Treating Vein Disease with Foam, Radiowaves, and Lasers
Vein treatment has changed dramatically in the past 20 years, says Danielle Bajakian, MD, a vascular surgeon at Columbia, but many patients still delay getting treatment.
“Because vein diseases are hereditary for the most part, a lot of patients delay their treatment because their mom or their grandmother had a procedure that required a prolonged hospital stay or had a lot of pain afterwards, and they remember those things,” says Bajakian, assistant professor of surgery at the Vagelos College of Physicians and Surgeons and director of the Columbia Vein Program.
“But most treatments that I offer for venous patients are office-based procedures that do not require an operating room, they don't require anything other than local anesthesia, and most don't even require an incision.” Most of the time, Bajakian can treat patients with laser therapy, radio frequency therapy, or sclerotherapy, which injects foam or another solution into veins to shrink small veins.
"Knowing that you can have procedures done in 20 minutes and really only need to block off time for a few office visits makes it a lot more appealing.”
Here are five things to know about vein diseases and treatment options in 2021:
Symptoms can be subtle sometimes.
“For some patients, it's obvious, and the things to look for are big ropy veins in the legs, varicose veins, and leg swelling or ankle swelling that’s worse at the end of the day. Dark pigmentation and a lot of spider veins around the ankles are easy ways to figure out if you have venous disease.
“However, some more subtle symptoms are leg heaviness or leg fatigue. It's typically worse at the end of the day or after you've been standing for a long time, sometimes combined with a little ankle swelling. Restless legs at night can be an early diagnosis of that type of problem. Some people also develop itchy dry skin around their ankles. These are all vague signs and symptoms that often get ignored.
“Think about people who stand for long shifts without moving around a lot: physicians, medical workers, pharmacists, retail workers, cashiers, chefs. That’s who tends to get these symptoms, and they often ignore them thinking heavy legs are normal after a long day.”
Standing for prolonged periods of time can lead to vein issues.
“The most common problem is superficial venous insufficiency, and I describe it as leaky valves in the veins. Since the veins are what bring blood from the feet back up to the heart, they have to work against gravity. So, your calf muscles pump the blood up these one-way valves that are supposed to close so that the blood doesn't flow back down again.
“When your valves are leaky, there’s a lot of increased pressure, which is one of the things that causes the heavy, achy, tired legs.
“In addition, fluid starts seeping out and people get ankle swelling. And sometimes tiny branches of the vein start serving as outflow valves, and that's where the varicose veins come from.”
Exercises and compression stockings can help.
“For good vein health, I always tell my patients to continue with exercise. And that doesn't have to be anything complicated. Walking a couple times a day is really helpful. Walking or exercising helps your veins bring blood from the feet back up to your heart.
“Trying not to stand or sit too much without moving around is really helpful. Elevating your legs at the end of the day, which helps gravity drain all that fluid from your legs, gives a lot of symptom relief.
“Lastly, compression stockings! The ones they make today are not the ugly ones our grandparents used to wear. They’re more breathable, easier to wear, better fabrics and technology.”
The pandemic has led vein symptoms to emerge.
“Exercise, walking around, and being active compensates for vein problems, whether we know about them or not. I frequently see patients in the office who have significant vein problems, but they're asymptomatic because they're so active.
“In the pandemic, because the gyms closed, because people are working from home, they're not as active. And a lot of people have gained weight.
“I've been seeing more and more patients who have had these types of vein problems for a really long time, who only now are symptomatic. They're confused as to why they've had varicose veins for 10 years, but only now are they having issues. I've been treating a lot more vein disease in the last three or four months than I have previously.”
Vein disease often needs long-term attention.
"It’s a common misconception that once you treat a vein, you're done for life. Vein disease is an ongoing chronic pathology. I see a lot of my patients for years and years because it can be a progressive disease.
“The benefit of seeing a surgeon like myself is that we address a thorough variety of vein problems and assess if the patient has other underlying pathologies. Many of my patients come in to have their veins treated, but I’ll find spinal problems, neurologic problems, sometimes even arterial problems.”
Danielle Bajakian, MD, is board-certified in vascular surgery and also directs the Critial Limb Ischemia Program at Columbia.