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If you suffer from varicose veins, you’re a member of a very large club. Some 25 million Americans face a daily struggle with the swollen, ropey veins that can cause throbbing pain, severe swelling and heavy, tired legs. The symptoms are sometimes so insidious that patients are unaware of how advanced their disease really is.

Half of all Americans over 50, and two-thirds of women over 60, have the condition. Surprisingly, many have dealt with it for decades because varicose veins can appear even in teenagers too young to vote. Of the 25 million Americans with venous insufficiency, approximately 7 million exhibit serious symptoms such as swelling, skin changes and venous ulcers. It is estimated that in America, 72% of women and 42% of men will experience varicose veins by the time they are in their 60s.

Also known as venous insufficiency, venous reflux disease is a medical condition that affects the circulation of blood in the lower extremities. The tiny valves that normally force blood back up towards the heart no longer function, causing blood to pool in the legs, and the veins of the legs become distended. Ten times more patients suffer from venous insufficiency than peripheral arterial disease in the United States and, although often mistaken as a cosmetic problem, the condition can produce a number of clinical problems for the patient.

Heredity is a factor in venous reflux disease—if your parents or siblings have had varicose veins, you’re more likely to develop them—and people who are obese or have had multiple pregnancies are particularly susceptible because the extra weight adds strain to the veins. Women are more vulnerable to the problem than men partly because the hormonal changes brought on by menstruation, menopause and hormone-based drug therapy can relax vein walls and cause venous reflux.

Lifestyle, particularly physical activity, can affect the odds of developing varicose veins as well. Standing for long hours, as is common with nurses, teachers, waitresses, flight attendants and other service personnel, or regularly lifting heavy objects also increase the risk of venous disease. Venous insufficiency can significantly impact a person’s lifestyle, especially when the person’s job requires extended standing or heavy lifting. Market research indicates that over 2 million workdays are lost annually in the US and $1.4 billion is spent each year on this common medical condition.

Venous reflux disease commonly produces varicose veins, the abnormally swollen and discolored superficial leg veins that affect more than 25 million Americans. Varicose veins can range from small, thin purple lines just under the skin (known as “spider veins”) to thick, bulging veins that can protrude well beyond the skin surface. In any form, varicose veins serve as indicators of venous reflux, a progressive disease that can cause significant circulatory problems as it worsens.

Venous reflux disease never goes away by itself—it’s a progressive condition that can only worsen unless treated. Fortunately, the minimally-invasive, device-based advances in medical technology, which have so profoundly impacted heart, lung and brain surgeries in recent years, are now having a similarly revolutionary impact on the treatment of varicose veins.

In the absence of other symptoms, patients with cosmetic concerns due to the presence of varicose veins may be evaluated with only a physical examination. However, patients presenting with other symptoms of venous insufficiency, such as those listed below, should also undergo an in-depth evaluation, including a duplex ultrasound study:

  • Leg pain, aching, tired or weak legs, especially after long periods of standing or sitting
  • Varicose veins
  • Burning or itching of the skin
  • Swollen legs and/or swollen ankles (edema)
  • Color and texture changes of the skin
  • Open wounds (skin ulcers)

Varicose veins are typically found in the superficial venous system and often involve the main trunk veins—the great and small saphenous veins—as well as tributaries. They are superficial veins that have expanded in response to increased pressure caused by incompetent or absent valves. Progressive vein dilation eventually prevents the valve cusps from closing properly, resulting in reflux. Alternatively, a lack of competent valves can also cause dilation of the vein. As one valve fails, increasing pressure is exerted on each more distal valve until it, too, becomes incompetent.

Swelling of the ankles is the next progressive state of venous insufficiency and occurs as the result of increased pressure in the veins, forcing fluid into the lymphatics and tissues. This can also cause changes in skin pigmentation. Severe pain and discomfort are typical of these conditions, particularly in the lower leg (calf and ankle) where proximity of nerves exacerbates the situation. In addition to superficial involvement, these stages often include some portion of the perforating, or deep vein, systems.

Venous ulcers indicate the most severe forms of venous insufficiency and typically involve both the deep (including perforators) and superficial vein systems. Extreme reflux and venous hypertension result in changes in the microcirculation of the skin, eventually leading to severe ulceration.

Anatomic involvement at these stages generally involves the saphenous system, the perforators and the deep venous system. A smaller subset of the population has deep system-only involvement (<5%) and an even smaller portion perforator-only incompetence.


Radiofrequency (RF) endovenous ablation is a minimally invasive treatment procedure for venous reflux disease, using radiofrequency to heat and seal diseased great saphenous and perforator veins and address the underlying cause of severe varicose veins. The catheter for the treatment of venous reflux delivers radiofrequency energy to a heating element to heat and contract the collagen within the vein walls and cause the shrinkage and collapse of the vessel. Although the word “catheter” can be intimidating, this is done in the office as a simple, fast, outpatient procedure.

The procedure involves inserting the catheter into the diseased vein through a very small incision and threading the device through the vessel up to the groin area. Radiofrequency waves are applied to the heating element in 20-second intervals to sequentially heat and ablate the vein in seven centimeter increments. After each segment is treated, the catheter is manually withdrawn down the vein and the process is repeated until the entire length of the vein has been ablated. The body automatically re-routes blood flow through healthier veins and the restoration of normal circulation relieves the distention of the surface veins. The ablated vein becomes scar tissue and is eventually absorbed by the body.

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