Varicose Veins and Venous Insufficiency
Interventional Radiology Nonsurgical Outpatient Procedure Treats Varicose Veins
Venous insufficiency is a very common condition resulting from decreased blood flow from the leg veins up to the heart, with pooling of blood in the veins. Normally, one-way valves in the veins keep blood flowing toward the heart, against the force of gravity. When the valves become weak and don't close properly, they allow blood to flow backward, a condition called reflux. Veins that have lost their valve effectiveness, become elongated, rope-like, bulged, and thickened. These enlarged, swollen vessels are known as varicose veins and are a direct result of increased pressure from reflux. A common cause of varicose veins in the legs is reflux in a thigh vein called the great saphenous, which leads to pooling in the visible varicose vein below.
Prevalence of Varicose Veins and Venous Insufficiency
Chronic venous disease of the legs is one of the most common conditions affecting people of all races.
- Approximately half of the U.S. population has venous disease--50 to 55% of women and 40 to 45% of men. Of these, 20 to 25% of the women and 10 to 15% of men will have visible varicose veins.
- Varicose veins affect 1 out of 2 people age 50 and older, and 15 to 25% of all adults.
Risk Factors
- Age
- Family history
- Female gender
- Pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of varicose veins.
Symptoms
Symptoms caused by venous insufficiency and varicose veins include aching leg pain, easy leg fatigue, and leg heaviness, all of which worsen as the day progresses. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms. In more severe cases, venous insufficiency and reflux can cause skin discoloration and ulceration which may be very difficult to treat. One percent of adults over age 60 have chronic wounds known as ulcers.
People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.
Diagnosis and Assessment
Varicose Vein Treatments
Minimally Invasive Vein Ablation Treatment
This minimally-invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh. Then laser or radiofrequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed.
Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.
Benefits of Vein Ablation Treatment
- The treatment takes less than an hour and provides immediate relief of symptoms.
- Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
- No scars or stitches - because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.
- High success rate and low recurrence rate compared to surgery.
- The success rate ranges for vein ablation ranges from 93 - 95 percent.
Insurance
Many insurance carriers cover the vein ablation treatment, based on medical necessity for symptom relief.
Surgical Treatment of Veins
Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures. One study found a 29% recurrence rate after ligation and stripping of the greater saphenous vein, and a rate of 71% after high ligation. These recurrence rates are similar to those reported in other studies.
Second Opinion
Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.
Additional Treatments for Varicose Veins
Ambulatory Phlebectomy
A minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.
Injection Sclerotherapy
Can also be used to treat some varicose and nearly all spider veins. An extremely fine needle is used to inject the vein with a solution which shrinks the vein.
Ultrasound-guided Sclerotherapy
Involves an interventional radiologist passing a thin tube called a catheter into the vein using ultrasound guidance and injecting substance that causes the veins to scar and close - rerouting the blood to healthier veins. The affected vein forms a knot of scar tissue that is absorbed by the body over time.
Source: http://www.sirweb.org/patients/varicose-veins/
Nonsurgical Treatments for Male Infertility Caused by Varicoceles
A varicocele is a varicose vein of the testicle and scrotum that may cause pain, testicular atrophy (shrinkage) or fertility problems. Veins contain one-way valves that work to allow blood to flow from the testicles and scrotum back to the heart. When these valves fail, the blood pools and enlarges the veins around the testicle in the scrotum to cause a varicocele. Open surgical ligation, performed by a urologist, is the most common treatment for symptomatic varicoceles. Varicocele embolization, a nonsurgical treatment performed by an interventional radiologist, is as effective as surgery with less risk, less pain and less recovery time. Patients considering surgical treatment should also get a second opinion from an interventional radiologist to ensure they know all of their treatment options. You can ask for a referral from your doctor, call the radiology department of any hospital and ask for interventional radiology or visit the doctor finder link at the top of this page to locate a doctor near you.
Prevalence
- Approximately 10 percent of all men have varicoceles - among infertile couples, the incidence of varicoceles increases to 30 percent
- Highest occurrence in men aged 15-35
- As many as 70-80,000 men in America may undergo surgical correction of varicocele annually
Symptoms
Pain – aching pain when an individual has been standing or sitting for long periods of time and pressure builds up on the affected veins. Typically, painful varicoceles are prominent in size.
Fertility Problems – There is an association between varicoceles and infertility. The incidence of varicocele increases to 30 percent in infertile couples. Decreased sperm count, decreased motility of sperm, and an increase in the number of deformed sperm are related to varicoceles. Some experts believe that blocked and enlarged veins around the testes, called varicoceles, cause infertility by raising the temperature in the scrotum and decreasing sperm production.
Testicular Atrophy – Shrinking of the testicles is another sign of varicoceles. Often, once the testicle is repaired it will return to normal size.
Varicocele Diagnosis
Diagnosis is fairly simple through either physical or diagnostic examination.
- Typical on left side of scrotum
- Visual physical exam - scrotum looks like a "bag of worms"
- Testicle can shrink in size / atrophy
- When varicoceles are not clearly present, the abnormal blood flow can often be detected with a noninvasive imaging exam called color flow ultrasound or through a venogram - an X-ray in which a special dye is injected into the veins to "highlight" blood vessel abnormalities
Varicocele Treatments
Currently there are two treatment options for men with varicoceles: Catheter-directed embolization or surgical ligation
Catheter-directed Embolization
Catheter directed embolization is a non-surgical, outpatient treatment performed by an interventional radiologist using imaging to guide catheters or other instruments inside the body. Through mild IV sedation and local anesthesia, patients are relaxed and pain-free during the approximately two-hour procedure.
For the procedure, an interventional radiologist makes a tiny nick in the skin at the groin using local anesthesia, through which a thin catheter (much like a piece of spaghetti) is passed into the femoral vein, directly to the testicular vein. The physician then injects contrast dye to provide direct visualization of the veins so s/he can map out exactly where the problem is and where to embolize, or block, the vein. By using coils, balloons, or particles, the interventional radiologist blocks the blood flow in the vein which reduces pressure on the varicocele. By embolizing the vein, blood flow is re-directed to other healthy pathways. Essentially, the incompetent vein is "shut off" internally by preventing blood flow, accomplishing what the urologist does, but without surgery.
Efficacy of Embolization for Varicoceles
Embolization is equally effective in improving male infertility and costs about the same as surgical ligation. Pregnancy rates and recurrence rates are comparable to those following surgical varicocelectomy. In one study, sixty percent conceived who were treated for infertility.
In another study, sperm concentration improved in 83 percent of patients undergoing embolization compared to 63 percent of those surgically ligated. Patients who underwent both procedures expressed a strong preference for embolization.
Recovery Time
- Average of one to two days for complete recovery for embolization, compared to two to three weeks for surgery
- 24 percent of surgical ligation patients required overnight hospital stay, compared to none for embolization
Benefits of Interventional Radiology Procedure
- No surgical incision in the scrotal area
- Effective as surgery, as measured by improvement in semen analysis and pregnancy rates
- Less recovery time-patients are able to return to normal daily activities immediately and without hospital admittance
- A patient with varicoceles on both sides can have them fixed simultaneously through one vein puncture site, compared to surgery, which requires two separate open incisions
- No general anesthesia
- No sutures
- No infections
- Cost-effective
Surgical Treatment of Varicocele
After the patient receives anesthesia, an incision is made in the skin above the scrotum, cutting down to the testicular veins, and tying them off with sutures. Although patients leave the hospital the same day, there is a two- to three-week recovery period.
Source: http://www.sirweb.org/patients/varicoceles/
