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Varicose Veins
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Varicose veins often begin to develop in adolescence, although they may occur later in adulthood. Major predisposing factors often include heredity, pregnancy and hormonal factors. Other contributing factors can include sedentary lifestyle, prolonged standing, obesity, leg injury, hot weather and intensive sports. Varicose veins are unsightly but can also lead to significant medical problems that may include swelling, phlebitis, bleeding and leg ulcers. Varicose veins are typically chronic and progressive. |
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Leg Vein Basics |
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Leg veins are divided into a superficial system and a deep system. Two major junctions connect these two systems: the saphenofemoral junction in the groin and the saphenopopliteal junction behind the knee. Perforating veins connect the veins of these two systems throughout the length of the leg. Normally, blood in the veins should flow from the legs towards the heart. Veins have values to prevent blood flowing or "leaking" back down the legs. Varicose veins are veins with just such a leak : the blood is flowing down instead of up. The veins become enlarged because they are congested with blood. Varicose veins occur in the superficial system, often stemming from valve dysfunction originating at one or both of the junctions. At times, the perforating veins may be the main source of a "leak". A small percentage of varicose veins are due to leaks in the deep system, especially after a deep vein thrombosis. Simple spider veins usually are not associated with leaks at a junction or perforating vein. Spider and varicose veins are due to a chronic disease of the veins and usually get worse over time. Removing problem veins will not cure your tendency to form such veins. You may develop new or recurrent veins after treatment. Usually this is a gradual process that takes place over years. |
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Phlebology
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Phlebology is the study and treatment of disease of the veins. Modern phlebology depends on an orderly and thorough evaluation in order to understand each patient's specific condition and to tailor the specific program to that condition. The evaluation determines the type and location of the varicose veins, associated complications, the source of the varicose veins and the status of the deep vein system. The evaluation generally consists of a physical exam and non-invasive testing. This testing is done in the office and usually includes Doppler and duplex ultrasound. Doppler enables us to hear blood flow in the veins, and duplex images the veins. Other testing is sometimes indicated. A detailed evaluation is usually unnecessary in patients with simple spider veins. |
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Fees And Insurance
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We do not file with most insurance companies. Payment is required at the time of service. MasterCard and Visa are accepted for your convenience. We will provide you with the necessary forms to file any claims with your insurance company. Spider veins are considered cosmetic by almost all insurance companies. Symptomatic varicose veins may be covered. Call your insurance company to find out their policy. We are happy to send a letter to your insurance company if they request this. |
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Conservative Treatment
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Spider and varicose veins are generally not life threatening and it is not necessary to do more conservative treatment measures. Conservative treatment measures include simple physical measures designed to improve venous blood flow. This approach aims to alleviate symptoms and slow the progression of the disease. The measures below attempt to improve blood return from the legs to the heart. If you have chronic venous insuffiency, please also refer to that handout.1) avoid heat on your legs (hot baths, hot clothes, sun, etc).2) avoid standing or sitting still for prolonged periods.3) walk (especially long walks) as much as possible.4) gentle aerobic sports (such as bicycling, swimming, walking are encouraged. 5) if you have large veins we advice avoiding weight-lifting and "pounding" sports as running. 6) Wear compression hose on a regular basis.7) on trips, we advice wearing your compression hose and taking frequent breaks to walk or at lest move your feet.
If you ever begin to bleed from a leg vein, elevate your leg immediately and apply pressure to the site. Please call our office if this happens. We usually treat such bleeding veins with sclerotherapy. |
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Spider Vein Treatment
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Schelotherapy is the treatment of choice for spider veins of the legs. It is effective for most patients with a low risk of significant complications. In some cases we use laser/light treatment is mast effective in conjunction with schlerotherapy.Spider veins do not have any useful function. To eradicate them does not adversely affect your circulation. Varicose veins are veins where blood is flowing the wrong way; reducing or eliminating these veins typically improves the circulation. |
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Varicose Vein Treatment
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Sclerotherapy, ultrasound-guided sclerotherapy, ambulatory phlebotomy, closure, endovenous laser and surgery are treatments designed to reduce/eliminate varicose veins. These treatments may be used alone or in combination, depending on the situation. Even if treatment completely clears visible varicose veins, new veins or recurrent veins can occur. Whenever possible, the treatment should attempt to eliminate the "leak" points. Sclerotherapy is the injection of sclerosant medication into a vein. The medication is designed to irritate the lining of the vein, hopefully causing the vein to seal off and dissolve. The blood then flows through the remaining normal veins thus reducing stagnation of blood flow. Ultra-sound guided sclerotherapy is a procedure used to inject certain veins by imaging them on an ultra-sound machine;i.e, veins below the surface of the skin. It is used as an alternative to surgical treatment. Ambulatory phlebotomy is the removal of varicose veins. It is done in the office under local anaesthesia. Incisions are generally tiny, such that suturing is not needed. The veins are grasped through this small incision and extracted. Closure is an in-office procedure that involves inserting a catheter, under local anaesthesia, into an abnormal vein and sealing the vein by heating it. It is an alternative to stripping. Endovenous laser treatment is another alternative to stripping. It involves placing a sterile laser fibre inside the target vein and sealing it with laser energy. This is done in-office under local anaesthesia. Other treatment options include ligation (tying off of veins) or stripping (tying off and removal of a segment of vein). These surgical procedures are generally done on an outpatient basis by a general or vascular surgeon. |
