New Techniques Rid Legs of Painful Varicose Veins

About 36 million Americans, most of them women, have varicose veins. They are often swollen, blue and lumpy and can be painful. How best to get rid of these veins--which are unnecessary for normal circulation--is hotly debated among doctors.

For years, the standard treatment was stripping surgery, in which large segments of varicose veins are removed through incisions in the skin. Now, doctors have other options, among them sclerotherapy and ambulatory phlebectomy.

Sclerotherapy, which advocates say has improved over years, involves injecting a special solution into the vein to make it collapse and eventually disappear. Jan V. Karlin, director of the Vein Clinics of America, Encino, says sclerotherapy works in almost all cases.

“Sclerotherapy works not only for spider veins (smaller, thread-like clusters), but for the largest varicose veins,” says Karlin. “It turns the veins into scar tissue so blood will not flow through them.”

He explains that sclerotherapy is an injection-and-compression technique--patients usually wear a compression stocking after the injection. The recurrence rate with 15,000 patients, he said, is less than 5% after five years.

Gabriel Goren, director of the Vein Disorders Center in Encino, prefers phlebectomy, a procedure he began doing a year ago.

Ambulatory phlebectomy involves making tiny incisions in the skin and removing short segments of vein. “Ambulatory phlebectomy is tedious but gives exceptional results,” he says.

Small incisions are made under local anesthesia, then special surgical hooks are used to “tease out” the vein. He says there are no stitches and, after three or four months, no scars.

Goren expects a recurrence rate of about 5% after five years. So far, none of the 100 patients he has operated on in the last year has had a recurrence.