Varicose veins of the legs are common. Dilation of the veins develops over time because of the pressure of the blood, and is made worse by pregnancy, excessive weight, or malfunction of the valves in the veins. Both large and small veins can become dilated. The larger veins lie deeper under the skin, and the smaller veins just under or within the skin itself. Often, it is the smaller veins which are more visible because they are closer to the surface. They can look like bluish or purplish blotches or lines. They may be painless, or there may be some mild aching or burning discomfort which is relieved by elevating the leg or wearing support stockings.
Varicose veins rarely cause significant medical problems. Occasionally they may cause inflammation of the skin or development of sores (ulcers) over the veins. Usually they are just unsightly and uncomfortable. Treatment is not necessary if they don't cause problems. Discomfort can be treated with compression (support) stockings. If this does not work, or if the veins are causing skin problems or cosmetic deformity, surgical treatment may be necessary.
Surgical treatment takes three forms: removal of the veins, vein ablation, or injection (sclerotherapy). Removal of the veins is an outpatient operation which is done for larger varicose veins. Vein ablation is taking the place of vein stripping; it is an office procedure using a flexible catheter inserted into the vein which produces controlled heating and shriveling of the vein. Injection is done in the office for the smaller veins (less than 1/8 inch diameter). It involves using a very fine needle to inject concentrated salt solution into the vein. This causes damage to the inside of the vein, causing it to become inflamed, and to scar up. If it works well, the vein becomes scar tissue, which is invisible under the skin. Sometimes, however, especially with larger veins, the procedure does not work well, and the vein simply clots, and then reopens as the clot dissolves. Often there is some brownish discoloration that develops around the injection site from breakdown of the blood clot. After the injection is done, the leg is wrapped firmly with an ace bandage or a compression stocking, to try to keep the vein empty so it will scar up. It is important to keep the compression dressing on for a few days to give te procedure the best possible chance of working. Several sessions may be necessary if the vein is long, or if there are many areas to be treated.
The risks of injection sclerotherapy are small, but important. First, there is never a perfect cosmetic result. It is impossible to make all blemishes disappear completely. There is often some discoloration of the skin in the area afterward. Rarely, there may be some inflammation of the area of the injection which could lead to a sore or scab appearing there, and subsequent scarring of the skin. Second, the injection may not work because the vein may not clot completely, and may reappear after a time, requiring a second treatment. Third, and very uncommon, the injection may cause phlebitis to spread into the larger veins inside the leg, which could be a serious and even fatal problem if it happens (which is very rare).
It is important to note that most insurance plans do not cover injection sclerotherapy. Also, if the insuror judges that the procedure is being done for purely cosmetic reasons, they may not pay for the operation either. This means that you may be responsible for the costs of the treatment, and you should make sure that you understand about this before going ahead with treatment.
