Varicose veins in the legs - the blue, bulging, kinked veins that are often seen on the back of the calf or on the inner leg - are not simply a cosmetic issue. They are the symptom of a circulatory problem that will continue to worsen unless properly treated, according to Marc Borge, M.D., a radiologist at Loyola University Health System.

The small superficial veins near the surface of the legs are the ones that can become varicose when the valves inside the larger draining veins (saphenous veins) fail. In a healthy vein, the one-way valves keep blood flowing upward toward the heart. If the valves are weak, blood flows backward and pools in the veins. Along with the visible signs, some people experience persistent itching, swollen ankles and feet and aching legs that can make standing for long periods difficult. In severe cases, the skin becomes dry, hard and discolored, and open sores may form.

"The problem usually starts at the top of the leg and progresses down as each ineffective valve puts additional stress on the valve lower down," explained Alpa Chandarana, M.D., a radiologist at Loyola University Health System.

Twenty-five million Americans suffer from the problem, called superficial venous reflux. By the time they are in their 60s, 72 percent of women and 42 percent of men will experience symptoms. Women and people over age 50 are at greater risk, as are women who have been pregnant, people who stand for long periods and people who have a family history
of the disease.

For mild symptoms, a primary care physician may recommend standing less and elevating the feet at intervals, or prescribe special compression stockings. As the disease progresses, the only effective, lasting solution is treatment of the incompetent saphenous vein. The most common surgical procedure to treat saphenous vein incompetence is known as vein stripping. The entire saphenous vein is removed by way of small incisions at the groin and knee with a mechanical device called a stripper. Subsequently, the patient's blood is diverted to other veins deeper in the leg that usually do not have valve problems.

A newer treatment called endoluminal saphenous vein obliteration - which was approved by the U.S. Food and Drug Administration in 1999 - accomplishes the same goal but with a quicker recovery time and fewer complications. The procedure is performed by an interventional radiologist on an outpatient basis. The physician makes a single, quarter-inch incision near the knee and uses ultrasound technology to guide a catheter into the saphenous vein. Then a probe inside the catheter applies radiofrequency energy to the walls of the vein until it collapses and closes off the circulation of blood.

After the procedure, most patients return to their daily activities in a day or two - compared with a week or more of recovery time after surgery. Patients experience less pain, bruising and infection than is associated with stripping. Studies in the Journal of Vascular Surgery and elsewhere have shown that, with both the surgical and nonsurgical approaches, more than 90 percent of patients experience significant improvement in their symptoms and remain reflux free for years.

For an appointment or to learn more about endoluminal saphenous vein obliteration at Loyola University Health System, call (708) 216-3727.

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