By LAURA JOHANNES
Wall Street Journal
July 22, 2008; Page D2
If varicose veins are ruining your summer, zapping them with a laser is an option. Companies that sell lasers to treat varicose veins say they can fix the problem with little pain and a short recovery. Physicians say the machines are very effective at reducing pain from veins, but it is often necessary to get additional procedures to achieve a satisfactory cosmetic result.
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Varicose veins are gnarled, enlarged veins, commonly found on the back of calves or inside of the legs. They are generally caused when valves leak and allow blood to flow backward. Besides being ugly, varicose veins can cause aches and discomfort in your legs and even lead to ulcers.
Traditionally, they’ve been treated by a surgery called ligation and stripping, in which the veins are tied off to redirect blood, then completely removed. It’s usually done under general or spinal anesthetic.
Laser surgery typically lasts less than an hour and can be done in a physician’s office, where a local anesthetic is used to numb the leg. A laser tip is inserted into the skin through a tiny needle puncture and the heat from the laser closes the leaking vein, forcing blood into other veins. Typically, the procedure completely seals the great saphenous vein, a large vein that runs down the inside of the leg. (Most of the blood flow in the leg is through hidden veins deep inside, so losing this vein usually isn’t an issue.)
According to a 111-patient study published earlier this year in the British Journal of Surgery, laser therapy was as effective as surgery in improving quality of life, but had faster recovery. Laser-surgery patients returned to normal activities in a median of two days, compared with a week for the surgery group, the study found. The study was funded by the distributor of a laser that is being sold in the U.S. by Angiodynamics Inc., of Queensbury, N.Y.
Compared with “vein stripping, there is less pain in the thigh and less bleeding,” says Richard Fowl, chairman of the department of surgery at the Mayo Clinic in Scottsdale, Ariz.
You will feel some pain or tenderness, and some people have bruises where the area was treated. One laser maker, Cool Touch Inc. of Roseville, Calif., says its laser causes less pain and bruising than rival models, but Angiodynamics says it hasn’t seen any evidence of a difference, and that if there is one, it is minor.
The cost of laser treatment varies, but typically ranges from $1,800 to $3,000 or more a leg. It is often covered by insurance, but many insurers require you to first attempt to control the problem by wearing tight stockings called compression hose.
The compression hose can bring relief of symptoms, but the beneficial effect goes away when you stop wearing them, says Douglas Joseph, an associate staff physician at the Cleveland Clinic who specializes in vascular medicine. Laser surgery removes the source of aching legs and “typically patients are very satisfied,” he adds.
But if you are primarily concerned about the appearance of your legs, you may be disappointed if you get just the laser. About 80% of patients will still have visible veins even after laser surgery, says John E. Golan, assistant professor at the Feinberg School of Medicine at Northwestern University in Chicago.
For this reason, many physicians will offer to perform a simultaneous phlebectomy, in which problem veins are removed through small incisions. That gets rid of the big ugly veins, but if you still have smaller spider veins, you can return for sclerotherapy, a minor procedure involving injecting a chemical into the veins, which scar and then eventually fade away.