After discovering that my legs had numerous veins that weren’t working well or not working at all, I sat down with the receptionist to schedule my varicose vein treatment – nearly 15 appointments for the next few months.
Fixing these diseased veins consisted of office visits (no hospital necessary) for either vein procedures or ultrasounds. Fortunately, all my visits were covered by my insurance. I strongly recommend finding a vein specialist that is covered by your insurance as the most expensive and invasive treatments for me were billed around $5,000 a leg.
Varicose vein treatment is different for large and small veins, but each vein clinic may have different procedures or recommendations. At my vein clinic, large veins were treated with ultrasound-guided Endovenous Thermal Ablation, or simply put, closing the veins with heat (endovenous is the medical term for “in the vein”). Smaller veins were treated with ultrasound-guided Sclerotherapy Injections, or closing the veins with chemical solutions/medications. Let me explain their differences and the procedures with each.
This type of ablation, or removal of the vein, uses either a laser (endovenous laser ablation) or radiofrequency (endovenous radiofrequency ablation) to create heat, which damages the cell walls, causing them to collapse and close the vein. So the vein is either treated with heat generated from laser energy or high-intensity, high-frequency radio waves that generate heat, sealing the problematic vein. My physician used endovenous radiofrequency ablation to close the largest two varicose veins in my thigh.
The veins that were going to receive the radiofrequency ablation were the Great Saphenous Vein (GSV) and Anterior Accessory Saphenous Vein (AASV). The GSV is the longest vein in the body which runs down the inside of the thigh, down the calf to the foot. The AASV is a tributary off the GSV and runs more along the front of the thigh.
Each vein was ablated on different days (I could not do multiple treatments in one day, per insurance) and about 3-5 days after each ablation, I had to have an ultrasound to verify that the vein was closed and no blood clots were visible. (Now you can see why there were so many appointments!)
Varicose vein treatment for my large varicose veins was an in-office procedure that took about 60-90 minutes for each visit. I was positioned on the table so that the vein being worked on was accessible. My leg was then cleaned, the sterile field was prepped, and the ultrasound technician took another look at the vein to be sealed.
When the doctor was ready to begin, she first injected anesthetic around the vein, always using ultrasound guidance. This consisted of 4-6 injections up and down the length of the vein. Because radiofrequency ablation generates intense heat (temperatures up to and around 250°F), the anesthetic solution is injected around the vein to protect the surrounding tissues and to improve contact between the vein wall and the catheter during the procedure.
After all the anesthesia was injected, a small, thin catheter was inserted into the vein and was pushed near the top of a venous junction. With compression on the leg for good contact between the catheter and the vein, the ablation began with the machine emitting consistent heat, treating the vein in small sections with the physician slowly pulling out the catheter a little bit during each interval, thus closing the vein.
Once complete, the catheter was removed and I was bandaged up. Before heading home, I had to put on my compression stockings (link to Amazon, I bought this brand upon recommendation from my doctor) and wear them for the next week. People can certainly head back to work the same day, but are instructed to take it easy (no heavy lifting). Ultrasound follow-ups are then performed within the next few days to verify a successful closure of the vein.
For closure of smaller veins in both the calf and the thigh, my doctor used ultrasound-guided sclerotherapy. This type of varicose vein treatment involves injecting a sclerosing agent (foam or liquid) into the diseased vein which produces an inflammatory reaction within the vein wall, causing scarring and closure of the treated vein. The solution irritates the inside the vein, causing it to harden and close over time. The vein is then reabsorbed by the body within a few months.
The sclerotherapy procedure was only similar to the heat treatments (thermal ablation) in that it was done with ultrasound guidance, but that’s where the similarities ended. After cleaning my leg with a disinfectant, the physician inserted a needle into the diseased vein and instead of using a heat source, she injected medication that would close my vein. There was no anesthetic or no high powered radiofrequency machine. All of the veins that needed sclerotherapy were done for that specific leg; I had to return later to treat the other leg.
After being bandaged up, I was instructed to walk around a room for a few minutes. Home care was similar to thermal ablation in that I was to wear my compression stockings for about a week, avoid heavy lifting and hot baths, take daily walks and over-the-counter pain meds for discomfort.
In contrast to the more-intense thermal ablation, I actually was more uncomfortable with the chemical sclerotherapy. With thermal ablation by radiofrequency, I received maybe 6 needle pokes and didn’t experience any pain during the procedure. However, this treated only one large vein at a time.
