By Laura Landro

For patients with varicose veins, a number of new less invasive treatments are replacing a difficult surgical procedure known as stripping that was often the only solution in the past, according to the Health Matters column in today?s Next section.

Growing in popularity are lasers and radiofrequency ablation to destroy veins, which cost $2,500 to $3,000 per procedure, compared with about $1,200 to $1,500 for surgical stripping, according to the American American Society for Dermatologic Surgery . While patients may have to pay out of pocket for any procedures that are strictly for cosmetic reasons — varicose veins can be unsightly in some cases without being painful or dangerous ? there is increasing recognition that varicose veins can cause serious complications such as bleeding veins, leg swelling and dangerous leg ulcers, making it more likely that insurers and the federal Medicare program will cover treatment as ?medically necessary. This is especially true if more-conservative treatment ? such as the use of compression stockings ? has failed, and if symptoms of varicose veins significantly affect daily living.

Suresh Vedantham, professor radiology and surgery at Washington University School of Medicine and vice president of the Venous Disease Coalition, tells the Health Blog that 70% to 80% of patients who seek treatment for varicose veins have ?life-impairing, significant symptoms? such as swelling, fatigue and burning symptoms that interfere with activity. ?Only a minority come in for strictly cosmetic reasons,? Dr. Vedantham says, and many who wait too long for treatment present with permanent skin changes, open sores and other problems ?that are very challenging to treat.?

An injectible drug, polidocanol, sold under the brand name Asclera and approved for use in the U.S. last summer, costs about $250 to $500. but it is used primarily for smaller spider veins that appear on the face as well as the legs, and for smaller reticular veins on the legs, as opposed to larger saphenous veins that can cause the most significant problems for patients.

Though the exact cause of varicose veins isn?t known, they develop when one-way valves in the veins that prevent the blood from flowing backward stop working properly, so blood pools in the superficial veins under the surface of the skin and causes them to get larger and less elastic.

Robert Weiss, a past president of the ASDA who heads the of the Maryland Laser, Skin and Vein Institute in Baltimore, says that when stripping was the only option ? pulling the veins out with a wire inserted in the skin through an incision ? many patients went untreated for fear of the procedure. when they hit their 60s, Dr. Weiss says, such patients often ended up with chronic venous disease, with valves in their leg veins that don?t function properly and impaired circulation of blood in the leg veins.

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