Venous insufficiency is a condition where the veins in your legs do not allow blood to flow back up to your heart as efficiently as they should. This can cause a variety of symptoms like leg pain, swelling, varicose veins, and skin changes. If you have been diagnosed with venous insufficiency, you may be wondering if you need surgery to treat it.
What is venous insufficiency?
Venous insufficiency occurs when the valves inside your leg veins stop working properly. Healthy veins have a series of one-way valves that prevent blood from flowing backward and pooling in your legs. When these valves become damaged, blood can leak back into your veins and collect in your lower legs, causing swelling and pressure.
Some common causes of venous insufficiency include:
- Family history of weak vein valves
- Pregnancy
- Obesity
- Prolonged standing
- Blood clots
- Varicose veins
- Previous leg injury
As venous insufficiency progresses, it can lead to serious complications like skin ulcers, bleeding, and permanent leg discoloration. That’s why it’s important to get an accurate diagnosis and appropriate treatment.
What are the symptoms of venous insufficiency?
Some common signs and symptoms of venous insufficiency include:
- Aching, throbbing, muscle cramping, or heaviness in the legs – This discomfort is often worse at the end of the day or after prolonged standing
- Swollen ankles and legs – Fluid buildup causes noticeable swelling, often worse in warmer weather
- Varicose veins – Rope-like, bulging veins become visible under the skin’s surface, often on the thighs or calves
- Itchy, discolored skin – The lower legs may itch and the skin can take on a reddish, brownish or purple discolored appearance
- Venous eczema – A condition that causes red, scaly, itchy skin on the lower legs
- Restless legs syndrome – An overwhelming urge to move the legs when resting, especially at night
- Leg ulcers – Open sores that won’t heal, usually around the ankles
Symptoms tend to get gradually worse over time if venous insufficiency is left untreated. See your doctor right away if you notice any persistent leg pain, swelling, sores, or skin changes.
How is venous insufficiency diagnosed?
Your doctor can use several tests to evaluate your leg veins and blood flow. Common diagnostic tests include:
- Medical history and physical exam – Looking for signs and symptoms of venous insufficiency. Your doctor will check for varicose veins, swelling, skin changes, and leg ulcers.
- Duplex ultrasound – Uses sound waves to create images of the veins in your legs. This checks the structure of your veins and blood flow.
- Venography – An X-ray of the leg veins using a contrast dye injected into the blood vessels.
- Plethysmography – Measures blood volume changes in the legs at rest and after exercising.
- CT or MRI scan – Advanced imaging tests to pinpoint a blockage or other abnormality in the leg veins.
Based on your test results, your doctor can determine if you have venous insufficiency, how severe it is, and the best treatment options.
What are the treatment options for venous insufficiency?
There are several ways to treat venous insufficiency. The options include:
- Compression stockings – Elastic stockings that squeeze the legs, improving blood flow and reducing swelling.
- Leg elevation – Keeping the legs raised above heart level to promote downward blood flow.
- Exercise – Movement helps pump blood through the veins.
- Weight loss – Dropping excess pounds takes pressure off the veins.
- Medications – Drugs like diuretics can reduce fluid buildup and swelling.
- Sclerotherapy – Injecting a chemical into varicose veins to shrink them.
- Endothermal ablation – Using heat to seal off and collapse varicose veins.
- Vein stripping – Removing problematic surface veins through tiny incisions.
- Venous bypass – Rerouting blood flow around blocked veins.
Mild cases can often be managed with conservative treatments like compression stockings and leg elevation. But more severe venous insufficiency usually requires a procedure to repair or remove damaged veins.
When is surgery needed for venous insufficiency?
If your venous insufficiency has led to serious complications, your doctor may recommend having a surgical procedure. Surgery is typically advised for venous insufficiency patients with:
- Skin ulcers that won’t heal
- Recurring open sores or infections
- Bleeding under the skin
- Persistent swelling that causes disability or severe pain
- Fatigue, burning, or throbbing pain that lasts for months
- Blocked major veins in the legs
Surgery can help relieve symptoms and reduce the risk of long-term problems when more conservative treatments have failed. Procedures may be done to remove varicose veins, redirect blood flow, or bypass blocked veins that disrupt normal circulation.
What types of surgery treat venous insufficiency?
Some surgical options for venous insufficiency include:
- Sclerotherapy – Small varicose veins are injected with a chemical solution that scars and closes off the veins so blood is rerouted to healthier veins.
- Laser surgery – Laser energy is used to seal off and make varicose veins disappear.
- Radiofrequency ablation – Heat energy generated by radio waves is used to collapse and seal varicose veins.
- Endothermal ablation – Varicose veins are filled with hot steam to wilt and shrink them.
- Vein stripping – Protruding varicose veins are tied off and pulled out through small incisions.
