (a vein ultrasound of the leg) to diagnose the underlying faulty vein.

This extremely common condition of the faulty trunk vein in the leg (usually the saphenous vein) is known as superficial venous reflux disease.  This reflux disease is the cause of varicose veins is 95% of patients.  Since this disease is a curable condition, varicose vein disease can ABSOLUTELY be cured.

The primary treatment for varicose vein disease and venous reflux is known as Endovenous Thermal Ablation (also known by the abbreviated terms of EVLT, VNUS, or Venefit).  The therapy involves a procedure done in the office of vein specialists (my recommendation is to always have it performed by a board-certified vascular surgeon).  Is is about a 45 minute procedure that is done under local anesthesia and which has a 98% permanent cure rate of varicose veins.  The doctor first inserts a IV into the faulty vein, then inserts a laser fiber or radiofrequency fiber into the faulty trunk vein under ultrasound guidance.  The thermal energy from this fiber destroys or ablates the faulty vein and the blood is immediately re-routed into the healthy veins.  The procedure is safe, low-risk, is well-tolerated by patients, and has a 98% cure rate.  It has become the standard of care for varicose vein treatment in the United States.  This is a well-proven procedure that is approved by all insurance companies as well as medicare.

I would suggest that you seek out a vascular surgeon in your community that is considered a specialist in vein treatment.  Doctors that offer you surface treatment of the branches, such as offering only injection sclerotherapy or phlebectomy of the branches are not curing the problem, rather they are leaving the main problem and cause behind (the faulty trunk varicose vein).   This will universally lead to failed treatment and recurrence of varicose veins. Most plastic surgeons, dermatologists, and general surgeons do not have the training or expertise to do this procedure . . . that is why it is important to seek our a vascular surgeon who is a vein specialist.

Thank you for the question . . . much more public education is needed to allow patients to make informed decisions regarding their options for varicose vein treatment.

Unfortunately, there is no cure for varicose veins. As a matter of fact, anyone who is treating patients with spider veins, varicose veins and reticular veins must remind the patient and educate the patient that he or she will have more vein problems throughout their lives and that there is no procedure that is available today that eliminates the formation of new varicose veins or spider veins or reticular veins.

This is hard for some patients to hear from a phlebologist but this is the hard truth. It is very important for them to understand this fact, otherwise they will be disappointed with the treatments provided, especially when they develop new veins in 6 months, 5 years or 10 years from now.

It is true that most vein diseases will return with enough time. But Treatment of varicose veins is of crucial importance especially CEAP class4, 5 and 6 patients. Those with impending ulceration or ulcers should almost be considered emergent cases as venous stasis ulcers are very difficult to treat and can even lead to amputations.

Vnus or EVLA are the treatment of choice for large straight veins with reflux. GSV and SSV.

Vnus is a radiofrequency ablation device and evla stands for endovenous laser ablation.

both work well with minimal side effects and downtime.

microphlebectomy for tortuous varicosities.

C 4 Skin pigmentation in the gaiter area (lipodermatosclerosis)
C 5 A healed venous ulcer
C 6 An open venous ulcer