Skirts and shorts not only allow us to move freely, but they help us deal with the country’s stifling heat. But it's the kind of fashion you avoid when you have legs covered in green, twisted, swollen veins.
“Varicose veins are enlarged, sort of swollen and twisted large veins commonly found on the legs. They are usually visible from just under the skin as those greenish snake-like cords that sometimes have bumps,” says Zaza Limcangco M.D., board-certified dermatologist of the Philippine Dermatological Society.
Veins carry blood from different parts of the body to the heart. When these veins weaken, they can accumulate blood and lead to congestion and clogging, says Regina Grace Buzon-Llorin M.D., associate physician at the Belo Medical Group. “The veins, then, become abnormally enlarged leading to the formation of varicose veins or spider veins.”
If you're looking into getting treatment for your varicose veins, Dr. Limcangco says it is important to undergo a Venous Duplex Scan (basically an ultrasound to see your veins) before anything else. “You can visualize which veins are indeed damaged and work on a treatment plan from there,” she says.
Once you and your doctor have a clearer picture of the state of your veins, you can then decide on a procedure. Here are options your doctor will likely discuss with you.
1. Sclerotherapy Estimated cost: P4,000 a session Sclerotherapy is the most common procedure for varicose veins. “It involves injecting a solution into the vein, causing the walls to swell, stick together, and then seal shut,” explains Dr. Buzon-Llorin. “This stops the blood flow and the vein becomes a scar tissue. The vein should eventually fade. Sclerotherapy is very effective if done correctly, and patients can experience about fifty percent to ninety percent improvement. It does not require anesthesia, and can be done in the doctor’s office.”
“You will feel a very bad cramping in your leg as the solution enters the veins. Then you have to wear medical grade support tights for two weeks to make sure that the solution and veins stay compressed and in place,” says Janet* who has had the treatment in the past. Adds Dr. Limcangco, “Sclerotherapy can require multiple injections. To reduce the discomfort, I ask the patient to take a pain reliever about an hour prior, and I use the smallest needle available, a lot smaller than those used for pedia patients.”
2. Foam Sclerotherapy Estimated cost: P4,000 a session If a patient has larger varicose veins that are not responsive to conventional sclerotherapy, this is the method Dr. Buzon Llorin suggests. “It is a type of sclerotherapythat involves creating a foam out of small volumes of the sclerosing solution, rapidly mixed with a small amount of air,” she explains. “A greater volume of the foam formed from a smaller amount of sclerosingagent can be injected and this could cause intense spasm of the vein.”
3. Radiofrequency Occlusion Estimated cost: P70,000 to P80,000 Jeffrey L. Chua M.D., endovascular surgeon at the Makati Medical Center, explains that during a radiofrequency (RF) occlusion procedure, “the saphenous vein is injected and a catheter is inserted in the vein. Once the catheter is inside, the vein is burned using radio frequency energy.” A special catheter is used, and this “catheter creates energy once attached to a machine.” The machine has a timer, which makes it more exact. With RF, the patient does not need to be confined in the hospital. She only needs to be mildly sedated, and she doesn’t experience scarring or much pain.
4. Endovenous Laser Treatment Estimated cost: P70,000 to P80,000 Dr. Chua says this treatment is “the same as RF, and the energy the machine produces is the same.” However, the laser treatment depends more on the steadiness of a doctor’s hand, which is why he says he prefers RF to the laser procedure.
5. Electrodesiccation Estimated cost: price unavailable This treatment is similar to sclerotherapy, except that the veins are sealed off with an electrical current instead of the injected solution. Dr. Buzon-Llorin says this treatment may leave scars.
6. Surgical Ligation and Stripping Estimated cost: P60,000 to P70,000 In this procedure, Dr. Buzon-Llorin says, “Veins are tied shut and completely removed from the leg. Since the deeper veins are responsible for the circulation of the larger volumes of blood, removing varicose veins, which are more superficial, will not affect blood circulation. Surgery requires either local or general anesthesia and must be done in an operating room on an outpatient basis.”
Dr. Chua explains the procedure further: “The incisions are made in the groin area and below the knee. The long saphenous vein, the main cause of the varicosities, is removed. This needs to be done in the operating room and the patient is given spinal anesthesia or a nerve block. The patient is admitted for at least a day or two.” Recovery might take a while because your body will feel quite sore and tender.
Dr. Limcangco cautions, “Vein replacement or vein stripping is probably the last treatment of choice I would recommend. With so many minimally invasive treatments available now, I would only recommend it when all others have failed, or if the duplex scan shows that this would be the best treatment for the patient. But, of course, with this procedure, success rate is very good.”
7. Ambulatory Phlebectomy Estimated cost: P10,000 to P15,000 A special light source is used to locate the veins in this treatment. Says Dr. Buzon-Llorin, “Tiny incisions are made in the vein, and then with surgical hooks, the vein is pulled out of the leg. This surgery requires local or regional anesthesia. The vein usually is removed in one treatment. The most common side effect is slight bruising. Compared to traditional surgery, ambulatory phlebectomy allows the removal of very large varicose veins, leaving only small scars. Patients can return to normal activity the day after treatment.”
However, Dr. Chua says that with this procedure, “the main problem or cause is not fixed. We do it if the patient doesn’t want major surgery.” He usually recommends this procedure after a patient has already undergone stripping and has developed new veins.
8. Mechanical Chemical Ablasion or MOCA Estimated cost: P50,000 to P60,000 The principle behind this treatment, says Dr. Chua, is similar to sclerotherapy. “But the machine has a device that will create foam and destroy the vein. It irritates the vein and destroys the intima of the vein, or the lining, so that the foam can attach to the vein, better for it to close.”