These aren't your grandparents' varicose vein treatments

Varicose veins are bulging or swollen, twisted and enlarged veins - most commonly in the legs - visible under the skin, often red or blue in color.

Anyone who remembers a parent, grandparent or other relative suffering from varicose veins back in the 20th century might initially feel a sense of dread if they face the prospect of undergoing treatment themselves — until they hear about the dramatic advances in medical technology that have revolutionized the treatment of varicose veins over the past 20 years.

What was once usually a painful surgical procedure involving days of hospitalization and weeks of at-home recovery and lost work has been largely replaced by a growing selection of minimally-invasive, essentially pain-free, in-office procedures that have patients walking around immediately after their treatments and returning to work the next day.

The results of the new procedures, both medically and cosmetically, have been excellent. The old-style methods typically saw high rates of recurrence and often extensive scarring. Many people with varicose veins once shied away from having the procedure done because of the discomfort and recovery time involved. But today's technologies have removed those fear barriers and taken varicose vein treatment to a whole new comfort level.

Varicose veins are bulging or swollen, twisted and enlarged veins — most commonly in the legs — visible under the skin, often red or blue in color. Normally, one-way valves in your leg veins keep blood moving toward the heart. When the valves don't work properly, blood backs up into the vein, which swells from the buildup, causing varicose veins. Varicose veins affect more women than men. Family history, older age, obesity and pregnancy are among the risk factors for developing varicose veins. Though very common, varicose veins don't cause major problems for many. However, if the flow of blood through the affected veins becomes worse, problems such as leg swelling and pain, bleeding, blood clots, venous ulcers and other skin conditions may occur.

The current-day methods for varicose vein treatment are guided by ultrasound technology and use various minimally-invasive technologies and procedures, including tiny fiber catheters, lasers and sealant solutions that close off problem veins and redirect blood flow through nearby healthy veins. Vein specialists perform the procedures right in the office. Low doses of local anesthesia may be used; patients are fully awake throughout. Most procedures take 60 minutes at most.

The choice of procedures from a growing menu of options depends on the specific nature and extent of a patient's vein condition, as well as the patient's own preference. A combination of different treatments often is used to deliver the best results.

The most common varicose vein treatments today include the following:

- Radiofrequency Ablation. Radiofrequency or microwave energy — which generates heat — is used to close the problem vein, redirecting blood flow to healthy veins, relieving symptoms. A tiny catheter is painlessly inserted into the vein, and the thermal energy causes it to shrink and seal shut.

- Medical Adhesive Closure. A small amount of a specially formulated medical adhesive — or glue — is injected through a small catheter into the problem vein to seal it, rerouting blood to nearby healthy veins.

- Endovenous Laser Thermal Ablation. Pulses of laser light are delivered inside the vein through a small fiber, collapsing and sealing it shut.

- Foam Sclerotherapy. A specially formulated foam solution is injected into a blood vessel through a small catheter to close it. The blood reroutes itself through healthy veins, restoring more normal blood flow.

Ambulatory Microphlebectomy. Tiny, slit-like incisions are made in the skin to surgically (without a scalpel) remove problem veins. The procedure is bloodless and generally painless.

Variations on the same methods used to treat varicose veins also are used to cosmetically treat spider veins, which are smaller than varicose.

Richard M. Basile, MD, FACS, is medical director of the Berkshire Vein Center at Berkshire Medical Center.