By Thomas E. Rembetski, MD

Varicose veins, or dilated veins in the lower extremities, are an affliction that has bothered man- and womankind for generations. Unsightly veins afflict up to 25 percent of all women and 18 percent of men. In addition to appearance concerns, typical complaints from patients with varicose veins are pain, swelling, achiness, heaviness and, occasionally, ulceration or thrombosis.

Traditional treatment methods have involved support stockings and even surgical intervention with stripping of the affected veins. Surgical stripping involves removal of the affected veins while the patient is under general anesthesia. Though the procedure is effective, recovery often is slow and debilitating.

Recent techniques for obliterating affected veins from inside the vessel, otherwise known as endoluminal techniques, have evolved. One technique involves passing a catheter into the affected vein and delivering energy via radiofrequency to seal the affected vein. A newer technique, endovenous laser treatment (EVLT), involves a similar procedure using a laser to seal the vein. The laser energy damages the vein walls, shrinking them and thus closing the faulty vein so blood no longer can flow through it.

This laser technique has several advantages. For the appropriate patient, the procedure can be done in an office under local anesthesia with some preoperative sedation. The patient is awake and comfortable during the procedure and can walk immediately afterward. Postoperative recovery is rapid, and patients, often within a day or two, feel quite well with minimal bruising or lingering effects.

For a patient to be a candidate for one of the procedures, his or her ultrasound should show that the greater saphenous vein, the large vein in the lower leg, is unable to function properly, resulting in symptoms such as those mentioned above. Loss of this vein presents no problem; with many veins in the leg, blood in the faulty veins will be diverted after treatment to normal veins and return to the heart.

Thomas E. Rembetski, MD

Current application of this office-based technique is being broadened to veins in the back of the legs, the lesser saphenous veins. Often, the smaller tributaries off the lasered greater saphenous veins will disappear, although occasionally "touchup" procedures involving limited work on those veins can be necessary.

Individuals who think they may be a candidate for the newer laser technique should see a primary care physician who can order an ultrasound and, if appropriate, make a referral to a vascular surgeon.

Thomas E. Rembetski, MD, is a vascular surgeon with Premiere Surgical Specialists in Reno. For an appointment or more information, please call 324-0288.

Northern Nevada Medical Center 2375 E. Prater Way, Sparks, NV 89434 775-331-7000