Three new options show promise for varicose vein treatment, physician says

National report - Three new methods of treating varicose veins appear to offer better outcomes for patients, along with fewer side effects than traditional treatments including surgery.

Robert Weiss, M.D., associate professor of dermatology at Johns Hopkins University in Baltimore described the new treatments - endovenous 1,320 nm laser, radiofrequency occlusion therapy and foamed sclerotherapy.

Traditionally, the predominant wavelength used for treating leg veins was 1,064 nm or the Nd: YAG.

Now, the CoolTouch Endovenous Laser System (1,320 nm Nd: YAG) and radiofrequency (RF) occlusion therapy allow physicians to remove large veins without surgery with a single treatment. Using a small tube inserted into the vein, the 1,320 nm infrared energy creates heating which contracts the vein wall collagen, thus occluding the vein. Both the RF and laser leave only one needle puncture and the procedure can be performed under local anesthesia in an office setting in less than an hour.

Radiofrequency endovenous occlusion is a minimally invasive substitute for ligation and stripping. To date, more than 50,000 closure procedures have been performed with 90 percent efficacy and low adverse event rate.

Just approved by the Food and Drug Administration (FDA), the major advantages of the endovenous laser is that unlike the other laser wavelengths used for endovenous, the 1,320 nm wavelength is not absorbed by hemoglobin. The mechanisms of this system technology are the same as RF.

"What this means for the patient is that there is no blood absorption," Dr. Weiss says. "Because varicose veins are irregular, you can sometimes get little pockets of blood. When other lasers hit that pocket, the vein can rupture. This (new device) translates to no more vein ruptures or perforations."

The rate of post-op bruising and pain is low, and patient satisfaction rates are high.

In addition, the endovenous laser with 1,320 nm has a lower overall incidence of side effects compared to surgery, so patients can resume normal activity immediately after the procedure in most cases.

"Two years of data suggests a very high success rate - better than stripping surgery - when performed properly," Dr. Weiss says.

To date, about 300 cases have been reported.

Advantages of foamed sclerotherapy

Dr. Weiss also discussed new uses of foamed sodium tetradecyl sulfate or foam sclerotherapy for reticular and telangiectatic complexes (lateral venous system).

"Basically, you 'fluff up' the solution with air, which is a special technique," he says. "That allows you to treat larger leg veins, blue leg veins with many fewer treatments because the foam displaces blood but doesn't get dissolved by the blood ... it makes better contact with the vein wall which gives a more uniform sclerosis or fibrosis of the vein wall, which is what we're trying to achieve with sclerotherapy."

Clinical test results of foam sclerotherapy have shown that the majority of patients (82.6 percent) achieved greater than 50 percent improvement after the first treatment. Follow-up treatments with foam however "have potential to increase side effects and should be used cautiously," Dr. Weiss tells Dermatology Times.

In addition, he has found that sclerotherapy treatments on telangiectasia are best performed with glycerine 72 percent.

Dr. Weiss has performed about 4,000 treatments using the foam procedure over the past two years, and "each year, we gain more experience and confidence that this is the way to go," he says. "Now we are sure of it."

Before performing any of these leg vein treatments, Dr. Weiss says dermatologists should follow three simple steps.