The disease isn’t new. No doubt our earliest ancestors suffered from varicose veins if they lived long enough to develop them. It’s always been a common complaint — some 40 percent of the US population suffers from this disease. So why call it a disease of the 21st century? 

The answer lies in how varicose veins are treated. In fact, a surgeon’s ability to treat varicose veins precisely and with a high degree of success has grown more in the first five years of the 21st century than it has in all of recorded history. 

The term “varicose veins” is used to refer to superficial veins that are dilated and tortuous, with a thick and ropelike appearance. Common usage of the term has extended to smaller abnormal veins which are also visible on the skin’s surface.

History first documents varicose veins in the fourth century BC in a Greek statue. Since then, treatment of varicose veins has evolved, culminating in the latter half of the 20th century with vein stripping and ligation. During this painful and sometimes unsuccessful procedure, veins were literally removed from the patient’s leg by attaching them to a vein stripping instrument, and then forcefully pulling the vein out. Recovery was prolonged, the procedure was not always successful, and patients frequently spent time in the hospital.
Thankfully, new technology is available that virtually eliminates the need for this very invasive procedure. During the 1990’s ultrasound diagnosis, coupled with new methods for treating all sizes of abnormal veins, began to emerge. In the 21st century, in addition to advanced use of ultrasound diagnosis, new technology has allowed us to develop cutting edge, nearly painless treatments for varicose veins. Those treatments, all of which are described below, include percutaneous laser, sclerotherapy, microphlebectomy, and treatment of large varicose veins with laser or ultrasonic energy. Now, varicose vein sufferers have the ability to live a life free of this painful and disfiguring condition.

Percutaneous Laser

Laser treatment through the skin, or percutaneous laser treatment, involves no incisions or scarring. It is an office procedure used to treat small “spider” veins, port wine stains (a red birthmark) and cherry hemangiomas (freckle sized red spots, often raised). More powerful lasers, such as the Cutera Coolglide XEO, can be used to treat larger, deeper veins as well. When selected by your surgeon, the cosmetic appearance of the treated area can be returned to normal.

Sclerotherapy

Sclerotherapy is the injection of various liquid medications into a vein to cause it to close. Veins are visible on the skins surface due to the blood contained within them. If the vein does not carry blood, it will not be visible. Instead of using laser energy to close the vein, the liquid solution causes irritation of the lining of the vein and the vein’s channel, or lumen, is blocked.

Microphlebectomy

Microphlebectomy (micro= small, phlebectomy= vein removal) is a technique where very small incisions are made using local anesthetic, near somewhat larger, often painful veins. Through these incisions, a portion of the vein is removed to interrupt the vein’s lumen with very little later discomfort. This causes the appearance and the symptoms caused by the abnormal vein to resolve. This technique requires no sutures and is done in the office with very little down time.

Treating the Largest Veins

For the largest veins, laser closure is used. The procedure is carried out under ultrasound guidance by placing a laser fiber into the vein, again using local anesthetic in the office. 
The vein’s lining is irritated by the laser energy and the vein closes immediately. After a process lasting about one-half hour, patients leave the office with an elastic wrap on their leg and return to their normal activities. 

Today, treating varicose veins can be minimally invasive, nearly painless and involve minimal recovery time. Office-based therapies are available and, for veins that have symptoms beyond their cosmetic appearance, most insurance companies, including Medicare, will pay for their treatment.