FAQ: Varicose Veins

Varicose veins are gnarled, enlarged veins that may be blue, red or the color of flesh. Any vein may become varicose, but those most often affected are veins in the legs and feet, since standing and walking increase pressure in the veins in that area. Varicose veins are often raised above the skin and appear as twisted, bulging ropes. They occur when valves in the veins carrying blood from the legs to the heart no longer work properly, forcing blood to collect in the legs.

For some people, varicose veins are merely a cosmetic issue. They can be unsightly and embarrassing. But, for others, the condition can be quite painful. In some cases, varicose veins may progress into what is known as chronic venous insufficiency (CVI), a more serious condition.

Treatments such as compression stockings are usually first prescribed to manage symptoms, but there are a variety of treatments that can actually eliminate the damaged varicose veins and halt the potential progression to chronic venous insufficiency (CVI).

Surgical approaches such as ligation with or without vein stripping have been used for years but are becoming less common as newer, minimally invasive methods have become more popular.

A common minimally invasive method of treatment is endovenous laser ablation, which involves inserting a thin, flexible tube or catheter into a damaged vein to seal it shut using heat. Blood that would seek to return to the heart through these veins instead travels through other veins. In time, the vein that has been treated shrinks and is absorbed by the body.

At the CardioVascular Institute, we prefer to use a similar, but newer minimally invasive ablation treatment known as Venefit Targeted Endovenous Therapy. Formerly known as VNUS Closure, the procedure is the only one to use radiofrequency ablation to get rid of varicose veins. Radiofrequency energy provides even, uniform heat that causes the vein walls to collapse and seal. Once this happens, blood flow is redirected to healthy veins. The treated vein dissolves over time.

Both the laser and the Venefit treatments involve less pain and a quicker recovery time than older, surgical options such as ligation and vein stripping. However, Venefit is associated with less bruising and less pain than laser treatment, as well as a faster improvement in quality of life and return to normal activities. Both methods have a very high rate of success in closing the veins.

The procedure is indicated for treatment of patients with symptomatic varicose veins such as those that are swelling, throbbing or aching. It can also halt the progression of varicose veins to chronic venous insufficiency (CVI.) The procedure is not used strictly for cosmetic purposes, though it often will improve the look of the veins.

The treatment is done in the Vascular Surgery Laboratory as an outpatient procedure.

The procedure itself takes 20 to 30 minutes, but you should plan on being in the office for up to an hour or so to allow for preparation and recovery.

The procedure is performed under local anesthesia and light oral sedation.

Outcomes are generally excellent with patient satisfaction high. Studies show very good success rates, resolution of symptoms, improved cosmetic appearance and better quality of life with few to no side effects. Studies report success rates of around 90 percent. Most patients report relief from symptoms such as aching and swelling of the legs. Treated veins may look cosmetically better, too. A small percentage of treated veins may need to be retreated after several years if symptoms return.

Side effects can include bruising, swelling, discomfort and, in some cases, temporary numbness in the area of the procedure. The risk of a blood clot forming is about one percent if you have never had a blood clot before. Wearing compression stockings and walking regularly afterwards reduces this risk.

Patients walk away from the procedure and typically return to their normal activities within a day. Patients are encouraged to be active on the day of the procedure and for several days afterwards. It is important to walk around to reduce the risk of a blood clot. Patients should not put themselves on bed rest. Patients cannot drive or drink alcohol for 24 hours after the procedure. Patients usually wear compression stockings immediately after the procedure and keep wearing them for about two weeks. Ibuprofen is prescribed to be taken the morning of the procedure and for three days afterwards to reduce inflammation, swelling and discomfort. Narcotic pain medication is not needed.

Arrange to have someone drive you to your procedure and bring you home. You cannot take public transportation, including a taxi, without being escorted by a family member or friend.

The week of your procedure, our office will send prescriptions to your pharmacy. You should pick up these medications and bring them with you to the procedure. You will be told by a clinical provider when to take these medications upon your arrival.

If you are on blood thinners, you should continue to take them prior to the procedure. There is no need to stop any medications prior to the procedure.

Wear comfortable, loose-fitting clothing and shoes. We will wrap your leg in an ACE wrap from your groin to your toes for 24 hours. The next day you may take off the ACE wrap and begin wearing your compression stockings. A prescription for the stockings will be given to you on your first visit.

Remember to bring the prescribed medications with you to your procedure appointment.

Park in one of the West Campus parking garages, located at 170 Pilgrim Road and 110 Francis Street. Valet parking is available in front of the Rosenberg Building on Deaconess Road. Take your garage ticket with you — parking is discounted for patients, family and friends. Walk to the Lowry Medical Office Building from the garage or valet station, take the elevator to the 5th floor, and enter the office in 5C to check in.

Of course, family and friends may accompany you and may wait in the office lobby if they so wish. Family and friends are not allowed in the procedure room.

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Please call the office main number at 617-632-9959 and we will direct your call to the best person to answer your question.