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Varicose Veins: Achieving Optimal Outcomes With Minimally Invasive Therapies

  • Authors: Robert A. Weiss, MD
  • CME Released: 5/26/2011
  • Valid for credit through: 5/26/2012, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for dermatologists, plastic surgeons, vascular surgeons, obstetricians/gynecologists, family and general practitioners, and phlebologists.

The goal of this activity is to review the available treatments for varicose veins, with a focus on minimally invasive procedures.

Upon completion of this activity, participants will be able to:

  1. Review the pathophysiology and risk factors for the development of varicose veins
  2. Outline the available treatment options for varicose veins
  3. Compare the risks, benefits, and side effects of available sclerotherapy agents for small varicose veins, reticular veins, and telangiectasias


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  • Robert A. Weiss, MD

    Associate Professor, Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland


    Disclosure: Robert A. Weiss, MD, has disclosed the following financial relationships:
    Served as an advisor or consultant for: BionichePharma Inc.; CoolTouch, Inc.; Cynosure; Lumenis, Inc.; Medicis Pharmaceutical Corporation; Merz Aesthetics, Inc.; Solta Medical-Aesthera; VNUS Medical Technologies
    Served as a speaker or a member of a speakers bureau for: Allergan, Inc.; CoolTouch, Inc.; Cynosure; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Lumenis, Inc.; Palomar Medical Technologies, Inc.; Solta Medical-Aesthera; Zeltiq Aesthetics, Inc.
    Owns stock, stock options, or bonds from: CoolTouch, Inc.
    Served as an investigator for: Cynosure; Eleme Medical; Fibrocell Sciences, Inc.; Galderma Laboratories, L.P.; Lumenis, Inc.; Medicis Pharmaceutical Corporation; Palomar Medical Technologies; Revance Therapeutics; Solta Medical-Aesthera; UltraShape; Zeltiq Aesthetics, Inc.

    Dr. Weiss does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

    Dr. Weiss does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.


  • Gina K. Kaeuper

    Freelance medical writer, Knoxville, Tennessee


    Disclosure: Gina K. Kaeuper has disclosed no relevant financial relationships.


  • Elizabeth Samander, PhD

    Scientific Director, Medscape, LLC


    Disclosure: Elizabeth Samander, PhD, has disclosed no relevant financial relationships.

  • Kristin M. Richardson

    Senior Scientific Director, Medscape, LLC


    Disclosure: Kristin M. Richardson has disclosed no relevant financial relationships.

  • Jane Lowers

    Senior Scientific Director, Medscape, LLC


    Disclosure: Jane Lowers has disclosed no relevant financial relationships.

CME Reviewer(s)

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


    Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Peer Reviewer

Disclosure: The peer reviewer has disclosed no relevant financial relationships.

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    Medscape, LLC designates this enduring material for a maximum of 1.75 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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Varicose Veins: Achieving Optimal Outcomes With Minimally Invasive Therapies

Authors: Robert A. Weiss, MDFaculty and Disclosures

CME Released: 5/26/2011

Valid for credit through: 5/26/2012, 11:59 PM EST



Varicose veins are an extremely common medical concern, with documentation of the condition and various interventions dating back thousands of years.[1] They are often unsightly, and cosmetic concern is "the most common reason patients seek consultation."[2] Beyond their appearance, varicose veins are associated with numerous health concerns because they are the visible surface manifestation of some degree of venous insufficiency syndrome. Patients may present with symptoms ranging from aches and cramps to visible ulceration and hemorrhage.[3,4] Even very small varicose veins may be of more than cosmetic concern because the outward signs of venous disease often do not match the significance of the underlying pathology.

Historical records document the universality of the condition as well as early attempts at surgery; stripping and cauterization; compression therapy; and sclerotherapy.[1] Trendelenburg's description of ligation of the great saphenous vein in the late 1800s established the technical foundation for the modern approach to venous surgery.[1] Technical advances in the early 1900s solidified the role of sclerotherapy in the treatment paradigm,[1] and continued research has led to increasingly successful and satisfying outcomes.

As in most areas of medicine, the treatment of varicose veins continues to evolve toward increasingly less invasive interventions. Less invasive therapies are associated with a number of benefits, including reduced treatment time, lower costs, fewer serious side effects, and improved treatment efficiency. These benefits, however, must be balanced against efficacy. Sclerotherapy is a minimally invasive yet effective option for the treatment of smaller varicose veins and is annually reported as one of the most popular cosmetic procedures, ranking seventh overall according to the 2010 American Society for Aesthetic Plastic Surgery's statistics for cosmetic procedures.[5]

In order to achieve optimal outcomes with sclerotherapy, the physician must have a comprehensive understanding of venous disease and the range of available interventions, including the benefits and limitations of each. With the recent approval of polidocanol, it is an opportune time to review the best uses of available sclerosing agents as well as the assessment, treatment, and follow-up strategies that generate the best outcomes. In addition, the increasing study and use of lasers and light therapy for the treatment of telangiectasias warrants a review of these therapies, especially as a helpful adjunct following sclerotherapy.

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