Less-Invasive Treatments for Varicose Veins

McClatchy Tribune Newspapers

MINNEAPOLIS - Teresa Maruna is on her feet all day in her job as a kidney dialysis technician, so her legs would feel tired in any case. But as someone predisposed to varicose veins, the pain could become excruciating and her ankles would swell to the point that they "seemed not to be ankles anymore."

Maruna, of Lakeville, Minn., is among nearly 40 million Americans with vein disease, most of them women. Over the years, treatment progressed from putting your feet up, to wearing support hose, to vein stripping - removing the enlarged vein from the leg. Now, less invasive treatments are becoming available, notably a laser technique that causes the vein to scar, collapse and be reabsorbed into the body.

"A varicose vein is kind of like a gallbladder," said Dr. Tim Goertzen, a radiologist at the Vein Center of St. Paul Radiology in Eagan, Minn. "It has a function, but when it's not functioning, its removal helps your whole body work better."

Varicose veins are physically painful, but there's also the emotional pain of how unsightly the ropey, twisted veins appear. They're almost always on legs, due to how gravity affects pooling of the blood. Vein disease actually is a leaky blood valve that interferes with the usual healthy flow of blood, which results in weakening or stretching the walls of a vein.

Goertzen said sufferers often ask what they did to cause this. While high heels, obesity and long hours of standing prevent your calf muscles from working as the "pumps" they're designed to be, he said, vein disease is a genetic predisposition, with women three times likelier than men to develop it. Nor is this a modern malady. "Greek sculptures showed varicosities in the veins," he said.

Goertzen, one of six Minnesota doctors who are board-certified by the American College of Phlebology, said physicians are seeing more vein disease as people live longer. He estimated that the Vein Center treats 500 patients a year.

Until about 10 years ago, varicose veins were treated by vascular surgeons who removed the veins, but advances in ultrasound and radiology opened the field of phlebology to others such as Goertzen, an interventional vascular radiologist. St. Paul Radiology ( has become a national training center for doctors wanting to learn the procedure.

"What makes this rewarding is when people have been told it's just something they have to learn to live with, or the treatments would hurt and put them out of commission for days or weeks," Goertzen said.

Maruna, 58, figured her vein disease had been developing over the past 10 years, but as with so many sufferers, she thought that her legs were just tired, that she was getting old. Eventually, though, a vein on her right leg became ulcerated.

At the Vein Center, she underwent a procedure called endovenous ablation, in which a catheter is inserted into the wall of the vein and travels its damaged length, using either a laser or radio frequency to heat the blood, which causes the vein to scar shut. The blood is redirected through healthy veins and the collapsed vein eventually is reabsorbed by the body within about six months.

The outpatient procedure is done with local anesthesia. Four days later, Maruna said, she was back to normal. "I got my ankles back," she said.


  • Avoid standing or sitting for long periods without taking a break.

  • Put your feet up when you can.

  • Move. Take a brisk walk at least three times a week.

  • If you're overweight, lose a few pounds to ease the pressure on your veins.

  • Avoid wearing tight clothes, especially around your waist and groin area.

  • Wear compression stockings if your doctor recommends them.

  • Avoid wearing high heels for long periods.

Source: National Institutes of Health

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