Clinical Response to Combination Therapy in the Treatment of Varicose Veins

What does that mean for my veins?

In this research study the physicians compared two different “schools of thought” regarding varicose leg vein treatment – should the varicose veins be treated with a more simple approach where only the main source of the varicose veins is treated, or should this main source be treated plus all of the other visible, “bumpy”, varicose veins?

The answer to this seems obvious – treat all of the veins, right? Well, not necessarily. In most cases the visible varicose veins are branches of a larger vein (usually the greater saphenous vein) where the problem starts because this larger vein has abnormal, “leaking” valves that cause pressure to build on the branch veins, which are the ones you see bulging under the skin. You can think of this as the trunk and branches of a tree – the larger saphenous vein is the “trunk” of the tree, whereas the visible, bumpy varicose veins are the “branches” of the tree.

Conventional wisdom, and a common approach to treating varicose veins, is to only treat the “trunk” vein, usually with an ablation procedure, and then the “branches”, or the bumpy varicose veins will then “deflate” and essentially “go away” just by treating the trunk. This is an attractive concept assuming only one procedure takes care of the whole problem.

In most situations, performing only the ablation procedure is sufficient, but perhaps as many as a third of patients treated with the single ablation procedure continue to have lingering problems with the remaining, untreated varicose veins, and additional treatments can be needed. Because the single ablation treatment isn’t adequate in every patient, another option is to also directly treat the visible varicose vein “branches” at the same time of the ablation procedure of the “trunk.”

You might wonder, after reading this, why don’t you just treat everything all at once in every patient? Well, the counter argument is that not all patients will require all the veins treated since most get the desired results after just treating the “trunk” vein with an ablation, and by treating all of the veins at once, additional procedures, time, expense, and slight risk are performed.

So, what did this research study show? In their comparison of over 500 patients treated at multiple hospitals over a 5-year period, the patients who had all the veins treated (ablation of the “trunk” vein, plus removal or injections of the “branch” veins) had better results – less pain after the procedure and no increase in risk.

What do I think about these results? I must admit that earlier in my practice I followed the more standard practice of just treating the main “trunk” vein with the ablation procedure, and then taking a “wait and see” approach on whether any remaining veins needed to be treated later. I still follow this philosophy for many patients, but more recently I have become a convert to the “fix everything at once” line of thought, especially when the bulging varicose vein “branches” are very large and painful.

I have found that performing the ablation of the “trunk” vein, while at the same time and under only local anesthesia (“numbing medicine” in the skin) all the big, bumpy veins can be safely and painlessly removed through teeny-tiny skin nicks that are covered with butterfly bandages and generally no stitches. Most importantly, I have observed that my patients are happier having everything fixed in one procedure!

Mark R. Jackson, M.D.
Board Certified Vascular Surgeon

* Original article “Clinical response to combination therapy in the treatment of varicose veins” published on December 14, 2019 by authors R. Gregory Conway, MD, MS; Jose I. Almeida, MD; Lowell Kabnick, MD; Thomas W. Wakefield, MD; Andrea G. Buchwald, PhD; Brajesh K. Lal, MD.
Original citation: Journal of Vascular Surgery: Venous and Lymphatic Disorders. Volume 8, Issue 2, March 2020, Pages 216-223

Meet Dr. Jackson

Carolina Vein Care | Vein Specialists in Greenville, SC | Varicose Veins, Spider Veins, Reticular Veins | Team Headshots | Mark R. Jackson, MD

Dr. Jackson then moved to Greenville in 2003 where he has practiced vascular surgery, started the vascular surgery program at St. Francis Hospital which in 2015 was recognized as a HealthGrades Top 50 Hospital in Vascular Surgery. Dr. Jackson has now started a new, independent medical practice with Dr. Julie Park specializing in the treatment of venous disorders such as varicose veins of the legs.