By J. Gordon Wright, MD, FACS, RVT, Founder of Midwest Vein Centers

"Because varicose veins are extremely prevalent and because they affect a younger, more productive segment of the population, the public health impact of varicose veins is significant."

Varicose veins and chronic venous insufficiency are two very common diseases. According to the Edinburgh Vein Study, (a large population based study published in 1999) approximately 33% of men and women aged 18-64 years have lower extremity varicose veins[i]. This agrees with two other large population based studies[ii], [iii] done in the 1960s and 1970s, and also agrees with the impression of any seasoned clinician – that varicose veins are a very common disease. By comparison, in the same age range of 18-64 years, coronary artery disease has a prevalence of less than 7% and cancer has a prevalence of less than 4%.

Although varicose veins are not as serious as coronary artery disease, their impact on the general population is significant. Because varicose veins are extremely prevalent and because they affect a younger, more productive segment of the population, the public health impact of varicose veins is almost as significant as the public health impact of coronary artery disease[iv].

Despite the significant impact that varicose veins have on the general public’s quality of life, most patients have poorly informed, unrealistic opinions regarding the treatment of varicose veins, and often do not seek medical advice until they reach the point of end-stage CVI with venous stasis dermatitis, chronic brawny edema, phlebitis, hemorrhage, and/or ulceration. Many patients formulate their opinions about the treatment options based on hearsay and family legend, and are unaware of the recent advances that have revolutionized the treatment of varicose veins and CVI.

THE ENDOVENOUS REVOLUTION

Without doubt, the most important advance in the treatment of patients with VV and CVI in the last hundred years has been the development of endovenous thermal ablation techniques to treat the saphenous system and its major branches.

This technique (which is clearly illustrated on the Midwest Vein Center’s website at http://www.midwestvein.com/ treatments_elt.html) is quick, leaves no scar, and is very effective. The procedure is the natural extension of two medical “Mega Trends” from the last few decades: less invasive surgery, and catheter based techniques to treat blood vessels from the inside (so-called endoluminal techniques). Endovenous techniques have essentially no downtime. Patients come to the office after work and return to work the next morning. This is radically different from vein stripping, which (in my opinion) are now toally antiquated procedures that should not be performed except under extraordinary circumstances.

DONE IN THE DOCTORS OFFICE

Another major advantage is the ability to perform this procedure in the doctor’s office under a straight local anesthesia with no oral or IV sedation. Patients truly appreciate the ease of having procedures done in an office-based setting, which is more private, personal and comfortable than having the procedure done in the hospital or surgi-center. Furthermore, the patients love the fact that they can drive themselves home immediately after the procedure. At first (in the mid 1990s) many physicians were performing endovenous obliterations in the hospital or surgi-center with IV sedation and cardio-pulmonary monitoring. Since the new millennium, however, most physicians have been performing these procedures in their offices. Recently, physician reimbursement is heavily penalized for performing this procedure in a hospital or surgi-center outside the office.