Treatments to Eliminate Varicose Veins in the Legs

Fundamental Reasons for Treating Leg Veins

Prominent veins in the lower extremities are not only an aesthetic concern but can also cause uncomfortable symptoms such as pain, heaviness, or muscle cramps. Untreated varicose veins increase the risk of serious complications, including the development of eczema venous eczema, lipodermatosclerosis (hardening of the tissue in the lower leg), persistent swelling (lymphedema), and, in severe cases, ulceration of the leg.

Treatment Options for Eliminating Varicose Veins

There are various medical and surgical procedures available to eradicate varicose veins in the legs:

Surgery for Larger Caliber Varicose Veins

• When problematic veins involve the great saphenous vein (usually on the inner thigh), the vein is tied off in the groin and then the vessel is removed. This procedure usually requires the use of a local anesthetic. For smaller veins in the lower leg, an office-based phlebectomy can be performed under local anesthetic. Additionally, perforating veins connecting the superficial and deep venous systems are tied off to prevent reflux.

Endovenous Thermal Ablation (Laser and Radiofrequency)

• These are advanced techniques that allow for the elimination of large veins while minimizing invasion. A thin catheter is inserted into the vein, which delivers energy (laser or radiofrequency) to heat the wall of the blood vessel, causing it to collapse and seal permanently. This procedure is performed with local anesthesia.

Sclerotherapy

• The Sclerotherapy consists of injecting a small amount of an solution irritant solution, such as hypertonic saline solution, sodium tetradecyl sulfate, or polidocanol, directly into superficial veins and perforating vessels. This causes the blood vessel to close and progressively disappear over the following weeks. Between one and five treatments may be necessary. For superficial spider veins, microsclerotherapy with ultra-fine needles is used.

Ultrasound-Guided Sclerotherapy

• This method is used to treat deeper veins of larger diameter. It uses ultrasound guidance to precisely inject a foamed solution (sclerosant foam) into the target vein.

Mechanochemical Ablation (MOCA)

• A procedure that uses a catheter rotating catheter (such as the ClariVein® system) inserted into the large varicose vein under ultrasound guidance. This device mechanically agitates the venous lining while simultaneously administering a sclerosant agent. The catheter is a disposable, single-use device.

Vein Adhesive

• Using the VenaSeal™ Sapheon closure system, a medical-grade cyanoacrylate adhesive is introduced into the vein. This is done under ultrasound guidance, using a disposable catheter designed for a single application, immediately sealing the vessel.

Vascular Lasers and Light Devices

• There are several types of vascular lasers vascular lasers and intense pulsed light (IPL) devices used to treat superficial spider veins. While historically less effective than microsclerotherapy, they can be a viable alternative for patients who are not candidates for other procedures.

Other treatment techniques currently under evaluation include thermal vapor ablation and high-frequency ultrasound ablation. ablation thermal vapor ablation and high-frequency ultrasound ablation.

Treatment Outcome and Final Considerations

Regardless of the treatment method selected for varicose veins, recurrence or the appearance of new veins over time is possible. Often, additional treatments can be chosen. To achieve the greatest possible efficacy, in many clinical scenarios, the strategic combination of two or more of the techniques mentioned above is recommended.