Published in the Lynn Haven Ledger, July 2011
Treating Leg Veins; Everything you Need to Know Article by: Jennifer Clark, PA-C, MPAS
pproximately 60% of American citizens suffer from venous disease. These Americans often complain of heavy, tired, achy legs with possible swelling, numbness, restless leg syndrome, muscle cramps, and burning. Many will develop large, ropey varicose veins and some people even develop skin changes and ulcers. Often times these symptoms can be improved with conservative management such as compression hose, exercise, weight loss, and elevation, however the underlying problem remains, and that is venous insufficiency. We treat this condition now by closing down the problematic vein with a minimally invasive procedure called endovenous ablation. During this procedure, heat produced by a laser or radiofrequency causes the vein to shrink down on itself and it eventually be reabsorbed by the body. By eliminating the vein that is not working correctly, the symptoms go away. This procedure has an excellent result with over 97% efficacy after one year. While this procedure is minimally invasive, there are some potential risks which are important to be knowledgeable of when deciding to pursue treatment. When closing the veins with ablation it is required to insert a catheter into the vein that is heated to provide treatment. There is a risk of penetrating the wall of the vessel by doing this. This can cause a collection of blood underneath the skin called a hematoma which will resolve over time. By using ultrasound to ensure proper positioning of the catheter this can easily be avoided. There are nerves that run in close proximity to the veins in the leg, one of which becomes very superficial towards the ankle, another becomes very close to the vein at the back of the knee. These nerves can be damaged if the ablation is performed too far down the leg or too close to the one behind the knee, which is why these areas are avoided. When the vein closes down after ablation, often the nerves can become irritated and patients may experience numbness to the inner thigh or the back of the calf that usually resolves in one to two months. During the ablation, numbing medicine is injected around the veins to provide anesthesia. After the procedure patients may develop bruising from this that will resolve in one to two weeks. Sometimes the treated vein can become inflamed, a condition known as phlebitis. The skin may become red and tender to the touch with what feels like a knot directly under the surface. This often resolves with warm compresses, anti-inflammatory medications, and elevation. And, with any procedure there is a risk for developing an infection. We use sterile technique which makes this risk very low. One very serious complication is the formation of a clot in the deep veins of the leg, also known as a DVT or Deep Vein Thrombosis. The national risk for DVTs after ablation is about 3%. Hormone replacement therapy and oral birth control pills can increase this risk, therefore by following recommendations to discontinue these medications 4-5 days prior to treatment can help reduce likelihood of clot formation. We also recommend avoiding physical inactivity after treatment. The development of a DVT is very uncommon, yet a very real concern which is why we recommend a DVT ultrasound several days after ablation treatment to ensure a clot has not formed, and if one has formed then we can initiate treatment promptly. In medicine it is vitally important that our patients have a full understanding of not only their medical condition, but the treatment options and potential complications associated with the recommended treatment. Our goal is to ensure we do everything possible to help our patients make an educated decision about whether or not to pursue endovenous ablation for treatment of venous insufficiency.