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More On Sclerotherapy
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Asclerosant is a medication used to sclerose or degenerate a vein. In the U.S. the FDA has approved three agents for use; sotradecol, sodium morrhuate, and ethanolamine. Sotradecol, in use since the 1940,s is still considered as an excellent agent and is commonly used worldwide. Sodium morrhuate has been associated with a very high allergy rate and is rarely used. Ethanolamine is not used for leg veins. Sometimes we use a sugar and salt medication. However, saline (i.e. hypertonic saline), popular primarily among U.S dermatologists, is a fairly weak agent that often causes a lot of burning or cramping. It is not FDA approved for use in the treatment of veins. Because of these reasons, it is not usually my first choice. There are several other sclerosants used around the world that are not FDA approved. They have not been submitted before the FDA (although Polidocanol is nearing FDA approval). Several are quite good and from time to time we recommend them. The number of injections done at each session varies with the type of veins being treated and the stage of treatment. A patient with certain varicose vein may get one injection only, whereas a patient with spider veins may get many. In either case, small needles are used and discomfort is usually mild. It is important to note that a series of treatments are usually required. The best results require some patience. We will estimate the number of treatments that may be required. You may require fewer or more treatments that we estimate. Treatment sessions are generally at four to eight week intervals. Sclerotherapy may be contra-indicated when a patient has/is; pregnant/nursing, lymph edema, fever, serious health problems, deep vein thrombosis, bedridden, collagen vascular disease, deep vein obstruction. |
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Pre-Sclerotherapy Instructions
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Avoid applying moisturizer to your legs the day of your treatment. Avoid shaving your legs the day of your treatment. Bring loose-fitting shorts for the treatment and something long (to cover the compression hose) to wear after treatment. Unless medically necessary(and please inform us if this is the situation), please avoid aspirin and blood thinners for several days prior to your treatment. Please inform us prior to your treatment if you have any medications allergies, are on medication, or have significant medical problems(cancer, lupus or other collagen vascular disease, hepatitis, Aids or other). Remember to bring your compression hose(or we usually have a pair you can purchase at the office). |
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Post-Sclerotherapy Instructions |
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You need to walk after treatment before you drive to work/home. Walk at least 1hour daily for several days. Avoid running and weightlifting for the period you wear your compression hose. Avoid prolonged standing still and sitting for several days. Also avoid hot baths and sun bathing for a week or so. It is always a good idea to wear compression hose on a regular basis. Schedule a follow up treatment about 4-8 after your treatment. |
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What To Expect |
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Generally results of treatment are best judged after at least 4 weeks following treatment. Some people will have dramatic improvement while others improve more slowly. We will access your progress at the follow up visit and discuss this with you. Maximal improvement often takes several treatments and several months. Improvement rather than perfection is the goal. Bruising and tenderness is generally mild and temporary. A TREATED VARICOSE VEIN MAY BECOME FIRM AND LUMPY. THIS USUALLY IS A GOOD SIGN. WE GENERALLY EXPECT THIS TO CLEAR WITH TIME. PLEASE LET US KNOW IF YOU HAVE A LUMPY AREA THAT IS TENDER; WE WILL DRAIN IT. Discoloration is common. This typically clears gradually over several weeks to months. Treated veins may fail to close or can reopen over time. It is expected that new veins will appear over time. If you experience any significant or unexpected problems, or have any concerns or questions, please do not hesitate to call us. Certainly if you have significant pain, swelling, redness or other problems you should call us. |
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Complications |
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No available treatment for leg veins is 100% successful in every patient. No level of improvement can be guaranteed. Treated veins may fail to close or reopen after initial closure. This may require additional or different treatment at additional cost. Varicose vein disease is a chronic disorder. Recurrent or new varicose or spider veins will likely develop over time. Brownish pigmentation can occur after treatment. This is generally temporary but may take months to resolve and rarely may be permanent. A blush of tiny, generally red veins can occur around a treatment site. These telangiectatic mattes may clear but can be permanent and difficult to treat. Other new veins can appear in treated areas. Rarely, the skin may ulcerate and heal with a scar. The healing can take several weeks to months. As with any medication, allergic reactions are possible. Such reactions are rare with the medications used for this procedure. The allergic reaction can range from very mild to a potentially life threatening reaction that requires emergency treatment and hospitalization. Infection of an injection site or vein may occur. Superficial phlebitis and inflammation around a vein occasionally occurs. It is tender but usually resolves with anti-inflammatory medication and compression hose. Deep vein thrombosis is very rare. This could lead to a blood clot in the lungs, a potentially life-threatening event. Please call us if you have any chest pain or shortness of breath following a treatment. Irritation or injury to a nerve causing either prolonged discomfort or dysfunction is very rare. An intra arterial injection could occur. This is very rare. The consequences of this may range from pain, scarring of the skin, muscle injury, to loss of the limb. Other side effects are possible although uncommon. |
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