What do an olympic swimmer, champion cyclist, hairdresser, and teacher have in com-mon? They all have and can suffer from varicose vein disease. Varicose vein disease is ex-tremely prevalent in the United States with estimates suggesting 30 million sufferers. In fact, approximately 50% of adults over 50 have venous insufficiency. Unfortunately less than 10% of people seek treatment.

So what is venous insufficiency or “reflux”? Venous insufficiency is a very common condi-tion 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 veins help keep blood flowing toward the heart —against the force of gravity. When the valves do not perform their function or become “incompe-tent”, blood can flow backwards or reflux. This reflux results in what is known as venous insuffi-ciency.

What predisposes an individual to venous reflux? Risk factors include increasing age, a family history of varicose veins, jobs that require long periods of continuous sitting or standing and obesity. In women, pregnancy—especially multiple pregnancies—is one of the most com-mon factors accelerating the progression of venous insufficiency.

Are varicose veins simply a cosmetic problem? While there is clearly a component of un-sightliness, many patients suffer from significant symptoms. Symptoms caused by venous insuf-ficiency and varicose veins are related to the increased pressure within the veins. Symptoms in-clude aching, throbbing, restless legs, fatigue and heaviness—all of which worsen as the day goes on. Many people find that they need to sit down in the afternoon and elevate their legs to relieve these symptoms. People who have venous insufficiency can have symptoms even with-out visible varicose veins. In severe cases, venous insufficiency can injure the skin near the an-kle resulting in dark pigmentation and scarring. In fact, 1% of adults over age 60 develop chronic wounds from venous disease known as ulcers.

Can the varicose veins improve on their own? Sadly, varicose vein disease is a progressive disease. Once the valves become damaged there is no cure. Compression stockings can im-prove symptoms particularly if they are measured properly. Some people even find that they wear them during exercise which helps them recover faster from their workout.

What are the treatment options? In the past, surgery was the only option, a procedure known as vein stripping. It was very invasive and required a prolonged recovery period. Today, we have a much less invasive procedure known as vein ablation.

Endovenous vein ablation is a minimally invasive outpatient treatment for venous insufficiency that is performed using ultrasound guidance. After applying local anesthetic to the skin over the vein, an interventional radiologist inserts a thin tube known as a catheter, about the size of a strand of spaghetti, into the abnormal vein. Through this catheter, laser or radiofrequency en-ergy is applied to the inside of the vein to seal it closed. By closing the abnormal vein, the vari-cose veins—which are close to the skin—shrink and improve in appearance. In addition, once the diseased vein is closed, the surrounding healthy veins are no longer burdened by the leak-ing blood flow. Other healthy veins take over to carry blood from the leg, re-establishing normal flow. In my practice, I use the Venefit RF procedure as it has been shown to be associated with less pain and bruising then laser.

The treatment typically takes less than an hour and provides immediate relief of symptoms. Pa-tients may immediately return to normal activity with little or no pain. There may be minor sore-ness or bruising, which can be treated with over-the-counter pain relievers.

There are absolutely no scars or stitches since the procedure does not require a surgical inci-sion, just a nick in the skin, about the size of a pencil tip. The success rate approaches 100% and there is a recent study from England showing a 5 year occlusion rate of 95%.

Is this procedure covered by insurance? Almost all insurance carriers cover a consultation with an interventional radiologist to assess a patient with a venous disorder. Venous insuffi-ciency treatments are covered benefits in most plans, based on medical necessity. If you re-quire treatment, your interventional radiologist can interact with your insurance company to as-sess your coverage.

Are there any other treatments besides ablation? Microphlebectomy and injection scle-rotherapy are other treatments for varicose veins. These procedures may be done alone or in conjunction with vein ablation.

Microphlebectomy is a minimally invasive technique to remove bulging varicose veins. The ab-normal vein is removed through a tiny nick using a special set of tools. This outpatient procedure is done under local anesthesia. Injec-tion sclerotherapy is used to treat varicose as well as spider veins. An extremely fine needle is used to inject the abnormal vein with a so-lution that eventually shrinks the vein. Recovery is rapid after both microphlebectomy and injection sclerotherapy.

Aaron Shiloh MD FSIRMedical DirectorSVAI715 Cherry lane, Suite 100Southampton, PA 18966215-808-VEIN (8346)