WHAT
ARE VARICOSE VEINS?
Arteries bring blood from the heart to the extremities, veins, which
have one-way valves, channel blood back to the heart. If the valves
don't function well, blood doesn't flow efficiently. The veins become
enlarged because they are congested with blood. These enlarged veins
are commonly called spider veins or varicose veins. Spider veins
are small red, blue or purple veins on the surface of the skin.
Varicose veins are larger distended veins that are located somewhat
deeper than spider veins.
Pain in the legs is frequently related to abnormal leg veins. Symptoms,
often made worse by prolonged standing, include feelings of fatigue,
heaviness, aching, burning, throbbing, itching, cramping, and restlessness
of the legs. Leg swelling can occur. Severe varicose veins can compromise
the nutrition of the skin and lead to eczema, inflammation or even
ulceration of the lower leg.
Vein disorders are not always visible; diagnostic techniques are
important tools in determining the cause and severity of the problem.
In addition to a physical examination, non-invasive ultrasound is
often used.
WHAT CAUSES VARICOSE VEINS?
Heredity is the number one contributing factor causing varicose
and spider veins. Women are more likely to suffer from abnormal
leg veins. Up to 50% of American women may be affected. Hormonal
factors including puberty, pregnancy, menopause, the use of birth
control pills, estrogen, and progesterone affect the disease. It
is very common for pregnant women to develop varicose veins during
the first trimester. Pregnancy causes increases in hormone levels
and blood volume which in turn cause veins to enlarge. In addition,
the enlarged uterus causes increased pressure on the veins. Varicose
veins due to pregnancy often improve within 3 months after delivery.
However, with successive pregnancies, abnormal veins are more likely
to remain. Other predisposing factors include aging, standing occupations,
obesity and leg injury.
HOW CAN PHLEBOLOGY HELP?
Phlebology is the field of medicine that deals with vein diseases.
It has been an established medical specialty in Europe for 50 years;
serious interest in phlebology has developed over the last 15 years
in the United States.
The American College of Phlebology was founded in 1985 and is the
largest phlebology society in the United States. It was established
to improve the standard of care related to disorders of the veins.
Its members are physicians and other health care professionals with
backgrounds in a variety of medical specialties who share a common
interest and expertise in vein diseases and disorders.
WHEN AND HOW ARE VEINS TREATED?
The most commonly asked questions are: Do veins require treatment
and What treatment is best? Veins that are cosmetically unappealing
or cause pain or other symptoms are prime candidates for treatment.
There are two general treatment options: conservative measures,
such as compression stockings, and "corrective" methods such as
sclerotherapy, surgery and light source/laser treatment. In some
cases, a combination of treatment methods works best.
SCLEROTHERAPY?
Sclerotherapy can be used to treat both varicose and spider veins.
A tiny needle is used to inject the veins with a medication that
irritates the lining of the vein. In response, the veins collapse
and are reabsorbed. The surface veins are no longer visible. Sclerotherapy
relieves symptoms due to varicose and spider veins in most patients.
With this procedure, veins can be dealt with at an early stage,
helping to prevent further complications.
You may need anywhere from one to several sclerotherapy sessions
for any vein region. Depending on the type and number of veins being
treated you may have one to many injections per session. Generally,
normal activities can be resumed after sclerotherapy. Medically
prescribed support hose and/or bandages may need to be worn for
several days to several weeks to assist in resolution of the veins.
The procedure, performed in the doctor's office, usually causes
only minimal discomfort. Bruising and pigmentation may occur after
sclerotherapy. Bruising typically disappears within 1-2 weeks. Although
pigmentation almost always fades, it can last for several months.
Scarring and other complications are rare.
ULTRASOUND-GUIDED SCLEROTHERAPY?
This is an in-office treatment alternative to surgical stripping.
With this technique, sclerotherapy is done while the doctor visually
monitors the vein on an ultrasound screen. This enables treatment
of veins that can't be seen because they are below the surface of
the skin and would otherwise require surgical removal.
ENDOVENOUS LASER TREATMENT?
Endovenous Laser Treatment is a treatment alternative to surgical
stripping of the greater saphenous vein. A small laser fiber is
inserted, usually through a needle stick in the skin, into the damaged
vein. Pulses of laser light are delivered inside the vein, which
causes the vein to collapse and seal shut. The procedure is done
in-office under local anesthesia. Following the procedure a bandage
or compression hose is placed on the treated leg. Endovenous Laser
Treatment is FDA-approved for the treatment of the greater saphenous
vein.
(ENDOVENOUS LASER TREATMENT)
The ClosureŽ procedure is a treatment alternative to surgical stripping
of the greater saphenous vein. A small catheter is inserted, usually
through a needle stick in the skin, into the damaged vein. The catheter
delivers radiofrequency energy to the vein wall, causing it to heat.
As the vein warms, it collapses and seals shut. The procedure is
generally done in an outpatient or in-office setting. It may be
done under local anesthesia. Following the procedure, the catheter
is removed and a bandage or compression stocking is placed on the
treated leg. The ClosureŽ procedure is FDA approved for the treatment
of the greater saphenous vein.
 
(RADIOFREQUENCY OCCLUSION)
SURGERY?
Surgical techniques to treat varicose veins include ligation (tying
off of a vein), stripping (removal of a long segment of vein by
pulling it out with a special instrument), and ambulatory phlebectomy
(removal of veins through tiny incisions, SEE SECTION BELOW). Surgery
may be performed using local, spinal or general anesthesia. Most
patients return home the same day as the procedure. Surgery is generally
used to treat large varicose veins.
AMBULATORY PHLEBECTOMY?
Ambulatory phlebectomy is a method of surgical removal of surface
varicose veins. This is usually done in the office using local anesthesia.
Incisions are tiny (stitches are generally not necessary) and typically
leave nearly imperceptible puncture mark scars. After the vein has
been removed by phlebectomy, a bandage and/or compression stocking
is worn for a short period.
LASER/LIGHT SOURCE TREATMENT?
A variety of laser/light source treatments are available today.
A light beam is pulsed onto the veins in order to seal them off
and cause them to dissolve. Light-based treatment is generally used
only to treat small veins. Treatments may be combined with sclerotherapy.
Multiple treatments are usually required.
WHAT RESULTS CAN I EXPECT?
With the evaluation and treatment methods available today, spider
and varicose veins can be treated at a level of effectiveness and
safety previously unattainable. Regardless which treatment method
is used, its success depends in part on careful assessment of the
problem by a knowledgeable phlebologist.
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