When It's Time to Treat Your Varicose Veins, Consult an Interventional Radiologist

March 22, 2022

An interventional radiologist may not be the first specialist that comes to mind when seeking varicose vein treatment, but there are many reasons why these doctors are uniquely qualified to diagnose and treat problematic veins. Using the vascular system as their workspace, interventional radiologists use tiny tools to navigate through the body's veins and arteries and fix problems wherever they occur.

To perform these intricate procedures inside the body, it's critical to see where you're going, and that's where radiology comes in. Unlike most surgeons, interventional radiologists are trained in both radiology and minimally invasive procedures. "We're experts in imaging, and many minimally invasive procedures utilize imaging," says Dr. Vladimir Sheynzon, assistant professor of radiology at Columbia University Irving Medical Center. He and his colleagues are board-certified radiologists who use MRI, fluoroscopy, ultrasound, and CT to guide many different procedures that treat everything from varicose veins to tumors.

When it comes to problematic veins, imaging techniques are used both to diagnose the problem and treat it. "Patients come in because they have visible veins above the knee or below the knee or both," says Sheynzon, describing what most people commonly think of as varicose veins. "Many have other symptoms as well." Varicose vein symptoms can include leg heaviness, swelling, fatigue, and pain, which get worse with standing, walking, or simply at the end of the day. They can also cause bleeding, changes in skin color, or a skin breakdown called venous ulcers.

These symptoms can indicate a more serious problem, says Sheynzon.

Varicose veins occur in what's called the superficial venous system, or the veins that lie near the skin of the leg. They are caused by faulty valves in the vein, which are there to help blood move against gravity and up towards the heart. "It's like the locks in the Panama Canal," says Sheynzon. "The valves open and close to prevent blood from seeping down toward the ankle." When the valves leak, blood pools in the veins, eventually causing them to swell or become "varicose".

The good news is that superficial veins are expendable, because there's another, deeper vein system that will take over once a superficial vein is removed. However, the same set of symptoms can also indicate a problem in the deep vein system, such as a blood clot, which is potentially much more serious.

That's why a vein consultation begins with an ultrasound to check the deep vein system, says Sheynzon. Ultrasound uses sound waves to create images of structures in the body, which radiologists can evaluate in real time. "Once we've ruled out a blood clot, we move on to look at the valves in the superficial veins."

The most common treatment for varicose veins used by interventional radiologists is called endovenous laser ablation treatment, or EVLT for short. Through a tiny nick in the skin, a catheter containing a tiny fiber optic probe is guided to the affected vein. The probe then transmits laser energy to vein, causing it to close and eventually be reabsorbed by the body. 

Ultrasound is used to guide the entire process. "It's all done with local numbing medication, and it's very safe and effective," says Sheynzon.

Most people find their way to Sheynzon and his interventional radiology colleagues through a referral from another physician. But, he says, patients are welcome to schedule a consultation on their own. With imaging at the heart of varicose vein evaluation and treatment, he adds, interventional radiology patients benefit from an additional level of expertise they can't find elsewhere.