Varicose Veins
Varicose veins are dilated and “ropy” appearing vessels that bulge under the skin. More than 30 million people are affected by varicose veins or chronic venous insufficiency (CVI) in the U.S. with only a fraction of them seeking treatment annually leaving the vast majority undiagnosed and untreated. Without treatment those with the disease may experience progressive symptoms, such as swollen legs, skin damage and/or ulcers that can be debilitating and significantly impact their quality of life. Fortunately, with proper treatment, that outcome is preventable.
Risk Factors for Varicose Veins:
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
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 or Venous Insufficiency. This can cause blood to pool in your legs and lead to the symptoms associated with varicose veins. Venous reflux is a condition that is 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.
Evaluation of 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.
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Spider Veins
Spider veins are small red and/or blue vessels that you can easily see but don’t usually feel on the surface of the skin. They are usually asymptomatic, but some can cause symptoms such as itching or throbbing. 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. 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 ulcerations or blood clots.Although effective, sclerotherapy treatments usually require several sessions for desired outcomes. Spider vein treatment is usually not covered by insurance.
Leg Pigmentation
If venous reflux disease progresses, it can result in venous stasis hyperpigmentation. The skin above the ankles can become darkly pigmented and thickened. Swelling can also be associated with this condition.These changes are a result of increased venous pressure and inflammatory reactions that occur in people with chronic venous reflux disease. All patients with these findings should be evaluated by an ultrasound exam to determine if there are specific veins that can be treated to alleviate the venous reflux disease.Eliminating the abnormal veins will slow down the progression of the disease and improve the skin changes and leg swelling associated with chronic venous reflux disease.
Leg Ulcers
If venous reflux disease progresses, it can result in leg ulcers. The skin can breakdown forming an ulcer that is difficult to heal. These ulcers are a result of increased venous pressure and inflammatory reactions that occur in people with chronic venous reflux disease.All patients with ulcers should be evaluated by an ultrasound exam to determine if there are specific veins that can be treated to alleviate the venous reflux disease. Eliminating the abnormal veins will help heal current ulcers and reduce the recurrence of future ulcers.
