What are Varicose Veins?
Varicose veins usually appear as swollen, ropey veins just under the surface of the skin most commonly occurring in the legs, ankles and feet. They are produced by a condition known as venous insufficiency or venous reflux, in which blood circulating through the lower limbs does not properly return to the heart but instead pools in the veins, causing them to become distended and tortuous.
What Causes Varicose Veins?
More than 25 million Americans suffer from venous reflux disease. Venous reflux disease, also known as venous insufficiency, is a medical condition affecting the circulation of blood in the lower extremities. Arteries carry oxygen rich blood away from the heart. Veins return oxygen poor blood to the heart, where blood is first pumped to the lungs, oxygenated, and then pumped back out through arteries to the body’s tissues. Valves in veins keep blood flowing in one direction--toward the heart. When these valves fail, the flow of blood in leg veins is influenced more by gravity, causing blood to pool in these veins, which then become stretched and dilated. Just like a balloon that never returns to its original size after it is inflated, varicose veins remain distended unless they are treated.
What is Venous Reflux?Venous reflux means that blood is flowing the wrong way in veins, usually because valves in these veins have failed.
To see a Windows Media Player video about Venous Reflux Click Here or on the image to the left.
Who Develops Varicose Veins?
Gender and age are two primary risk factors in the development of venous reflux. An estimated 72% of American women and 42% of men will experience varicose veins symptoms by the time they reach their sixties. Women who have been pregnant more than once and people who are obese, engage in heavy lifting, have a family history of varicose veins or spend a great deal of time standing have an elevated risk for the condition, but venous reflux may occur in nearly anyone at almost any age. Varicose veins never go away without treatment and frequently progress and worsen over time.
Common Symptoms of Varicose Veins
Symptoms can include pain and fatigue in the legs, swollen ankles and calves, restless leg syndrome, burning or itching skin, skin discoloration and leg ulcers. Standing for a prolonged period of time may be uncomfortable due to blood pooling in dilated leg veins. In less severe cases, thin, discolored vessels – “spider veins” – may be the only symptom. Elevation of the legs, avoidance of prolonged standing, and wearing compression stockings usually improves symptoms. Some patients with varicose veins initially report that they have no symptoms, but after wearing compression stockings they realize that their legs feel lighter and “have more energy.” This suggests that these patients became accustomed to the heaviness in their legs, not recognizing that this sensation is abnormal.
Complications of Varicose Veins
Severe varicose veins can have a significant impact on the lives of people who work on their feet – nurses, postal workers, teachers, flight attendants et al. Research has shown that more than two million workdays are lost each year in the US, and annual expenditures for treatment total $1.4 billion.
Prevention of Varicose VeinsUnless you live on the space station, your leg veins will be subject to the effects of gravity. The ability to prevent varicose veins is debatable, however, below are some tips that may help in the prevention of varicose veins and spider veins:
Treatment of Varicose Veins
When ablating the greater saphenous vein, the procedure involves inserting the catheter into the diseased vein through a very small incision and threading the device through the vessel up to the groin area. Radiofrequency waves are applied to the heating element in 20-second intervals to sequentially heat and ablate the vein in seven centimeter increments. After each segment is treated, the ClosureFAST catheter is manually withdrawn down the vein and the process is repeated until the entire length of the vein has been ablated. The body automatically re-routes blood flow through healthier veins, and the restoration of normal circulation relieves the distention of the surface veins. The ablated vein becomes scar tissue and is eventually absorbed by the body.
What are the benefits associated with endovenous ablation?
Is the loss of varicose veins a problem?No. Varicose veins are unhealthy and actually can be detrimental to circulatory health. Varicose vein removal has no adverse affect on the body. Blood is rerouted through healthy veins with intact valves so that blood travels away from the feet and returns to the heart in an efficient manner. The greater saphenous vein is frequently obliterated during endovenous ablation. Although the greater saphenous vein is the preferred conduit harvested by cardiac surgeons during bypass surgery, a diseased and dilated greater saphenous vein makes a poor bypass conduit and therefore cannot be used for cardiac bypass surgery. A normal saphenous vein should always be preserved because it may be required in the future for open heart surgery.
