Varicose Veins & Spider Veins
Varicose veins and spider veins are the most common forms of venous disease. They affect almost half of the adult population in the United States. Fortunately, most of them do not cause symptoms and do not need to be treated. But there are many people who suffer from complications of varicose veins which can manifest as aching, fatigue, cramps, pain, swelling, phlebitis (inflammation of the veins), blood clots, bleeding, and even leg ulcerations (skin breakdown).
What are varicose veins and spider veins?
Varicose veins are dilated and “ropy” appearing vessels that bulge under the skin. Varicose veins can often be symptomatic. Spider veins are small red vessels that you can easily see but cannot feel on the surface of the skin. They rarely cause any symptoms.
Who is at risk?
The following risk factors increase the chance of developing varicose veins:
*Heredity *Prolonged standing
*Female gender *Multiple pregnancies
*Increasing age *Heavy lifting
*Obesity *Prior blood clots
What are the causes of varicose veins?
Your legs are made up of a network of veins. A healthy vein contains valves which open and close to assist the return of blood to the heart. Varicose veins are caused by damaged or diseased valves, which result in backward flow of blood in your legs, a condition known as Venous Reflux. This can cause blood to pool in your legs and lead to the symptoms associated with varicose veins. Venous reflux is a condition that can be progressive. If left untreated, it can worsen and cause more advanced symptoms such as skin changes and even ulcers. Most varicose veins are associated with saphenous vein reflux. Eliminating the saphenous vein will help relieve the symptoms, eradicate current varicose veins, and prevent future varicose veins.
Varicose veins should be evaluated by a physician who understands venous disease and is experienced with the current technologies available to treat venous disease. The evaluation will involve a history and physical examination along with an ultrasound study. Identifying which veins are abnormal with the ultrasound is extremely important. Treatment of varicose veins without identifying the incompetent vessel causing the problem can result in a high recurrence of more varicose veins. Most insurance companies will cover the initial evaluation.
How do you treat varicose veins?
Traditionally, “stripping” the saphenous vein was the treatment of choice for saphenous vein reflux. With the introduction of the VNUS Closure radiofrequency device and laser devices, there has been a revolution in the treatment of varicose veins. This new technique is referred to as “Saphenous Vein Ablation.” These new devices allow eliminating venous reflux by obliterating the inside of the vein with heat derived from a catheter emitting radiofrequency or laser energy. A thin catheter is inserted into the vein and energy is delivered to the vein wall, causing the vein to seal shut. As the catheter is withdrawn from the leg, a sealed vessel is left behind. Once the diseased vein is closed, blood is re-routed to other healthy veins. Patients are required to wear medical support hose for a short period of time following the treatment. These procedures are associated with much less pain and fewer complications compared to traditional vein stripping. Most patients report a noticeable improvement in their symptoms within 1-2 weeks following the procedure. Many patients can resume normal activities immediately. Saphenous vein ablation usually takes about 30 minutes and can be done under local anesthesia in our clinic. Most insurance carriers will cover the cost if it is deemed medically necessary.
What problems are associated with saphenous vein ablation?
The following complications can occur but are uncommon:
- Vessel perforation
- Hematoma or bleeding
- Nerve injury
- Skin burn
- Deep venous thrombosis
- Pulmonary embolus
- Failure to ablate the vein being treated
An important factor to consider is that the great saphenous vein is used for heart and leg bypasses for cardiovascular surgery. If the vein is severely diseased and would not be a suitable conduit for future bypass surgery, eliminating the vein is not an issue. But if the vein is still suitable despite being diseased, it may not be wise to ablate it. The choice should be determined by the patient’s age, symptoms, desired outcome, and associated cardiovascular disease. This decision should be discussed between the physician and the patient thoroughly.
How do you treat spider veins?
Spider veins that are directly associated with saphenous vein reflux, will have a high rate of recurrence if the saphenous vein is not treated. In some instances, saphenous vein ablation would be necessary before treatment of the spider veins. But most patients will only need local spider vein treatment, which involves sclerotherapy and/or laser/radiofrequency therapy. Sclerotherapy is performed by injecting the spider veins with a chemical that locally destroys the spider veins. It is usually a simple procedure, but can lead to discoloration of the skin and in rare cases skin ulceration. Laser/radiofrequency therapy involves burning the spider veins directly on the skin. This therapy can also cause skin discoloration in darkly pigmented individuals and even skin burns. Although effective, the above treatments usually require several sessions for desired outcomes. Spider vein treatment is usually not covered by insurance.
To schedule a consultation call us at 713-790-0000.