Varicose Veins

Varicose Vein Causes

Enlargement of veins close to the skin are called varicose veins (varix from the Latin for vein - usually twisted and swollen). Heredity predisposition plays a large role in the formation of these unsightly veins of the legs. If you closely questioned your relatives you'd almost surely find an ancestor or two with similar problems.

Hormonal effects play another contributing role in the formation of these abnormalities. Increased levels of estrogen (and progesterone during pregnancy) cause a dilatation of normal veins. In pregnancy, the enlargement of these veins is in response to the increased total blood volume that the fetus demands. Interestingly, the varicose veins of pregnancy almost always revert to normal size within 6 months post-partum. That is one of the reasons our office strongly advises against surgery during this time. As a rule our patients are placed in support hoses for the duration and undergo surgical therapy during pregnancy exclusively for an occasional case of phlebitis (inflammation of an individual vein).

However, if there is a positive family history for varicose veins, there is a very real chance that your veins will not come back to normal following pregnancy. At that time a referral to our office is indicated.

Men also develop these varicose veins but, being men and usually wearing pants, tend not to "self-refer". We see about 3 women for every man in our office with these varicosities. Again, heredity plays a very strong role in the formation of these bulging and painful veins. Injury from work or sports is another contributing factor.

Varicose Vein Symptoms

SIGNS are what you and the surgeon can see on physical examination. SIGNS of vein (venous) disease consist of small spider veins, blue green veins under the skin, larger ropey, bulging veins (varicose) which can be raised above the skin or visible and/or felt.

If these veins are left untreated, they can lead to increased SYMPTOMS with long term ramifications such as skin erosion causing ulcers (Venous Stasis Ulcers).

SYMPTOMS are what you, as the patient, can FEEL. SYMPTOMS of venous disease are many and varied. Venous disease may be present without symptoms and only presenting because there are SIGNS on physical examination. Common symptoms are: pain, burning, stinging, itching, heaviness, aching, swelling, redness, skin changes, spontaneous bleeding, leg cramps and restless leg syndrome.

Some symptoms are reduced by exercise, elevating the limbs, applying cool or warm heat and medications such as Advil or Tylenol and compression/support stockings. Vein disease symptoms can be made worse with sitting and/or standing for prolonged periods, premenstrual, pregnancy, exercise and walking/stair climbing. Leg cramps and restless leg syndrome can disrupt sleep cycles.

Treatment options for Varicose Veins

Laser Treatment (Endo-Venous Laser Ablation)
Endo Venous Ablation (Inside Vein Elimination)

This vein treatment is for non-functioning (INCOMPETENT) deeper veins. The most common veins treated are the Large Saphenous Vein and the Small Saphenous Vein. It can also be used to treat incompetent branches of these veins if indicated. The procedure is done in our office under a special type of local anesthesia and takes approximately 45 – 60 minutes. If this procedure is combined with MICROPHLEBECTOMY (removal of large surface varicose veins) it may take a little longer.

A small laser fiber is inserted into the vein to be treated and positioned using state-of-the-art Duplex Ultrasound. These are not incisions but rather, small punctures which leave little or no marks when healed. As the laser is activated, the heat produced seals the vein from the inside. The patient experiences no pain during this procedure. When this is done, the blood is no longer able to "pool" in the non-functioning vein and is returned to the heart through other healthy veins. A very light dressing is applied and a compression stocking after the procedure and then the patient is encourage to walk around to promote circulation. The stocking is worn for 3 – 4 weeks depending upon lifestyle.

Patients are able to return to work and most normal activities within two days. In some cases, patients are able to work the next day.

DORNIER 940 Diode Laser

The DORNIER 940 Laser system is a highly advanced system that physicians are using throughout the world to quickly and SAFELY treat the cause of painful and unsightly varicose veins.

This system is used in the ENDOVENOUS LASER TREATMENT (ELT) which is FDA approved. This is the procedure of choice compared to vein "stripping" of the past (which is a procedure performed in hospital, usually with general or spinal anesthesia and a painful and extended recovery period. Scarring is often associated with stripping.)

ENDOVENOUS LASER TREATMENTS are quick (usually about 45 minutes), one time and minimally invasive with little or no marks. Patients are able to return to most normal activities within a day or two. Walking is encouraged immediately after the procedure and for the recovery time.

DORNIER is a leader in the market of lasers for ELT for treatment of incompetent veins

Microphlebectomy

Micro (small) Phleb (vein) Ectomy (removal). This is a wonderfully successful approach to the removal of large painful, unsightly varicose veins. It is performed in the office under a special types of local anesthesia while the patient is awake and alert. A small nick is made in the skin and the vein removed with a fine surgical hook. The "incision" is similar blowing up a balloon. If you write on the balloon and deflate it, the writing is very small. Hence quite large veins are removed through tiny nicks with an excellent cosmetic result as well as relief from symptoms associated with larger varicose veins.

This procedure is often done in conjunction with EVLA (Endovenous Laser Ablation) for deeper vein malfunction.

Medical Compression Stockings

Our center recommends medical grade compression for all procedures whether spider vein, varicose veins or venous insufficiency. All of the staff in our vein center are certified fitters for Bauerfeind and Sigvaris hosiery to ensure your comfort, support and to maximize your treatment. We carry a range of hose for different treatments. If you are a candidate for endovenous ablation or micro-phlebectomy our hose will be worn by patients before and after treatment. Many insurance plans require a trial of medical compression before approving medically necessary vein treatments.

Sclerotherapy and laser treatments are enhanced by wearing compression stockings for a short period. Many people will then go into a more fashionable hose for maintenance especially when working in fields where they stand or sit for extended periods, travel by car or air frequently or just like they way their legs feel at the end of the day. Our experienced staff will assist you with the correct size and style for your particular vein treatment. We recommend Bauerfeind and Sigvaris medical compression hose for effective compression, style and comfort.

Stripping and Ligation

For over 100 years, the only treatment for varicose veins was 'Stripping and Ligation". This procedure was (and still is) performed in hospitals under general anesthesia. Blood loss during the procedures was significant.

Often there was a lot of severe pain for a prolonged period of time (4 – 6 weeks) during which the patient was unable to work or carry out most activities of daily living.

Scarring was common due to multiple larger incisions made the entire length of the leg. Many people suffered from nerve damage and later had a recurrence of their varicose veins and symptoms.

Sclerotherapy (injection) of Larger Varicose Veins

Some patients underwent "injection of sclerosing solutions" into larger varicose vein and also deeper non-functioning (incompetent) veins.

This procedure is also still performed today in some areas. This therapy can be associated with blood clots or collections necessitating repeated trips to the office for drainage.

Another complication can be loss of the skin overlying the areas treated. This treatment is often ineffective due to the size of the veins and the poor contact made between vein wall and the injected solution.

More Information About Varicose Veins

• Varicose Vein Common Questions
• Varicose Vein Before and After Pictures
• Insurance Coverage
• Initial Consultation