What are varicose veins?

Varicose veins are twisted, enlarged veins, near or raised above the surface of the skin often dark blue in color. Varicose veins are often a symptom of an underlying condition called venous insufficiency.

Varicose veins do not occur suddenly. It usually takes years for symptoms to develop. Varicose veins are commonly inherited, although it is important to note that anyone can get them. Often times varicose veins are common in people that have had certain types of leg injuries or deep vein blood clots. Varicose veins also become more frequent as people work standing still or sitting down. These activities deprive veins of regular circulatory flow of the leg muscle. In healthy veins, one way valves direct the flow of venous blood upward and inward. Blood is collected in superficial small veins and flows into larger veins. The blood eventually passes through valves into the deep veins and then centrally to the heart and lungs. When one or more of these valves fail to function correctly or leaks, some blood flows down the leg, in the reverse direction. The blood tends to overfill and distend the branches of superficial veins under the skin.

Deep veins can withstand this pressure because of their construction and because the surrounding conforming muscle prevents the veins from becoming excessively distended. Over time, this additional venous blood pressure causes the veins to stretch, bulge, and become visible. Continued exposure to high pressure can cause superficial veins of any size to become dilated and twisted.

When valves fail, blood will accumulate under pressure causing swollen, engorged or rope-like veins. These are varicose veins, which are abnormal. These veins have become weakened and fill up with blood. The valves inside these veins no longer close allowing blood to leak back down the leg producing a distention of the vein. Varicose veins are common, affecting mostly women

What are the different treatment options?

• Sclerotherapy is a technique, which involves the use of a very fine needle to inject a solution (sclerosant) directly into the veins. The solution causes the lining of the vein swell, eventually sealing off the blood vessel and preventing blood flow.
  
  Prior to treatment, a complete medical history is taken and a thorough examination made in order to determine, among other things, how long the problem has existed, the severity of the symptoms, whether or not the condition is affected by physical activity, and if there has been prior surgery or treatment of the veins. The physician determines if the deep venous system is affected, in which case surgery may be recommended before sclerotherapy is undertaken. Preoperative instructions may include the elimination of certain drugs, which contain aspirin in order to minimize the possibility of excess bleeding. The physician decides whether or not the area to be treated should be shaved. The veins are usually marked while the patient is in a standing position.
  
  Larger veins are usually treated first. After the skin is thoroughly cleansed with alcohol, the physician uses a syringe with a tiny needle to inject a small amount of sclerosing (hardening) solution directly into a vein. The solution displaces the blood within the vein, causing it to blanch or turn white. The solution then causes the vessel to become irritated and swell shut, prohibiting the blood from reentering the vein. When the needle is withdrawn, pressure is immediately applied to the area. The skin may be kneaded to help disperse the solution and reduce bruising. Each vein may require several injections and most disappear in two weeks to two months.
   

• Endovenous laser therapy is a quick, minimally invasive laser procedure is an alternative to vein stripping and leaves no scar, has a short and relatively pain-free post-operative recovery period, and is performed under local anesthesia in the doctor's treatment room. The treatment itself will take less than one hour and initially involves both a physical and an ultrasound examination to map the vein to be treated.
  
  The area of the leg affected is anesthetized locally and a thin laser fiber is inserted into the abnormal vein, delivering the laser energy in short pulses. The laser energy heats the vein causing it to shrink and collapse, preventing blood from pooling.
  
  Walking immediately following the procedure is encouraged and normal daily activity can be resumed immediately. However, strenuous physical activity such as aerobics should be avoided for one week. Patients may experience bruising and soreness for 3-5 days after the treatment. Pain is usually improved by walking or oral pain relief medications.

 We are excited to share that we have achieved spectacular results using this non-surgical alternative to vein stripping surgery.  The obvious advantages to this procedure: 

1)      In office procedure

2)      Done under local anesthesia

3)      Patients can resume activities of daily living and work the next day.

4)      No scarring since there are no incisions, other than one needle mark.

• Until recently, vein ligation and stripping was the standard for treating larger or perforating varicose veins. If the majority of the valves in the vein are healthy, ligation can be used to isolate the faulty valves and the remaining vein may be left in place to continue circulating blood. If the vein is heavily damaged it is usually removed, or stripped. To strip a vein, an incision is made below the damaged vein and the vein is grasped and surgically removed. Most people are able to return to their normal daily and recreational activities within a few weeks. Some common side effects from vein stripping and ligation surgery may include temporary pain or discomfort, bruising, hematoma, numbness, and less frequently wound infection. Vein stripping is an invasive procedure and should not be performed on older individuals for whom surgery poses a risk due to other medical conditions. It is also not an appropriate choice for people who have circulatory problems of the legs, skin infections, blood-clotting defects or an abnormal passageway between and artery and vein. Pregnant women are also inappropriate candidates for vein stripping.

Who should not be treated?
Patients should wait at least three months after pregnancy or major surgery before being treated for vein disease. Patients who have suppressed immune systems, persons with deep vein thrombosis or incompetence and patients who cannot ambulate for other reasons are not good candidates for treatment.

If the vein is closed by the treatment, where does the blood go?
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.

What can happen if varicose veins aren't treated?
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 loss.

What are the complications of vein treatment?
Fortunately, sclerotherapy and Endovenous laser therapies have rarely been associated with any serious complications when properly performed. Common minor complications of these procedures include bruising, mild itching, tenderness and tightness in the treated leg for up to two weeks after the treatment.
Will insurance cover the treatment?
Most insurance companies cover the treatment of vein disease that is associated with substantial pain and other complications. Each insurance company has its own rules for the types of therapy that are covered.

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