Varicose Veins


Description  

Varicose veins are dark purple or blue veins that may appear twisted and bulging – like cords. They commonly appear on the backs of the calves or on the inside of the legs but can form anywhere from groin to ankle.

Varicose veins usually are the result of a breakdown of the great saphenous vein, an internal vein on the inside of the thigh. This breakdown of saphenous vein one-way valves causes leakage of blood in the wrong direction. Blood leaks from the thigh into the calf and pools inside the calf veins. This pooling of pressurized blood causes veins to stretch, bulge, and become varicose. If left untreated, varicose veins can lead to dangerous blood clots or large ulcers inside of the ankle.

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Common Risk Factors

  • Heredity – family history of varicose veins
  • Gender- Women are at a higher risk than men
  • Pregnancy- especially during the late term
  • Obesity
  • Excessive standing and sitting

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Symptoms

Beyond the obvious visible symptoms associated with varicose veins, there are times when varicose veins are deep within the legs, not revealing outward signs. Often varicose vein symptoms are mistaken for other problems.

Signs and symptoms of varicose veins may include:

  • Achy or heavy feeling in the legs
  • Burning, throbbing, muscle cramping in the legs
  • Swelling in the lower legs
  • Legs feel worse after prolonged standing or sitting
  • Itching around one or more veins
  • Skin ulcers near the ankle, which represent a severe form of vascular disease and require immediate attention.

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Tests and Diagnosis:

An initial consultation with a vascular surgeon or trained technician can be conducted to determine if varicose veins are a possible cause for pain or discomfort. At this consultation, patients’ legs are examined and a variety of questions are asked to determine the level of discomfort identified by the patient. Further testing is required to determine the actual presence of varicose veins.

  • Ultrasound – an ultrasound is conducted to determine the size and location of varicose veins.  

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Treatment options

Thanks to endovenous technology, both the saphenous vein and the varicose bulges are easily treated in the office with local anesthesia. Because varicose veins are a medical problem that can lead to complications if left untreated, the treatments are usually covered by most insurance carriers. Fortunately, physicians have many tools to correct varicose veins.

Before and After Gallery

Conservative Treatment
Conservative treatment options refer to a non-invasive form of treatment, where medications and surgery are not used to treat varicose veins. Patients can use self-help measures such as:

  • Eating healthy
  • Exercising more
  • Wearing support hose
  • Wearing loose clothes
  • Elevating legs
  • Avoiding long periods of standing or sitting.

This regimen has proven helpful in reducing leg pain and preventing varicose veins from getting worse. Conservative treatment will not remove existing abnormal veins.

Schlerotherapy
Schlerotherapy is the most commonly used treatment for small varicose veins. This treatment involves injecting a small volume of liquid into the diseased vein, which causes inflammation of the vein walls, as a result the vein walls stick together and collapse. This solution effectively prevents the vein from working and consequently the vein stops carrying blood, and disappears with time. Schlerotherapy usually requires repeated treatments and can cause brown discoloration of the vein that may take up to a year to disappear.

Ultrasound Guided Schlerotherapy
Ultrasound guided schlerotherapy is a procedure used to treat deeper veins that cannot be seen or felt and for larger superficial veins. Using ultrasound, a solution is injected into the veins causing the vein walls to collapse. Compression stockings are then used to make sure that the vein walls remain collapsed. Ultrasound guided schlerotherapy requires expert knowledge that conventional schlerotherapy does not. As larger veins are treated, smaller spider and reticular veins will often disappear.

Some advantages with this procedure include no scarring and the disappearance of smaller veins; however, some patients develop brownish discolorations or allergic reactions. In rare instances, some patients have developed skin ulcers. Ultrasound-guided schlerotherapy is an alternative to vein stripping and endovenous laser treatment.

Microphlebectomy
Microphlebectomy also known as ambulatory phlebectomy is used to treat larger varicose veins that are too big for laser treatment. This procedure involves making tiny punctures or incisions through which the varicose veins are removed with a tiny hook. The incisions are so small no stitches are required. Patients are able to walk following the procedure and scarring is very minimal.

The VNUS Closure® procedure
The VNUS® Closure procedure brings state-of-the-art technology to an age-old disease.

The Closure® procedure is performed on an outpatient basis. Using ultrasound, the physician positions the Closure® catheter into the diseased vein, through a small opening in the skin. The tiny catheter delivers radiofrequency (RF) energy to the vein wall. As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins.

Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. Your doctor may encourage you to walk, and to refrain from extended standing and strenuous activities for a period of time.

Patients who undergo the Closure® procedure typically resume normal activities within a day.

Video available for this procedure
Endovenous Laser Ablation
Lasers used for varicose vein treatment are a preferred alternative to surgical stripping to treat varicose veins. Unlike surgical stripping, endovenous laser ablation permanently closes off the vein while leaving it intact. During the treatment, a thin laser fiber is inserted into the diseased vein, generally through a small puncture in the leg. The physician then delivers laser energy through the fiber, which causes the vein to close as the fiber is gradually removed. This simple procedure can be performed in a physician’s office or an ambulatory setting. It’s minimally invasive, so there is very little risk of scarring and postoperative infection. Normal activities can be resumed immediately following surgery.

Vein Stripping
The rise of laser surgery to remove large varicose veins has made vein stripping virtually obsolete. It is used only medically necessary situations as determined by the physician. To strip a vein, an incision is made in the groin region, the vein is grasped and surgically removed with a small rod. Most people are able to return to their normal daily and recreational activities within a few weeks. Some common side effects from vein stripping may include temporary pain or discomfort, bruising, hematoma, numbness, and less frequently wound infection

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Frequently Asked Questions 

During our patient consultations we noticed a few of the same concerns. To better understand the surgical procedures and recovery process here are answers to some of the most frequently asked questions below.

We do encourage you, however, to call our office and schedule a consultation for a more in-depth understanding of the procedures.

How long will I be out of everyday activities?

There is really no “recovery” to speak of. In fact, you’ll be up and walking as soon as it’s over, able to return to normal activity within a few days with a majority of patients.

How much scarring will I have?

With injection, you will notice no scarring. With microphlebectomy and ELVeS or VNUS lasers, small 1-2 mm incisions will occur, which over time will fade leaving virtually no scarring.

How long will it last?
After treatment of varicose veins with a combination of ELVeS ro VNUS, microphlebectomy and/or sclerotherapy, 80-90% of patients will have no recurrence of varicose.

What are the risks involved with laser surgery?
Risks in treating benign conditions are very rare. Although some patients may experience redness or tenderness, no long-term problems have been discovered as a result of laser surgery in the treatment of veins.

Will my insurance cover it?
Until a physician can adequately assess your condition, it’s impossible to predict insurance coverage; however, typically insurance providers will cover medically necessary procedures. Insurance companies will not cover strictly cosmetic procedures. Our office can assist you in determining the extent of your coverage and we can arrange financing for covered procedures.

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Helpful Links

http://www.vnus.com/vascular-disease/varicose-veins.aspx

http://www.womenshealth.gov/faq/varicose-spider-veins.cfm

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