- Ambulatory phlebectomy – Varicose veins are removed through micro-incisions, usually with local anesthesia.
- Vein bypass – Using a vein from another part of your body to reroute blood flow around a blocked leg vein.
These minimally invasive procedures are done on an outpatient basis and require little recovery time. They have high success rates for improving symptoms and appearance.
What factors determine the best surgical option?
The most appropriate surgery depends on factors like:
- The size, location, and extent of your varicose veins
- Your symptoms and how severely they interfere with daily life
- Your general health and medical history
- Your doctor’s expertise with different procedures
- Your personal preferences for treatment
Talk to your vascular surgeon about whether vein stripping, venous bypass, radiofrequency ablation, or another procedure is right for your individual case.
How should you prepare for varicose vein surgery?
Steps to take before varicose vein surgery include:
- Stop taking blood thinning medications like aspirin, ibuprofen, or warfarin for 1-2 weeks beforehand.
- Arrange for someone to drive you home after your surgery.
- Get lab tests as directed to ensure you’re healthy enough for surgery.
- Follow your doctor’s recommendations for eating, drinking, and medication the night before surgery.
- Make plans for time off of work or other duties for recovery.
- Arrange for someone to help you with daily activities while recovering.
It’s also a good idea to stock up on comfort items you may want during recovery like pillows, ice packs, loose comfortable clothing, books, etc.
What happens during varicose vein surgery?
The steps of your vein procedure may include:
- You’re given anesthesia to keep you comfortable.
- Your surgeon inserts a thin tube (catheter) into the vein.
- The catheter delivers heat, laser energy, chemical agents, or other methods to collapse and seal the vein shut.
- The sealed vein eventually gets absorbed into surrounding tissue and fades.
- Dissolvable stitches or glue may close the tiny incisions.
- Your leg is wrapped with a compression bandage.
Methods vary somewhat depending on the specific surgery. Procedures take anywhere from 15 minutes to a few hours depending on the extent of the veins being treated. Your doctor will discuss the details with you beforehand.
What is recovery like after surgery for venous insufficiency?
Recovery timeframes vary based on the type of surgery, but you can expect:
- Mild discomfort, bruising, and swelling around treated veins and incisions.
- Wearing compression stockings for 1-2 weeks to prevent blood clots.
- Keeping your legs elevated when possible to reduce swelling.
- Being able to return to most normal activities within 1-2 days.
- Treated veins to fade within a few weeks as they get reabsorbed.
- Visible improvement in varicose veins within 2-3 months.
- Avoiding strenuous exercise and heavy lifting for 2-3 weeks.
Ask your doctor for specific instructions on wound care, bathing, activity, and signs of complications to watch for. Take acetaminophen or other recommended medications as directed for pain. Call your doctor if you experience severe pain, bleeding, fever, pus, redness, or swelling.
What are the benefits of surgery for venous insufficiency?
Benefits of having varicose vein surgery include:
- Reduced pain – Surgery can eliminate the aching, throbbing, cramping leg pain of venous insufficiency.
- Less swelling – Removing problem veins can greatly reduce swelling and fluid buildup in the legs.
- Improved appearance – Varicose and rope-like bulging veins will be removed.
- Enhanced mobility – Symptoms won’t weigh you down so you can be more active.
- Decreased leg fatigue – You’ll feel less heaviness and tiredness in your legs.
- Prevents complications – Surgery can stop venous insufficiency from worsening and causing sores or ulcers.
- Long-lasting results – Vein procedures deliver permanent improvements in most patients.
In severe cases of chronic venous insufficiency, surgery can provide life-changing relief from debilitating symptoms.
What are the risks associated with varicose vein surgery?
Potential risks and complications include:
- Bleeding or bruising at the incision sites
- Wound infection
- Damage to nearby nerves
- Blood clots
- Deep vein thrombosis
- Recurrence of varicose veins
- Changes in skin color around treated veins
Scarring and nerve damage are uncommon with minimally invasive techniques. Discuss the specifics risks of your surgery with your doctor.
How much does varicose vein surgery cost?
According to the American Society of Plastic Surgeons, the average cost of varicose vein treatment is:
- Sclerotherapy – $376 per session
- Laser ablation – $933 per leg
- Vein stripping – $1,705 per leg
However, costs can range widely based on your provider, insurance coverage, and the complexity of your case. Many policies cover some procedures to treat varicose veins and venous insufficiency. Check with your insurance company about your specific benefits.
Conclusion
Venous insufficiency that causes persistent symptoms or progression can often be corrected with surgery. Procedures like sclerotherapy, ablation, vein stripping, or bypass can relieve pain, swelling, skin changes, and other problematic symptoms. Surgery provides lasting results and can prevent long-term complications. Discuss your options with a vascular surgeon to determine if surgery is appropriate for your individual case of venous insufficiency.