Laser surgery among ways of treating varicose veins

Dear Doctor K: I have varicose veins. For a while, they were just unsightly. But recently, my leg has started to ache. What does treatment involve?

Answer: Varicose veins occur when veins that lie just below the skin’s surface become swollen with too much blood. They usually form in the legs and appear blue, swollen, kinked or twisted.

Veins return blood back to the heart. When you use the leg muscles to walk or run, they also help pump blood up toward your heart. When blood moves upward toward the heart, gravity is pulling the blood downward away from your heart. (That’s not true, of course, if you’re lying flat, or standing on your head.)

To offset the pull of gravity, our veins have multiple little valves inside of them. These valves open when blood is pushed up toward the heart. But they close when blood is pulled downward by gravity, stopping the downward flow.

In a varicose vein, valves don’t close properly and blood gets pulled back down inside the veins. This causes pressure to increase inside the veins, and that results in swelling. The pressure inside the vein also can cause the wall of the vein to break and blood to leak out into the tissues around the vein.

Varicose veins often run in families. Pregnancy, regularly standing for long periods and obesity also increase the risk.

When varicose veins cause symptoms, they often include:

A dull ache, pressure or heaviness in the legs;

Swollen feet and ankles;

Itching skin near the damaged veins.

You can prevent symptom flare-ups by periodically lying down or sitting with your legs elevated above the level of your chest. Also, wear support or compression stockings when you walk or stand for long periods of time. The stockings prevent blood from pooling in the veins and prevent leg swelling and strain on the valves.

A doctor can treat varicose veins with sclerotherapy. This involves injecting an irritating substance into the affected vein, causing it to scar and shut down. Laser therapy can treat the smallest varicose veins.

More severe symptoms may require surgery. One option is vein stripping and ligation. The abnormal veins are tied off and pulled out of the body through small cuts in the skin. (I’ve put an illustration of this procedure on my website, AskDoctorK.com.)

Another outpatient surgical procedure, ambulatory phlebectomy, also removes veins through small skin incisions. It is performed under local anesthesia (you are awake). It involves smaller incisions, and therefore smaller scars. You can walk right after the procedure is over but need to wear compression stockings. Another new treatment uses laser or highfrequency radio waves to seal off abnormal veins.

These treatments can relieve symptoms, but they don’t guarantee that new varicose veins won’t develop in the future. Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.