Venous Insufficiency and Varicose Veins

Treatments for Leg Pain: Closure Procedure and Sclerotherapy

By Kevin D. Martin M.D., F.A.C.S. Sashi Kilaru M.D.

First rule out that your leg pain is not due to an arterial blockage. Many people have pains in their legs after they have been standing or sitting for a while. Pains in the calves or hip/buttocks that occur while walking may be due to arterial blockages and may be described as a cramp, tiredness or weakness of the muscles. This condition can be diagnosed by a physician, and further work up undertaken to correct the arterial problem.

Leg pain due to venous problems may get better with walking and is aggravated by standing on your feet or prolonged sitting. The pains may be described as an ache, burning or heaviness, and is from superficial venous reflux or insufficiency. This is caused by the one-way valves in the veins failing and allowing elevated back pressure to come into the superficial veins of the leg. The result is the ache, heaviness, sometimes bursting feeling that patients have after standing. It may cause the leg to swell and some of the veins may become enlarged (varicose veins). The heaviness, or pain, is relieved by elevating the legs, only to return when the patient is on their feet again.

In the past stripping the saphenous vein and varicosities was the mainstay of treatment. With the development of ultrasound the underlying problem of the venous valve reflux was identified. Now treatment is aimed mainly at stopping the reflux or back pressure. This can be accomplished by stripping the vein, but this standard operation does have pain, bruising and swelling associated with it. Frequently the patient needs to be off work 2 weeks or so to recover from the operation.

New Procedure: VNUS Closure

A relatively new approach to stopping painful venous reflux is called the Closure radiofrequency ablation of the greater saphenous vein. This minimally invasive procedure uses a special catheter to heat the inside of the vein causing it to contract and close as the catheter is withdrawn. We do this procedure as an outpatient with the safety and convenience of sedation or anesthesia in the operating room. Patients have little pain compared to traditional vein stripping and are usually able to return to normal daily activities after a couple of days.

While closing the saphenous vein reflux will relieve the heaviness, there may still be some enlarged varicose veins. While these may not ache they may be unsightly and they can be removed at the same time as the closure procedure through tiny needle puncture with pleasing cosmetic results. Sclerotherapy may also be used for some veins later.

To find out if your leg pain is due to venous reflux requires evaluation of your legs and veins. Reflux in specific veins is needed to be a candidate for the VNUS Closure procedure. A painless ultrasound examination of your veins can be done conveniently in our offices to determine if your leg pain is from venous reflux.

Sclerotherapy for Varicose Veins

Sclerotherapy is a very simple, effective, and commonly used intervention for removing varicose veins that are not too large. This procedure involves the injection of a concentrated saline or specially-developed solution into the varicose vein. The solution then hardens, causing the vein to close up or collapse. Healthier blood vessels located nearby absorb the blood flow of the collapsed vein. Sclerotherapy reduces symptoms of varicose veins and improves appearance of the skin in approximately 85% of people who undergo the procedure.

Sclerotherapy can be done in the vascular surgeons office and does not require any anesthesia. The leg is elevated to drain the blood out of it, and the sclerosant (the solution used) is injected into the affected area of the vein. After the injection, pressure is applied to the area, and compression stockings or elastic bandages are worn for several days. In some cases, the procedure might require several injections during the same appointment, or at another appointment.

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