Varicose veins and venous insufficiency affect one out of every two people age 50 and older, and 15 to 25 percent of all adults.
What is venous insufficiency?
Venous insufficiency is a very common condition that results from incompetent valves in the deep or superficial venous system. The valves become leaky so the blood flows backwards or “refluxes”. The pooling of blood in the legs can cause swelling and discomfort and if left untreated, can result in varicose veins, leg ulcers, or bleeding varicose veins. In the illustration below, you can see how the leaky valves allow the blood to flow in the wrong direction. The backup of blood flow can cause large bulging varicose veins.
Prevalence of varicose veins and venous insufficiency
Varicose veins and venous insufficiency affect one out of every two people age 50 and older, and 15 to 25 percent of all adults.
Risk factors:
- Increasing age
- Family history
- Jobs with continuous standing or sitting
- Obesity
- Multiple pregnancies
Symptoms of venous insufficiency:
- Aching
- Throbbing
- Fatigue
- Heaviness
- Burning
- Redness
- Swelling
- Bleeding varicose veins
- Leg ulcers
Diagnosis and assessment
All patients with suspected venous insufficiency see the Nurse Practitioner and interventional radiologist for consultation regarding their clinical situation. A thorough history and physical exam is obtained as well as a reflux ultrasound of the venous system.
Treatment options
The decision to treat is made by the Interventional Radiologist after review of the clinical situation and venous reflux ultrasound results.
The treatments that we offer in IR are endovenous laser treatment (EVLT), microphlebectomy, and sclerotherapy. Sometimes, patients need a combination of one or more treatments to achieve the desired result.
Endovenous laser therapy
Endovenous laser ablation is a minimally invasive treatment that is performed under ultrasound guidance. Patients are pre-medicated with an oral benzodiazepine and local anesthetic is used along the course of the vein.
The interventional radiologist accesses the superficial vein through a small incision in the skin. The catheter is inserted all the way up to the groin and a laser fiber inside the catheter then burns the vein closed.
By closing the abnormal vein, the varicose veins shrink and improve in appearance. In addition, once the diseased vein is closed, the surrounding healthy veins are no longer burdened by the leaking blood flow. Other healthy veins take over to carry blood from the leg, re-establishing normal flow.
Benefits of vein ablation:
- Treatment takes about an hour or less
- Almost immediate return to regular activities
- Near immediate relief of symptoms
- No scars
- Success rate ranges from 93-97%
Microphlebectomy
If large bulging varicose veins are visible and symptomatic, the interventional radiologist may recommend removing the vein through several small incisions in the leg. This is called a microphlebectomy or ambulatory phlebectomy.
Sclerotherapy
Sclerotherapy is a series of injections using a sterile detergent to irritate and close spider veins, reticular veins, and varicose veins. Occasionally, sclerotherapy is used in the superficial veins if the vein is too close to the surface of the skin.
Other information
Insurance
Most insurance carriers cover a consultation with an interventional radiologist to assess a patient with symptoms of venous disease. Venous insufficiency treatments are covered benefits in most plans, based on medical necessity.
Pre-treatment requirements:
- Venous reflux study
- Consultation with interventional radiologist
- Conservative measures may be required for a minimum of 6 weeks prior to insurance approval
JULIANA MESSER, ANP-BC
