AVI SERVICES

Varicose Veins

Interventional Radiology Nonsurgical Outpatient Procedure Treats Varicose Veins

Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don't close properly, they allow blood to flow backward, a condition called reflux. Veins that have lost their valve effectiveness, become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in a thigh vein called the great saphenous, which leads to pooling in the visible varicose vein below.

Prevalence of Varicose Veins and Venous Insufficiency
Chronic venous disease of the legs is one of the most common conditions affecting people of all races.

Approximately half of the U.S. population has venous disease--50 to 55% of women and 40 to 45% of men. Of these, 20 to 25% of the women and 10 to 15% of men will have visible varicose veins.
Varicose veins affect 1 out of 2 people age 50 and older, and 15 to 25% of all adults.
Risk Factors
- Age
- Family history
- Female gender
- Pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of varicose veins.
Symptoms

Symptoms caused by venous insufficiency and varicose veins include aching leg pain, easy leg fatigue, and leg heaviness, all of which worsen as the day progresses. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms. In more severe cases, venous insufficiency and reflux can cause skin discoloration and ulceration which may be very difficult to treat. One percent of adults over age 60 have chronic wounds known as ulcers.

People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins as well as from varicose veins, because in both cases the symptoms are caused by pressure on nerves by dilated veins.
Diagnosis and Assessment

An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging guidance, will use duplex ultrasound to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. The doctor will map the great saphenous vein and examine the deep and superficial venous systems to determine if the veins are open and to pinpoint any reflux. This will help determine if the patient is a candidate for a minimally invasive treatment, known as vein ablation.
Varicose Vein Treatments

Minimally Invasive Vein Ablation Treatment
This minimally-invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, the interventional
radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh. Then laser or radiofrequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed.

Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.
Benefits of Vein Ablation Treatment
- The treatment takes less than an hour and provides immediate relief of symptoms.
- Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
- No scars or stitches – because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.
- High success rate and low recurrence rate compared to surgery.
- The success rate for vein ablation ranges from 93-95 percent.
Insurance

Many insurance carriers cover the vein ablation treatment, based on medical necessity for symptom relief.
Surgical Treatment of Veins

Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures. One study found a 29% recurrence rate after ligation and stripping of the greater saphenous vein, and a rate of 71% after high ligation. These recurrence rates are similar to those reported in other studies.
Second Opinion

Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor, call Advanced Vein Institute at 402-484-6677 or the radiology department of any hospital and ask for interventional radiology.
Additional Treatments for Varicose Veins

Ambulatory Phlebectomy
A minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

Injection Sclerotherapy
Can also be used to treat some varicose and nearly all spider veins. An extremely fine needle is used to inject the vein with a solution which shrinks the vein.

Ultrasound-guided Sclerotherapy
Involves an interventional radiologist passing a thin needle into the vein using ultrasound guidance and injecting a solution that causes the veins to scar and
close, which re-routes the blood to healthier veins. The affected vein forms a knot of scar tissue that is absorbed by the body over time.
EndoVenous Laser Treatment (EVLT) – The Solution You’ve Been Looking For
EndoVenous Laser Treatment (EVLT) – The Solution You’ve Been Looking For.
EVLT eliminates unsightly varicose veins with no hospital stay, no scarring and no lengthy recovery or side effects. In less than an hour you can be free from bulging, twisted varicose veins and back to enjoying your everyday activities. EVLT is safe, fast, and effective. With EVLT by AngioDynamics you can show off your legs again.

EVLT uses targeted laser energy to seal the vein shut and help you look and feel better fast.

Treatment in less than an hour.
Can be performed at Advanced Medical Imaging.
Up to 98% success rate.
Immediate relief of symptoms.
No general anesthesia or hospitalization
No scars

Here’s what to expect from the EVLT procedure:

Your doctor uses ultrasound to map out your vein.
Local anesthetic is applied.
A thin laser fiber is inserted through a tiny entry point, usually near the knee.
Laser energy is delivered to seal the faulty vein.
Walking immediately after the procedure is encouraged. Normal daily activity can be resumed; just avoid rigorous activities such as gym workouts.
There may be minor soreness and bruising. Any discomfort can be treated with over-the-counter, non-aspirin pain relievers as necessary.

Frequently Asked Questions

What does EVLT stand for?
EndoVenous Laser Treatment

How does the procedure actually work?
A laser fiber is fired inside and along the length of the faulty, varicose vein. The laser energy damages the vein walls, shrinking them closed so that blood can no longer flow through.

Is loss of this vein a problem?
No. There are many veins in the leg and after treatment the blood in the faulty veins will be diverted to normal veins with functional valves. The resulting increase in circulation will significantly relieve symptoms and improve appearance.

What are the side-effects and complications of this procedure?
EVLT, like all minimally invasive procedures, can potentially have some slight bruising, which commonly disappears within the first few weeks. With EVLT, you may feel a delayed tightness (or “pulling” sensation) 4-7 days after laser treatment which is normal and expected following a successful treatment.

All surgical procedures involve some element of risk and have potential for complications. This should be balanced against the risk of complications if your varicose veins remain untreated. Consult your physician for further information.

What are the alternatives to this treatment?
Surgery (called ‘Ligation & stripping’) is the traditional treatment, but it can be quite painful and often has a long recover time. It is performed in a hospital, involves general anesthesia, leaves a scar, and has a fairly high recurrence rate (on average 10-25%).

Other alternatives include ultrasound guided sclerotherapy (injection therapy) and radio frequency electrosurgery. Injection therapy for a saphenous vein has a high recurrence rate frequently requiring retreatment and is generally limited to smaller varicose and spider veins. Radiofrequency electrosurgery is more limited in the range of patients it can treat and the treatment time is longer than EVLT.

How successful is EVLT?
Clinical data with up to 5 years of follow-up show success rates of 93-98%. This is much higher than surgical ligation and stripping, radiofrequency electrosurgery, and injection sclerotherapy. Market researchers predict that, based on its superior efficacy and lower morbidity, endovenous laser treatment will soon become the new ‘gold standard’.

How much does it cost?
EVLT, when medically necessary (e.g., for relief of symptoms), is commonly reimbursed by most carriers (including Medicare), limiting the cost to the patient. Contact your specific insurer for details.

To find out more information or to schedule your appointment, please call 402-484-6677.

AVI SERVICES

Varicose Veins

Interventional Radiology Nonsurgical Outpatient Procedure Treats Varicose Veins

Frequently Asked Questions