Laser Treatment Of Varicose Veins

For many women, varicose veins are not only unattractive, but uncomfortable or even painful.  Varicose veins are a common condition, affecting 1 in 2 American over age 50 or about 15% of men and 25% of women of all ages.  Risk factors include aging, family history, being female, and number of pregnancies.  In addition to their cosmetic problems, varicose veins can cause aching leg pain, night cramps, fatigue, and a sense of leg "heaviness" or restlessness. These symptoms are due to pressure on the near-by nerves from dilated veins and they usually increase as the day progresses.  Left untreated, nearly half of patients with significant varicose veins will eventually have worsening symptoms which may include leg swelling, eczema, pigmentation, hemorrhage and ulceration.  However, the prospect of traditional surgery was often a deterrent to treatment.   For many patients, a minimally-invasive laser treatment of varicose veins called Endo Venous Laser Treatment (EVLT) may now be an appealing option.  This is supported by a study recently published in the Journal of Vascular and Interventional Radiology (August 2003) which showed that this later procedure has a high long-term success rate, relatively low complication rate, and relatively rapid recovery time.

This study showed that minimally invasive laser treatment of varicose veins had a 98% success rate and a long-term recurrence rate of less than 7%; these results are far superior to those for traditional surgical ligation or vein stripping procedures.  Traditional surgery often requires general anesthesia (which carries its own risks) and up to two weeks of recovery time.  Pain, bruising and scarring are common during this time.  EVLT, on the other hand, is an outpatient procedure associated with relatively little pain, local anesthesia, no scars, less cost and rapid recovery time.  The procedure itself takes less than an hour and patients can return to their normal daily activity the same day.  In this study, 25% of patients reported bruising and most patients also reported a transient sensation of tightness or pulling as the vein shrinks. 

EVLT is performed by interventional radiologists.  After applying a local anesthetic to the vein, the doctor inserts a thin catheter (about the size of a piece of spaghetti) through a nick in the skin in the thigh and guides it up the great saphenous vein.  Laser energy is then applied to the inside of the vein, heating the vein and then sealing it closed.  Because the procedure does not require a surgical incision, there is no scarring.  Soreness and bruising are treated with over-the-counter pain relievers.

EVLT costs Apr. $2,000 to $3,000 per leg; traditional surgery generally costs two to three times as much.  Many insurance companies cover the treatment costs when symptoms are present.  While the treatment is relatively new, it is now being offered at about 200 sites across the country.

Created: 9/23/2003  -  Donnica Moore, M.D.