What is recovery like after endovenous laser ablation?The procedure leaves nearly imperceptible scars, is associated with minimal postoperative pain, involves a rapid recovery period, and provides almost immediate relief from symptoms. Minor soreness and bruising can be treated with over the counter pain medication such as Aleve, Motrin, or Tylenol. After the procedure, patients are encouraged to walk and resume their normal activities, wearing compression stockings for about three weeks. An ultrasound is usually performed within three to five days post procedure to make sure that the treated vein has closed and to evaluate for the rare complication of a deep venous thrombosis (DVT). Another follow up appointment is typically made with Dr. Schilperoort about three to four weeks later for a final postoperative check.
What are the risks associated with endovenous ablation?
As with any medical procedure, there are potential complications. These include:
How successful is endovenous laser ablation (EVLA)?All data indicate that endovenous laser ablation is a safe and effective procedure. The FDA has approved it for the treatment of varicose veins. Endovenous laser ablation is minimally invasive and enjoys a 98% success rate with a recurrence rate of 7% after two years.
What are alternatives to endovenous ablation?
What is the difference between cosmetic surgery and medical necessity?Physicians have been debating the treatment of varicose veins for well over two thousand years. Ancient artwork depicts varicose veins and the legendary Hippocrates wrote about them in the fifth century BC. Medical necessity and health insurance are now major factors in determining the course of treatment for varicose veins.
What are Spider Veins?
Spider veins are tiny dilated blood vessels visible as purple, blue or red streaks, located just below the surface of the skin and sometimes occurring in web-like groups. Spider veins can occur on the face, chest, and abdomen, but are more common on the thigh, calves, and ankles. Unless treated, they are permanent and tend to increase in number over time. Although spider veins are mainly a cosmetic problem, they can be an indication of venous disease below the surface of the skin. Spider veins drain into deeper veins called reticular veins. Reticular veins may or may not be visible to the naked eye, but can be easily seen with the use of high intensity light applied directly to the skin (transillumination). Identification and treatment of reticular veins is an important aspect of the successful treatment of spider veins.
Symptoms of Spider Veins
Spider veins are usually of cosmetic concern, but may be associated with itching or burning. If spider veins are associated with leg heaviness, fatigue, and/or swelling, dilated veins below the skin surface may be to blame. Occasionally spider veins spontaneously rupture and bleed, or they may bleed with trauma such as may occur during shaving.
Treatment of Spider Veins
To see a Windows Media Player video about Spider Vein treatment Click Here or on the image to the left.Sclerotherapy is often used to treat varicose and spider veins. Using a tiny needle, veins are injected with a solution that irritates the lining of the vein wall, causing them to collapse and gradually fade away. This procedure is performed in office, usually lasting approximately 30 minutes. Multiple treatments may be needed to reach desired results. The sclerosing agent is often mixed with air to create foam that will displace the blood in the vein. For optimal results, reticular veins associated with spider veins also need to be sclerosed. Compression stockings are worn for about two weeks post procedure. Most patients resume normal activities immediately. An allergic reaction to a sclerosant is rare, but has been reported. Staining, or brown discoloration on the skin is a possible side effect of sclerotherapy. This staining may take six months or longer to fade. Rarely sclerotherapy may result in the breakdown of a small area of skin resulting in an open wound (an ulcer). Some patients may develop lace-like matted webs of tiny, dilated, red, blue, or purple capillaries, arterioles, or venules visible just below the skin surface after sclerotherapy.
Laser ablation can also be used to eliminate tiny spider veins in fair skinned patients. At Northern Arizona Vein Center we use the state-of-the-art, high performance Dornier Medilas D FlexiPulse diode continuous wave laser with a 940 nm wavelength. Short pulses of laser energy are applied to spider veins, effectively obliterating them. The 50 milisecond pusles feel like tiny needles and are usually well tolerated by most patients. Cooling of the skin may decrease the discomfort of laser treatment. Tanning should be avoided for two to four weeks before laser treatment. Laser and sclerotherapy are frequently used to complement each other during the same treatment session.
