Veins are the blood vessels that return blood to the heart from the body. To overcome the force of gravity, inside the veins are one-way valves which open to allow blood flow to the heart, and close to prevent “reflux” of blood back to the body. When these valves fail to function, or if the vein is damaged so the valves do not completely close, blood can begin to pool, flow backward, or reflux in the vein and cause a variety of vein complications. An abnormal circulatory condition with decreased return of blood from the leg veins up to the heart, with pooling of blood in the veins is called venous insufficiency.
Spider veins are the small, thread-like colored veins that are most often seen on the surface of the skin. While many people seek treatment for spider veins for cosmetic reasons, spider veins also can result in substantial discomfort requiring therapy.
Varicose veins are the large, “rope-like” veins which are often 1/4” or larger in diameter that have lost their valve effectiveness
as a result of dilation under pressure. Varicose veins generally grow in size over time and can result in substantial pain and complications if not treated.
The most common symptoms caused by venous insufficiency and varicose veins include aching pain, easy leg fatigue, leg heaviness, cramps, restlessness and swelling of the legs all of which worsen as the day progresses. Many people find they need to sit down in the afternoon and elevate their legs to relieve these symptoms. In more severe cases, venous insufficiency and reflux can cause skin discoloration and ulceration which may be more difficult to treat. One percent of adults over age 60 have chronic ulceration.
Chronic venous disease of the legs is common. Approximately half of the U.S. population has venous disease – 50 to 55% of women and 40 to 45% of men. Of these, 20 to 25% of the women and 10 to 15% of men will have visible varicose veins. Women have higher incidence of vein disease than men. Varicose veins affect 1 out of 2 people age 50 and older, and 15-25% of all adults. People without visible varicose veins can still have symptoms. The symptoms can arise from spider veins as well as from varicose veins, because, in both cases, the symptoms are caused by pressure on nerves by dilated veins.
Risk factors include age, family history, female gender and pregnancy. In women, pregnancy, especially multiple pregnancies, is one of the most common factors accelerating the worsening of varicose veins.
Fortunately, most vein disease can be seen by looking at the size and color of the vein at the skin surface. In some cases, however, the diseased vein may be deeper in the body and not visible through the skin. As a result, paying close attention to other symptoms is important in diagnosing vein disease. Many patients with vein disease experience cramping, aching, burning, itching, soreness or “tired” or “restless” legs, especially in the calf muscles. If you experience these symptoms, we can quickly and easily perform a test to determine if you have disease.
We use duplex ultrasound to assess the venous anatomy, vein valve function, and venous blood flow changes, which can assist in diagnosing venous insufficiency. We map the greater saphenous vein and examine the deep and superficial venous systems to determine if the veins are open and to pinpoint any reflux. This helps us determine if you are candidate for a minimally invasive treatment, known as Endovenous Laser Vein Treatment.
Depending on the type and stage of vein disease, there are many different treatments. During your initial free consultation, we can explain in detail all of the options. The following are common treatments performed for vein disease:
For minor pain from varicose veins, a compression stocking may be beneficial. The compression stocking will assist the leg in the pumping of blood back to the heart. While the vein disease symptoms may be relieved, compression stockings will not make the varicose veins go away.
Used commonly for spider veins and small varicose veins, sclerotherapy involves injecting a small volume of liquid into the diseased vein. The sclerosing liquid acts upon the lining of the vein to cause it to seal shut, eliminating the vein completely. Sclerotherapy is quickly performed in our office and no anesthesia is required.
In the past, the only treatment for large varicose veins was to surgically remove or ‘strip’ the vein from the body. Surgical stripping is done in an operating room under anesthesia and requires a considerable recovery period for the patient. Surgical stripping has now become an outdated procedure because it is very invasive and yields extremely poor results. More recently, a modified version of stripping known as Ambulatory Phlebectomy has grown in use.
In this version, multiple micro-incisions are made to hook and remove the vein one portion at a time. Although more incisions are made than in standard vein stripping, the damage to the leg and post-surgery recovery time are greatly minimized and the poor results associated with standard vein stripping are now a thing of the past. Ambulatory Phlebectomy is minimally invasive and yields excellent results.
In the last few years, the use of lasers has become an accepted alternative to surgical stripping to treat varicose veins. This minimally invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, we inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guide it up the great saphenous vein in the thigh. We then deliver laser energy through the fiber which causes the vein to close as the fiber is gradually removed. This heats the vein and seals the vein closed.
Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow. Endovenous Laser Therapy can be performed in less than one hour, and the patient is encouraged to walk immediately following the procedure.
The treatment takes less than an hour and provides immediate relief of symptoms. You can return to normal activity immediately with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers. There is no scar, because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip.
Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures.
To date, the industry shows a 93% success rate. Over the last six years we’ve treated thousands of patients with a 100% success rate at our clinic. The efficacy rate is much higher than surgical ligation or stripping.
Because there are many veins in the leg, the blood that would have flowed through the closed vein simply flows through other healthy veins after the procedure. The loss of the diseased vein is not a problem for the circulatory system.
Varicose veins generally worsen over time. Initially, slight pain and restlessness in the diseased leg will be felt. If untreated, this pain will increase and result in limitations in walking and cramps during sleeping. Eventually, varicose veins can lead to open sores on the foot, blood clots and tissue lost.
The single most important cause of vein disease is heredity. Approximately 70% of all patients with varicose veins have parents with the same condition. Pregnancy, especially multiple pregnancies, is a contributing cause of vein disease. Other factors influencing vein disease are age, obesity and jobs which require long periods of standing.
Generally no. If you have a family history of vein disease, there is nothing you can do to change your genes. Being overweight can accelerate the progression of vein disease, and long periods of standing can also add to the problem. Diet and footwear are generally believed to be irrelevant in the formation of vein disease.
Fortunately, Sclerotherapy and Endovenous Laser Therapy have rarely been associated with any serious complications when properly performed. Common minor complications of these procedures include bruising, mild itching, tingling, tenderness and tightness in the treated leg for up to two weeks after the treatment.
Patients should wait at least three months after pregnancy or major surgery before being treated for vein disease. Persons with deep vein thrombosis or incompetence, and patients who cannot ambulate for other reasons are not good candidates for treatment.
Most insurance carriers will consider coverage for venous insufficiency treatments, based on medical necessity for symptom relief.