Varicose Vein Treatments? Any Cures?

Varicose veins around the inner aspect and sometimes front of the knee are often the result of a problem you can't see with your eyes, venous insufficiency.  This problem is diagnosed with an ultrasound.  During the ultrasound we look for veins that have bad valves and as a result have blood moving the wrong way (down) the veins.  Once the vein with bad valves is identified, there are several options for closing it down to treat your underlying circulation disorder.  After this, if the bulging veins do not shrink up, I typically perform a procedure called a micro-phlebectomy in the office to remove them.  Once this problem is treated, your vein problem is "cured" at least temporarily.  Because vein disease is genetic, there is a good chance that you may develop additional vein issues in the future.  I also would have to recommend a board certified vascular surgeon specializing in veins as we have the most complete and thorough training to treat this disease.

For varicose veins, we typically recommend a safe, minimally invasive procedure called Sclerotherapy. A salt solution is injected directly into each vein, causing them to collapse and ultimately disappear. For long-term improvement, we often complement Sclerotherapy with IPL (Intense Pulsed Light) photofacial and the Excel V laser, which treats both superficial and deep vascular conditions on all skin types. I suggest seeing an expert for a formal evaluation to determine if this is the best solution for you. Best, Dr. Emer

 Often varicose veins around the knees are the result of a problem with the veins below the surface of the skin, venous insufficiency.  This problem is diagnosed with an ultrasound.  During the ultrasound we look for veins that have bad valves and as a result have blood moving the wrong way (down) the leg instead toward the heart.  Once the veins with bad valves are identified, there are several options for closing it down to treat your underlying circulation disorder. Once this problem is treated, your vein problem is "cured". However, because vein disease is genetic, there is a good chance that you may develop additional vein issues in the future.  I also would have to recommend a board certified vein specialist some who is a diplomat of the American Board Venous and Lymphatic Medicine. 
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5 Minute Medical Chat: Varicose Veins are Easier to Treat with Today's Options
Quick Facts- 60% of all men and women suffer from some kind of disorder in the vein- about 25% of those are men- Duplex ultrasound allows you to get a better look at the circulatory system in the leg- Newer techniques like duplex ultrasound allow doctors to get a better picture of what's going on instead of just listening to blood flow in the leg
Varicose Veins
There are 2 venous systems in the leg: the deep system, and the superficial system. The deep system is the main system to bring the blood back to the heart. The superficial system, which is closer to the surface, carries about 10% of your blood back to the heart. 
Various techniques can help solve problems with the superficial (surface) venous system and allow the deeper vein systems to take control of blood flow. 
In most cases, problems in the superficial system are the main cause of varicose veins. The word varicose means swollen.
Spider Veins and Varicose veins come about when the valves that normally keep blood from running backward fail, or become loose. This can result in "backwash", where veins become stretched and swelling results.
In addition to a "purple snake" appearance, varicose veins can cramp and hurt at night. The legs can feel heavy. There can be an itchy rash if circulation is reduced to the skin.
Cause
The exact cause is unknown, but there can be an influence from genes, or hormones. Pregnancy, menopause, birth control pills and other influences can weaken vein valves. Lifestyle, and job type can also influence varicose veins (ex: such as jobs where there are long periods standing or sitting.)
Diagnosis and Treatment
Newer techniques like duplex ultrasound allow doctors to get a better picture of what's going on instead of just listening to blood flow in the leg.
In the past you might have a metal rod inserted near the groin and actually passed through a vein, with a cap on the end, to pull out the vein entirely. This "stripping" is hardly ever done these days. Stripping is a significant surgery, done under general anesthesia, and has long period of recovery time.
Lasers can also be used now to send concentrated light into the vein to collapse it. There can be slight discomfort, but the skin is quickly cooled off.
There is also a new technique called "foam sclerotherapy". The foam is injected into a vein, gradually causing the walls to swell and stick, blocking the vein
Some techniques like foam are especially suited to spider veins, others are general.
Prevention 1-2-3
1) Don't sit with your legs crossed; it puts pressure on the veins2) When resting, elevate your legs3) When sitting anywhere, in a plane or at a desk, get up and walk about every hour.
In addition, engage in regular exercise that involves your legs to help prevent varicose veins.

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.

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

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.