Heart Rhythm Center

How common are Varicose Veins?

Over 30 million Americans suffer from varicose veins or a more serious form of venous disease called Chronic Venous Insufficiency. Only 1.9 million seek treatment annually while the vast majority remain undiagnosed and untreated.

In the USA, 23% of adults have varicose veins, 6% have more advanced disease with leg swelling, skin changes, and leg ulcers.

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What are Varicose Veins?

Varicose veins are engorged, tangled veins that are noticeably visible under the skin and are typically found in the legs.

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What leads to and causes Varicose Veins?

Many factors contribute to the presence of venous diseases, including:

• Gender

• Age

• Family history

• Multiple pregnancies

• Obesity

• Standing all day at work

• Prior injury or surgery

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How do veins normally work?

Venous blood flows from the capillaries to the heart. This blood flow occurs against gravity due to the muscular compression of the veins with calf muscle pumps, negative intrathoracic pressure, and the low pressure and low flow nature of the venous system.

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Why do Varicose Veins form?

Most varicose veins are caused by a combination of primary venous disease and structural weakness of the vein wall. Other causes include previous Deep Vein Thrombosis (DVT), deep vein obstruction, superficial thrombophlebitis, or arteriovenous fistula.

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Venous valves are important structures facilitate blood flow in normal venous systems. The Great Saphenous Vein (GSV) is found in the inner thigh and has at least 6 valves. The Short Saphenous Vein (SSV) is found in the back of the leg and has 7-10 valves. Other valves are located in the deep veins of lower limbs.

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What are the symptoms of Varicose Veins?

Patients with venous disease or CVI may have varicose veins with or without the following symptoms:

• Leg pain, aches, cramps

• Leg heaviness and fatigue

• Restless legs

• Burning or itching of the skin

• Leg or ankle swelling

• Skin changes such as limb swelling, pigmentation, lipodermatosclerosis, and eczema.

• Lower leg ulcers

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What are Venous Leg Ulcers:

A skin ulcer occurs when an area of skin breaks to expose the underlying flesh. Venous leg ulcers are the most common type of skin ulcer and usually appear above the ankle. They are caused by increased blood pressure in the veins of the lower leg, which pushes fluids out of the veins and directly underneath the skin. The added pressure damages the skin, which may become an ulcer.

Both Superficial and Perforator vein reflux are usually involved in venous ulceration. Perforator veins serve as connections between the two networks of veins in the extremities, the superficial venous system, and the deep venous system. They work similar to the rungs of a ladder connecting side rails and typically drain blood from the superficial veins to the deep veins as part of the process of returning oxygen-depleted blood to the heart. Perforator veins have one-way valves designed to prevent backflow of blood down towards the superficial veins. When those valves no longer function properly, reflux occurs and the resulting buildup of blood and pressure causes the superficial veins and the perforators to become incompetent. Incompetence can cause varicose veins by transmitting highly pressurized blood from the deep venous system to the low pressure blood of the superficial veins. Perforator veins in the lower leg and ankle are particularly vulnerable to distention and incompetence. The resulting circulatory problems create an increased likelihood of edema, skin discoloration, dermatitis, and skin ulcers in the immediate area.

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How to assess and diagnose Varicose Veins:

Patient assessments include a complete evaluation of current health status, past medical history, reported symptoms, and a complete physical exam.

A non-invasive and diagnostic ultrasound study is then performed in order to determine the source of reflux, evaluate venous occlusion or thrombus, and map the course of the incompetent superficial veins.

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What are the available treatment options?

Although there are many advanced catheters and surgical treatment options available for varicose veins, a conservative approach is typically recommended in the early stages of the disease. Conservative therapies treat the symptoms rather than the underlying cause.

Such conservative therapies include:

• Exercise programs that target the calf muscle pump.

• Leg elevation to alleviate the pressure in the lower legs.

• Compression stockings or compression therapies to narrow the veins, decrease venous volume, and reduce venous reflux by shifting blood volume. Compression therapy may be effective in relieving swelling and pain when used alone or combined with other therapies, however, patient compliance is typically poor due to feelings of discomfort.

• Unna Boots are used to treat venous disease that has progressed into venous ulcers. A moist gauze bandage made of zinc oxide, calamine lotion, and glycerine can promote healing, increase blood return to the heart, and reduce infection. The boot wraps from just below the knees to the toes, covering the ulcer and the lower leg. The gauze then dries and hardens. An elastic bandage is wrapped snugly over the Unna boot.

Invasive therapies such as Vein Stripping and Ligation are used for patients who have no success with the conservative approach.

Vein stripping and ligation are surgical procedures that involve tying off the varicose veins associated with the main superficial vein in the leg and removing the vessel. A vein stripping procedure is usually performed in a hospital operating room under general anesthesia and begins with an incision in the groin area to expose and ligate, or tie off, the diseased great saphenous vein and surrounding tributary veins. The goal is to remove the targeted vein from the leg. The recovery period following vein stripping surgery may be up to four weeks before patients can return to normal, daily activities.

Non-surgical treatments include an endovenous ablation procedure, which is a minimally invasive treatment that can be performed as an outpatient procedure using imaging guidance. In an endovenous ablation procedure, a thin catheter is inserted into the vein and up the great saphenous vein in the thigh. Laser or radiofrequency energy is applied to the inside of the vein, which heats it and causes the vein to close and allows blood to re-route itself to other healthy veins. See below for more details about the Venefit endogenous vein ablation procedure using the ClosureFast Catheter.

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How the Venefit Endogenous Vein Ablation Procedure works using the ClosureFast Catheter:

Thermal energy is transferred from the ClosureFast catheter’s heating element to the vein wall through conduction. Heating of the vein wall tissue causes endothelial destruction and collagen contraction that results in vein occlusion. The procedure can be performed under general and/or local anesthesia. Using ultrasound guidance, the ClosureFast catheter is positioned into the diseased vein through a small opening in the skin. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed closed. Once the diseased vein is closed, blood will re-route itself to other healthy veins.

Venefit Procedure Highlights:

• Proven results with positive patient outcomes and experience

• Relief of symptoms within 2 days

• The average patient typically resumes normal activities within a few days

• Outpatient procedure

• Can be performed under anesthesia

• Covered by most insurance providers for patients diagnosed with venous reflux

• Low risk

Potential complications include but are not limited to: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia (numbness or tingling), skin discoloration, skin burn, and/or adjunct nerve injury. Your physician will have a consultation with you to determine if your conditions present any special risks and to discuss these potential complications.

 

 

 

 

 

 

 

 

 

 

 

 

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