More About Varicose Veins
Varicose veins (or spider veins) are swollen, ropey, gnarled veins that can cause throbbing pain, severe swelling, and heavy tired legs. This medical disorder affects 25 million Americans including one-half of all people over the age of 50 and two-thirds of all women over 60. Most of these people have suffered with varicose veins for decades.
Heredity is the major factor in varicose veins. If your parents or siblings have had varicose veins, then you are more likely to develop them. People who are obese or women with multiple pregnancies are particularly susceptible because the extra weight puts strain on the veins. Women are more prone to develop varicose veins than men, in part because female hormones tend to relax vein walls and contribute to development of venous reflux..
Your lifestyle can also affect your odds of developing varicose veins. People whose career requires standing for long periods of time – nurses, teachers, waitresses, flight attendants, and other service personnel – have a greater chance of developing venous disease. People who do heavy lifting are also at risk.
Once varicose veins – or venous reflux disease – appear, the condition does not go away by itself. The condition is progressive and worsens with time if not treated. In past years, the treatment option was surgical – vein stripping – which required cutting out the diseased veins. Fortunately, medical advances now offer a relatively painless, minimally invasive technique to treat varicose veins in the outpatient setting. You no longer have to live with unsightly swollen veins and the associated pain and tired legs associated with them.
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Symptoms of Varicose Veins
Not all varicose veins cause symptoms. For some, small discolored vessels or minimal leg swelling are the only signs of venous reflux disease. However, for millions of Americans, the symptoms are severe enough to impact quality of life. Throbbing pain, cramping, leg fatigue, muscle cramps, “restless” legs, burning or itching of the skin, and ankle swelling are many of the symptoms associated with venous reflux disease. In advanced serious cases, the venous disease can result in significant skin changes and ulceration. These venous stasis ulcers are located on the lower leg and are very difficult to heal without treating the underlying venous reflux disease. When symptoms like these are present, they can seriously affect the patients’ daily lives causing them to miss work and limit recreational activities. Sufferers complain of being unable to walk, stand, or sit for extended periods without feeling pain or exhaustion.
Venous Reflux Disease
Venous reflux disease, also known as venous insufficiency, is a medical condition that affects the circulation of blood in the lower legs. As the leg muscles contract, blood is “pushed” or pumped back to the heart so that it can be recirculated through the body. To keep the blood flowing in one direction, upward to the heart, there are tiny valves or leaflets that keep the blood from reversing flow back down the legs or refluxing. When these valves become damaged, the blood pools in the legs and the veins become distended.
Venous reflux commonly causes varicose veins, the abnormal swollen and discolored superficial leg veins that affect 25 million Americans. Varicose veins can range from small, thin, purple lines just below the skin (also called “spider veins”) to thick ropey bulging veins that extend well above the skin surface. In any form, varicose veins are indicators of venous reflux, a disease that can cause significant circulatory problems as it progresses.
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Varicose Vein Treatment Options
Vein stripping and ligation is a surgical procedure that involves tying off the varicose veins associated with the main superficial vein in the thigh and then using a specialized tool to physically remove the vessel. This technique is performed in the operating room under general anesthesia. Because of the trauma and bleeding associated with the surgery, there is usually pain, swelling, and bruising, with up to four weeks recuperation before patients can resume normal activities. A 1999 study in the Journal of Vascular Surgery found surgical vein stripping was effective 71% of the time in eliminating reflux disease.
This technique is a minimally invasive procedure that uses a small laser on a tube (catheter) inserted into the vein. When the laser is fired, it heats the blood and vein wall, destroying and sealing the vein. This technique is effective in 9 out of 10 patients in treating the venous reflux disease. However, studies indicate that many patients experience post-procedure pain that can last several weeks. Bruising and discoloration may also result and last several weeks.
Radiofrequency Ablation or VNUS Closure
This technique is also a minimally invasive procedure that involves inserting a thin catheter into the vein. The tip of the catheter delivers radiofrequency energy to the vein wall causing it to heat, collapse, and seal shut. The thin catheter is referred to as a VNUS Closure device. This part of the procedure generally takes less than five minutes and is essentially painless. The success rate of closure of the treated vein is 97% at one year with this device.
Treating Your Varicose Veins
During your initial office visit evaluation, one of our physicians will determine if your leg symptoms are likely the result of venous reflux disease and causing the varicosities. An in-depth ultrasound exam of the venous system of your legs will be scheduled. The ultrasound exam will be performed by an experienced, certified ultrasound technologist who has received special training in evaluating venous disease of the legs. This ultrasound exam is an important part of your evaluation for a number of reasons:
- It maps out the abnormal veins to be treated, some of which cannot be seen on clinical exam.
- It establishes the direction of blood flow in the veins, that is, if abnormal “backflow” is occurring through diseased valves and to what extent.
- It allows our physicians to make sure the deep veins in your legs are open and healthy, which is critical to know prior to treating the diseased superficial veins.
You will be asked to wear special compression stockings for a period of time. This is so-called conservative therapy. These stockings may improve your symptoms while wearing them but does nothing to address the underlying problem, and symptoms inevitably recur once the stockings are removed. Most insurance companies require a trial of stocking wear before they will approve payment for minimally invasive treatment. Once these initial steps have been taken, you will be scheduled for treatment. Treatment is performed in our outpatient office with local anesthesia. The procedure itself usually takes less than an hour. There is usually little discomfort during the procedure and less post-procedure pain and bruising when compared with traditional vein stripping and laser treatment.
Varicose vein disease can be likened to a tree with a larger trunk and smaller branches. Initial treatment involves closing off the main trunk which usually results in the “branches” or smaller varicose veins receding or getting smaller over weeks to months. Additional therapy is sometimes needed to treat persistent varicosities.
Primary treatment is a minimally invasive procedure using the VNUS Closure device. A small nick in the skin of the lower thigh is used to insert a small tube or catheter into the diseased vein under local anesthesia. The tip of the catheter heats the vein wall using radiofrequency energy. Heating the vein wall causes the collagen in the wall to shrink, closing the vein. After the vein is shut, the blood naturally reroutes to the deeper health veins. Studies have shown the VNUS Closure device to be greater than 97% successful at one year followup. Other varicose veins may need to be treated with additional therapy such as sclerotherapy. This involves injecting medication into the vein which irritates the vein wall and also results in its occlusion. Because treatment with closure is minimally invasive and uses a catheter, it results in little or no scarring. Most patients report improvement in their symptoms within one to two weeks of the procedure. Generally patients can return to normal activities immediately after the procedure.