Facts & Questions
Veins are the blood vessels that return blood to the heart from the body. To overcome the force of gravity, one-way valves inside the veins open to allow blood flow to the heart, and close to prevent “reflux” of blood back to the feet. When these valves fail to function, or if the vein is damaged so the valves do not completely close, blood can begin to pool in the vein and cause a variety of vein complications due to congestion and pressure build-up.
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 are usually a sign of hidden disease in the underlying veins in the legs.
Varicose veins are the large, “rope-like” surface veins which can grow to ¼” or larger in diameter. Varicose veins often grow in size and length over time and can result in substantial pain and complications if not treated. They are also usually caused by underlying vein disease.
Depending on the type and stage of vein disease, there are many different treatments. Your physician can explain all of the options. The following are common treatments performed for vein disease:
Compression Stockings For minor pain from varicose veins, compression stockings may be beneficial. The compression stocking or hose will assist the leg in the pumping of blood back to the heart. While the vein disease symptoms may be relieved, compressions stockings will not make the varicose veins go away.
Sclerotherapy Used commonly for spider veins and small varicose veins, sclerotherapy involves injecting a small volume of a 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 a physician’s office and no anesthesia is required.
Surgical Stripping and Ambulatory Phlebectomy Historically, the only treatment for large varicose veins had been to surgically remove or ‘strip’ the vein from the body. Although now nearly obsolete, surgical stripping is done in an operating room under anesthesia and requires a considerable recovery period for the patient. More recently, a modified version of stripping knows as ambulatory phlebectomy has grown in use and is patient- preferred. In this minimally invasive version of surgical stripping, multiple small incisions are made under local anesthesia to hook and remove the vein one portion at a time. More incisions are made than in standard vein stripping, but the damage to the leg and post-surgery recovery time are minimized.
Radiofrequency Ablation and Laser Ablation Therapies In the last two decades, the use of heat provided through radiofrequency coils and lasers have become the preferred alternative to surgical stripping to treat varicose veins. With both techniques, a thin laser fiber is inserted into the diseased vein, generally through a small puncture in the leg. After delivering a local anesthesitic, the physician then delivers radiofrequency or laser energy through the fiber which causes the vein to close as the catheter is gradually removed, similar to heat-sealing a package. These procedures are usually performed in a physician’s office in less than one hour, and the patient is encouraged to walk immediately following the procedure.
Patients should wait at least three months after pregnancy or major surgery before being treated for vein disease. Persons with a new deep vein thrombosis, and patients who cannot ambulate for other reasons may not be good candidates for treatment. Conservative management options are available.
Because there are many veins in the leg, the blood that would have flowed through the closed vein simply redirects and 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 sleep. Eventually, varicose veins can lead to open sores or nonhealing wounds and tissue loss on the lower legs. They are also associated with slow flow in the legs that can lead to blood clots.
Fortunately, sclerotherapy and endovenous ablation therapies have rarely been associated with serious complications when properly performed and the post procedure discomfort is usually minor. Common minor complications of these procedures include bruising, mild redness, numbness, tenderness, and tightness in the treated leg for a few days to up to two weeks after the treatment.
Most insurance companies cover the treatment of vein disease that is associated with substantial pain and other complications, but individual insurance companies may limit the types of therapy that are covered.
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 heaviness, cramping, aching, burning, itching, swelling, soreness, restlessness or “tired” legs, especially in the lower portions of the legs. If you experience these symptoms, your physician can quickly and easily perform a test to determine if you have vein disease.
Vein disease of the legs is one of the most common medical conditions. Approximately 80-100 million people have some form of vein disease. Varicose veins affect between 15-25% of all adults, and approximately 50% of all people over age 50. Women have a higher incidence of vein disease than men.
The single most important cause of vein disease is heredity. Approximately 70-80% of all patients with varicose veins have a parent 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 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 but can lead to progression.
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