With sclerotherapy, all the affected veins in one leg were sealed in one office visit. Therefore, I was stuck with a needle about 15 times just for the one leg. There was definitely more pain from more needle sticks. Also, the chemical agent being injected into the vein burned and hurt sometimes, but only for a few seconds. Obviously, I was left with more sore wounds after sclerotherapy despite it being a less invasive treatment.
I also did experience pain due to blood that was trapped in closing veins (from sclerotherapy injections). At follow-up visits, the doctor retreated any veins that remained open and told me that the swelling, heat, and pain I was experiencing were normal side effects while the vein closes.
As time went on, a few of the closed blood vessels felt like a firm cord, just under my skin. Some of these closed veins left a temporary “staining” on my skin. Although a common side effect, this occurs because a small amount of red blood cells leak into the surrounding tissue and skin, slightly darkening the skin color.
I had no complications from the thermal ablations, other than bruising and soreness.
This type of sclerotherapy does not use ultrasound guidance. At my very last appointment, a nurse was able to treat any last spider veins that were visible under the skin. Spider veins and varicose are similar in that they are both caused from a weakening of the vein walls and valves. However, spider veins are usually less than 1 mm in diameter, can appear blue or red, usually don’t cause pain, and are generally harmless to your health. Treatment of spider veins is almost always considered cosmetic and is usually not covered by insurance.
Again, this was an office visit where the nurse simply looks for spider veins and injects the same type of sclerosing agent or medication/chemical solution that was used previously, but does not use an ultrasound. It’s simply done by sight.
I was sent home with numerous bandages on my legs, instructed to wear my compression stockings, continue taking walks, and take pain meds if necessary.
As with all medical procedures, there is a risk involved to both thermal ablation and sclerotherapy varicose vein treatment. These include:
This was obviously my main concern, since I was having two huge veins closed on each leg. However, these were superficial veins and not the deep veins that are below muscles or along bones. When these large superficial veins are closed after the treatment, blood is automatically rerouted through other veins in the body. Over time, the closed vein simply gets absorbed by the body.
During my varicose vein treatment, my legs were attended to one at a time. So I’d have all the work done on one leg before starting the other. I have to say that after just one thermal ablation on my first leg, I could feel a difference, mostly when I was exercising. During a workout on an elliptical machine, I realized that my right leg felt significantly lighter. I couldn’t believe it! I never knew my legs felt heavy, until noticing it after one leg’s treatment. Once both legs were completely treated, that heavy feeling in my legs and feet went away and my cardio activities became slightly easier.
Obviously, there is a cosmetic benefit to getting rid of these varicose veins, but I am happier that the blood flow in my extremities is ‘normal’ again!
Gone is the heaviness to my legs and feet at the end of day, as well as the tightness in my calves. I would say I’ve had an 80% improvement in my restless legs. I am so incredibly grateful I went and sought help when I found that bulge. Little did I know my legs were such a mess!
According to my vein physician, anytime my legs start to feel heavy/sluggish or when I just want to follow up on my progress, I should call the vein clinic back to have another ultrasound on both legs. Because varicose veins are part of a chronic, recurring, and progressive condition, there is always the possibility that there will be new varicose veins or new problems in existing veins. Therefore, it’s critical to follow-up with your doctor on a regular basis.
I can’t encourage readers enough to see a vein specialist if they are experiencing any of the same symptoms I did. It’s crazy to believe that my body wasn’t functioning properly and any symptoms from it I attributed to getting older and doing too much. Sometimes we must notice even the slightest signs of trouble from our bodies. Your health depends on it!
One piece of advice I’d recommend is to have these procedures done in the winter, if possible. I had this done throughout last summer and I had to wear compression stockings for many days in a row. Having to wear the super tight stockings, as well as pants to cover them, made the summer temperatures harder to bear.
If you’ve experienced varicose vein treatment, please leave a comment. I’d love to hear from you!
To Your Health!
veinclinics.com, veinhealth.com.au/standard-sclerotherapy, premierveinandvascular.org/blog/radiofrequency-ablation-vs-laser-ablation, evtoday.com/articles/2010-mar/endovenous-thermal-ablation-of-the-anterior-accessory-great-saphenous-vein
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