Vein treatments are rapidly evolving as new technology is introduced.
Less than 20 years ago, the standard treatment for large varicose veins in legs was stripping and ligation. This surgery for the treatment of varicose veins had to be performed in a hospital operating room. It involved deep incisions at the groin and knee, general anesthesia, and a higher risk of complications than newer treatment options.
In the 1980s, the development of duplex ultrasound made it possible to see blood flow through veins in real time. Itsparked a flood of innovation in the field of varicose vein treatment.
Safer and less invasive techniques have been developed and refined every decade since. Let’s look at the latest treatments for varicose veins below.
Advancements in RF Ablation
First approved by the Federal Drug Administration (FDA) in 1999, radiofrequency (RF) ablation uses the heat of radio waves to close and seal varicose veins.
Guided by ultrasound, a vein specialist inserts a radiofrequency catheter — a thin, flexible tube — into the vein to be treated. Next, they inject fluid around the vein to make it contract around the catheter and to insulate surrounding tissue from the heat that is generated. The process is called tumescent anesthesia. The fluid contains numbing medicine to minimize the patient’s discomfort.
Once proper placement is confirmed by ultrasound, the RF catheter is activated and slowly pulled out of the vein, ensuring that the entire vein is destroyed. The body immediately diverts the blood through a healthier vein.
The small incision used to insert the catheter requires no stitches. RF ablation can be performed in a doctor’s office. It’s much safer than surgery and only local anesthesia is needed. Recovery from radiofrequency ablation is much faster and less uncomfortable than recovery from stripping and ligation.
Advancements in RF ablation have improved the quality and speed of vein treatment. Modern catheters are as thin as 2 mm in diameter, further minimizing the incision size and infection risk.
New ClosureFast catheters have overlapping segments to eliminate gaps in treatment, promoting thorough closure of the vein along its length. Changes in the second generation of ClosureFast catheters also allow for larger varicose veins — greater than 12 mm in diameter — to be treated with RF ablation.
Venclose RF ablation catheters offer multiple heat settings in a single catheter, reducing the time the catheter must remain inside the vein by 30%. Both ClosureFast and Venclose have added features designed to streamline and optimize the process of positioning the catheter.
Developments in EVLA
Endovenous laser ablation (EVLA) was approved for use in the U.S. in 2001. It uses the heat of a laser to seal off varicose veins. The procedure is nearly identical to RF ablation, but a thin laser fiber is introduced into the vein instead of an RF catheter. EVLA offers many of the same benefits as RF ablation: short recovery time, fewer side effects, and a low risk of complications.
When it was first introduced, EVLA was more painful than radiofrequency ablation. Technological improvements have significantly decreased bruising and discomfort while maintaining high success rates.
The latest treatment for varicose veins in terms of EVLA feature newer lasers using water-specific laser wavelengths (WSLW), which have been found to cause fewer side effects. VenaCure, for instance, uses a highly effective 1470 nm WSLW laser — as compared to the first EVLA treatments, which used 810 nm lasers.
New jacket-tip fibers keep the laser fiber from making direct contact with the wall of the vein. The end of the fiber is covered with a ceramic or metal coating. Studies have shown that jacket-tip fibers significantly reduce pain and bruising, providing even greater improvement than changing the wavelength alone.
Radial fibers became available around 2008. They are capped with a plastic tip containing a prism that sends the laser out 360° around the side of the fiber. Researchers have found that radial fibers also cause less pain and bruising than bare-tip fibers, with initial success rates of up to 100%.
Improvements in Sclerotherapy
Since the 1980s, sclerotherapy has been the treatment of choice for spider veins. A chemical solution called a sclerosant is injected directly into the spider vein. The solution irritates the lining of the vein, causing the vein to shrivel up. Over time, the remains of the vein are naturally reabsorbed into the body.
Sclerotherapy is even more cost-effective and less invasive than RF and laser ablation. The needles used are so small that no anesthesia is needed. However, the original liquid solutions were not as successful at closing larger varicose veins.
One of the first advances in sclerotherapy was the introduction of foam sclerotherapy. Two syringes are used to mix the chemical solution with air during each injection, creating a consistency comparable to shaving cream. Foam sclerosants more evenly coat the lining of the vein, improving the success rate of sclerotherapy.
In 2013, a microfoam called Varithena received FDA approval for the treatment of large varicose veins. It uses a stronger, prepackaged microfoam chemical solution that eliminates the need to create the foam during injections.
Varithena keeps its bubbles longer than other types of foam and is more effective at covering the walls of larger veins. It is injected with ultrasound guidance and is a safe and effective treatment for varicose veins.
Mechanochemical Ablation (MOCA)
In mechanochemical ablation, a rotating catheter removes some of the lining inside the vein while spraying it with a sclerosant. The damage done to the lining allows the sclerosant to penetrate deeper, making it effective enough to treat larger varicose veins.
ClariVein is the latest treatment for varicose veins in this area of technology. It is a new MOCA device with FDA approval. ClariVein does not require tumescent anesthesia. In a recent study, the average pain score was less than one on a scale of 0–10. However, health insurance does not yet typically cover this treatment, although this could change soon.
VenaSeal is the brand name for a new procedure that uses a medical adhesive called cyanoacrylate to seal off varicose veins. A catheter is guided into the vein, like in radiofrequency ablation, but cyanoacrylate is applied instead of heat. There is no need for anesthesia, so there are fewer side effects and a shorter recovery period. Most patients do not have to wear compression stockings after a VenaSeal treatment.
Exploring Your Options
Technological advances over the decades have transformed vein treatment. Medical experts can provide safer and more comfortable alternatives to surgery.
Consult a vein specialist to discuss the latest treatments for varicose veins in more detail. To find an expert near you, use My Vein Treatment’s vein specialist locator tool.