Tired of venous pain? Consider minimally invasive options

Varicose veins are bulging, twisted veins visible below the surface of the skin that signal chronic venous insufficiency (CVI). CVI is a type of venous disease that occurs when the valves in the leg veins malfunction; this causes the blood to flow back and pool in the legs instead of back up to the heart.

As a result, CVI can produce painful and debilitating symptoms of burning, throbbing, itching, swelling, cramping, heaviness, and other leg pains. If you suffer from these sensations, you may want to see a vein specialist and consider options for pain relief and CVI treatment.

Mohammad Reza Amini, MD, director of peripheral arterial and venous disease services at the International Heart Institute at Loma Linda University, outlines various minimally invasive treatment options you can consider to relieve symptoms of CVI.

The first step is to talk to your doctor about your symptoms. “Be sure to mention your symptoms and work out a plan of action with your doctor as soon as they arise,” he says. “It’s a good idea to treat varicose veins before chronic venous insufficiency progresses too far and causes irreversible damage.”

Depending on the circumstances, your doctor may suggest that you start with a “conservative” approach, which involves changing your lifestyle and behavior, using clothing such as compression stockings, and taking medication.

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If initial conservative attempts fail to alleviate symptoms, Amini says you and your doctor can determine that the best course of action involves intervention for CVI, usually called vein closure procedures. As the name suggests, vein closure procedures aim to close the veins responsible for feeding or feeding varicose veins. As the varicose veins dissipate, much of the swelling and other painful symptoms associated with CVI will also subside.

By minimally invasive means involving only local sedation, doctors can close “feeder veins” in several different vein closure procedures. The type of procedure you choose will depend on the type of problem you have, your preferences, your insurance coverage, and what your provider offers. LLU International Heart Institute offers the following options for minimally invasive vein closure procedures:

  • Sclerotherapy: Doctors inject a chemical into the feeder veins that scars them so they can no longer carry blood. The blood then returns to the heart through other veins and the body absorbs the scarred veins.
  • Endovenous laser ablation: A tube (catheter) inserts heat from a laser source directly into the affected vein to close the vein. Once the vein is closed, less blood pools in the leg and overall venous flow improves.
  • Radiofrequency ablation (RFA): A tube (catheter) inserts heat from a radio wave source directly into the affected vein to close it. Vein closure ultimately improves overall venous flow.

Amini says all minimally invasive procedures for CVI can happen on an outpatient basis and usually take no longer than 45 to 60 minutes. Minimally invasive vein closures are performed in stages – one leg vein at a time. Thus, patients can undergo multiple cycles of vein closure surgery through separate appointments. Patients do not need to stop medications or engage in any special preparation before undergoing these procedures performed at Loma Linda University International Heart Institute.

Doctors will use a map of the patient’s venous system acquired by ultrasound during previous visits to identify the feeder veins to close. Then, during the procedure, doctors use imaging tools such as ultrasound to guide them as they insert a catheter into the veins in the leg and occlude the veins.

After the procedure, the patient can move around and go about the rest of the day’s activities as usual, says Amini. Patients are advised to avoid placing extreme heat or cold on the area where a catheter was inserted for approximately five days to aid healing. Patients typically return for an ultrasound within two to seven days of the procedure. These examinations aim to ensure that the veins are closed and to answer any patient questions or concerns.

You need to be able to keep the big picture in mind while continuing to address risk factors and comorbidities.Dr. Reza Amine

Amini says minimally invasive vein closure procedures have different short-term side effects; for example, bruising, numbness and tingling. But, ultimately, as the side effects wear off, the procedures all yield similar long-term results, he says — more than a 90 percent success rate of veins remaining closed within five years.

“I haven’t seen any patients come back with closed veins that reopened after a vein closure procedure,” says Amini, who performed the procedures at LLU International Heart Institute for more than eight years. “On the other hand, I’ve seen the same patients come back with new varicose veins popping up.”

For this reason, Amini advises you to continue to invest time and effort in maintaining your health before and after a vein closure procedure. Additionally, he says it’s essential to minimize and manage other risk factors for venous disease, such as obesity, hypertension and diabetes. In other words, having the procedure does not absolve you of other health issues that may arise if you ignore your cardiovascular health; he says it is an aspect of health to be constantly maintained.

“You need to be able to keep the big picture in mind while still addressing risk factors and comorbidities,” he says. “Listen to your body, be aware of how you feel, and don’t wait to explore your options if you have chronic venous insufficiency.”

At Loma Linda University’s International Heart Institute, physicians are committed to providing patients with compassionate, comprehensive, and personalized cardiovascular care. To learn more, please visit lluh.org/heart-vascular or call 1-800-468-5432 to schedule an appointment.

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