Your Aching Legs

By February 4, 2020 No Comments

Vein Closure Procedures Can Help Relieve Symptoms and Improve Appearance

D o you suffer from swelling, cramping, pain, or pressure in your legs? Are your legs restless? Wish you could do something about the appearance of “spider” veins or bulging veins in your legs? These symptoms may be caused by venous insufficiency. Fortunately, there are several treatment options, including laser venous ablation and sclerotherapy. We interviewed Mark Ilyagu, MD, one of our internal medicine doctors, to learn more about the different treatment options that are available.

aching legs

Question:  What treatment options are available and what would make someone a good fit for them?

Dr. Ilyagu:  Vein closure procedures are used to address venous insufficiency due to backward flow of blood in a patient’s leg veins. Often, this backflow is the result of weakness in small valves that exist within the leg veins. Normally, these tiny valves close to prevent backward flow of blood in the veins, but sometimes the valves are faulty, which allows backflow to occur, causing unpleasant symptoms. There are both superficial and deep veins in your legs. During vein closure procedures, we close off superficial veins and your body re-routes blood through the deeper veins, which improves symptoms.

Because this condition is often caused by genetic factors, these problems tend to run in families. However, diabetes can also play a role as can smoking cigarettes, being overweight, and having a sedentary lifestyle. Being sedentary (leading a lifestyle with little to no physical activity) is a big contributing factor. Think about it this way, when you move around, especially with your legs, you are helping your heart to pump blood through your veins, which helps blood circulation in your legs. But, if you’re a “couch potato,” you won’t get this benefit. That’s just one of the many reasons I encourage patients to stay active.

Question:  What are common symptoms of venous insufficiency?

Dr. Ilyagu:  Common symptoms of venous insufficiency can include:

  • Leg swelling
  • Leg cramping
  • Leg pain
  • Restless legs
  • “Spider veins” (small red, blue or purple veins visible through the skin)
  • Reticular veins (larger veins visible beneath the skin’s surface), and 
  • Varicose veins (bulging veins beneath the surface of the skin).

In advanced cases, symptoms can also include:

  • Chronic discoloration of the skin
  • Worsening leg swelling
  • Fluid weeping through the skin of the legs
  • Skin ulcerations, and
  • Poorly healing wounds

Question:  What procedures are used to address these issues?

Dr. Ilyagu:  There are several different procedures that can be used to address venous insufficiency, including:

  • Endovenous laser or radio frequency ablation 
  • Sclerotherapy and Varithena® sclerotherapy, and 
  • Phlebectomy, also referred to as “vein stripping”

Which procedure is used depends upon a patient’s specific medical needs including where problem areas are located, for example above versus below the knee, and the vein branch where the problem area is located. 

At Rudoy Medical, I perform the following procedures:

  • Endovenous Laser Ablation:  In this procedure, we first numb the procedure site using a local anesthetic such as lidocaine. Then we insert a catheter into the vein through a small incision. A solution is injected through the catheter to anesthetize the area and shrink the vein so it hugs the catheter. Finally, we insert a guidewire that heats up to cauterize the vein. We slowly withdraw the wire and catheter, which burns the vein closed. (At Rudoy Medical, we use laser ablation, rather than radio frequency ablation because the laser procedure tends to have a wider range of applications.)
  • Sclerotherapy:  This procedure is typically used for simpler situations such as spider veins. Basically, a specialized foam is injected into the vein causing the vein to close off. Blood is then rerouted through other veins.
  • Varithena® Sclerotherapy:  This procedure is used for more complex situations, often involving larger, more problematic veins. The procedure is similar to sclerotherapy but ultrasound imaging is used to guide the procedure, and a patented foam called Varithena® is injected into the vein causing it to close off.

Question:  Who is a good candidate for one of these procedures, and who is not?

Dr. Ilyagu:  If the decision is made to undergo one of these procedures, most people are good candidates. However, there are some contraindications (conditions that suggest a particular patient should not have the procedure) such as having a history of a deep vein thrombosis or “DVT,” which is a blood clot that forms in a vein deep in the body, or patients with a history of arterial insufficiency or those with a pacemaker or defibrillator.

Question:  Is the procedure painful?

Dr. Ilyagu:  The procedure should not be painful. The only pain a patient will likely feel is when the initial anesthetic is injected.

Question:  How long does each procedure take?

Dr. Ilyagu:  The time will vary depending upon a patient’s particular condition as well as which type of procedure is being performed. In general, each procedure takes around 20 – 30 minutes to complete.

Question:  What, if anything, do patients need to do to prepare for these procedures?

Dr. Ilyagu:  Each patient will receive a full ultrasound workup in our office. This is very important because it allows us to determine how many problem veins are present and where they are located. This helps me to determine which procedure is best suited for a particular patient’s needs.

Question:  Can all of these procedures be performed in an outpatient setting?

Dr. Ilyagu:  Yes, these are ambulatory procedures, meaning that they can typically be performed in our office and the patient is free to go home following the procedure.

Question:  What type of post-procedure care is required?

Dr. Ilyagu:  Generally, after-care involves getting the patient up and walking. Depending upon which procedure has been performed, it may be recommended to walk for 30 minutes immediately following the procedure, such as on a treadmill. We may also recommend that they wear compression stockings, and we often help them put compression stockings on before they leave our office. We want to be sure there’s good blood flow after procedure, and compression stockings and walking both help with this.

Question:  What are common risks and side effects associated with these procedures?

Dr. Ilyagu:  Typically, these procedures have a low risk of side effects, and if they do occur, they are generally mild and are treatable. Nevertheless, possible side effects include, but aren’t limited to:

  • Swelling at the site of the procedure
  • Pain at the site of the procedure
  • Infection
  • Bruising or a hematoma
  • Blood clots

Question:  Are the procedures typically “successful” in relieving symptoms?

Dr. Ilyagu:  These procedures typically have a success rate exceeding 90%. However, it’s important for patients to understand that, in a given leg, there could be multiple problem locations. We treat the entire leg, not just one location, so multiple procedures often will be required to resolve their symptoms.

Question:  Are these procedures typically covered by insurance or are they considered cosmetic in nature and therefore paid out of pocket by patients?

Dr. Ilyagu:  That’s a great question. Often, procedures intended to reduce symptoms caused by more significant issues such as varicose veins may be covered by insurance plans, while procedures to address cosmetic issues such as spider veins may not be covered, meaning the patient would be responsible for the cost. We recommend that patients come in for a consultation so we can help determine which procedures will best address their symptoms. Patients should also consult with their insurance plan before scheduling a procedure to determine the extent of their financial responsibility.

Ready to Learn More?
If you would like to learn more about the vein closure procedures offered by Rudoy Medical, please call us today to schedule a consultation about your symptoms and the treatment options that may be best for you.