The newest addition to Northern Arizona Vein Center is the VeinGogh device (www.veingogh.com) made by Refine USA. This device allows for treatment of tiny surface veins (telangectasia) on the face and legs with excellent results. Refine USA developed Microburst Technology™, a unique, proprietary electrical output that allows the VeinGogh system to create an effective, controllable heating of dermal vasculature without significant discomfort or visible damage to the surrounding tissue—a true break-through in aesthetic medicine. Veins that are simply too small or too close together to allow for sclerotherapy can be treated with VeinGogh.
Despite appropriate treatment, spider veins may recur later in life, possibly due to the underlying genetic predisposition that led to the development of spider veins in the first place. Treating spider veins does not keep new ones from appearing, but treating new ones every few years may be appropriate to keep them from becoming too extensive. After child bearing years, which are associated with hormonal swings, spider veins may develop more slowly.
Superficial thrombophlebitis results from clotting and inflammation in a superficial vein. The skin over the vein becomes red, swollen, and painful and may be mistaken for an infection. Instead of feeling like a soft normal vein, a phlebitic vein feels like a hard cord under the skin. Superficial thrombophlebitis most often affects the superficial veins in the legs but may also affect superficial veins in the groin or in the arms. Superficial thrombophlebitis in the arms usually results from having an intravenous catheter. Thrombophlebitis occurs more frequently in people with varicose veins because the blood tends to flow more slowly and with less uniformity than in normal veins. However, most people with varicose veins do not develop thrombophlebitis. Even a slight injury can cause a varicose vein to become inflamed. Unlike deep vein thrombosis, which causes very little inflammation, superficial thrombophlebitis involves a sudden (acute) inflammatory reaction that causes the thrombus (blood clot) to adhere firmly to the vein wall and lessens the likelihood that it will break loose. Unlike deep veins, superficial veins have no surrounding muscles to squeeze and dislodge a thrombus. For these reasons, superficial thrombophlebitis rarely is associated with pulmonary embolism (blood clot travelling to the lung). Superficial thrombophlebitis usually subsides by itself. Taking an anti-inflammatory agent, such aspirin, ibuprofen, or naproxen usually helps relieve the pain. The condition generally subsides in a matter of days, but several weeks or months may pass before the lumps and tenderness subside completely.
Deep Venous Thrombophlebitis (DVT)Deep vein thrombosis is the formation of blood clots (thrombi) in the deep veins. Deep vein thrombosis occurs most often in the legs or pelvis but occasionally develop in the arms—usually due to catheter insertion. Blood clots can form in veins if a vein is injured, a disorder causes blood to clot (hypercoagulable state), or blood is flowing very slowly in a vein. Blood clots may cause a leg or arm to swell. A blood clot in a deep vein can break loose and travel to the lungs, which is called a pulmonary embolism. Ultrasonography and blood tests are used to detect deep vein thrombosis. Anticoagulants are given to prevent pulmonary embolism, which can be a life threatening complication of DVT.
Deep Venous InsufficiencyWhen the one-way valves fail in the deep veins, deep venous insufficiency results. If a person has had a DVT, clots in the deep veins may heal by being converted to scar tissue, which damages the valves in the veins. Because the damaged valves prevent the veins from functioning normally, fluid accumulates (a condition called edema) and the ankle swells. The edema can extend up the leg and even affect the thigh if the blockage is high enough in the vein. Edema tends to be worse toward the end of the day, because blood must flow upward, against gravity, to reach the heart when a person is standing or sitting. Overnight, edema subsides because the veins empty well when the legs are horizontal. Sometimes after a DVT, the affected veins are destroyed. In people whose veins are obliterated, leg edema is always present, generally worsening at the end of the day. The skin on the inside of the ankle may become scaly and itchy and turn a reddish brown. The discoloration is caused by red blood cells that escape from swollen (distended) veins into the skin. The discolored skin is vulnerable, and even a minor injury, such as that from scratching or a bump, can break it open, resulting in a venous ulcer. In addition to aggressive wound care to heal an ulcer, lifelong compression stockings are usually recommended in such patients.