What are varicose veins?
Varicose veins are abnormal veins that can occur in the legs. They can be small, thin purple-colored lines (called “spider veins”) that lie just below the surface, or they can appear as thick, bulging, or knotted veins. While many people think that varicose veins are simply a cosmetic issue, there is often an underlying medical problem that causes varicose veins. This medical condition is called venous insufficiency. Varicose veins are very common in the United States, affecting approximately 15% of men and 25% of women. Over 25 million people in the United States are affected.
What are the Risk Factors for Varicose Veins?
The risk factors for varicose veins are:
- Family History – there is a strong familial component to venous disease. If your parents or siblings have varicose veins, you have an increased risk.
- Female gender
- Multiple pregnancies
- Occupations or lifestyles where you stand for long periods of time or perform heavy lifting
- Previous DVT (Blood clots in your legs)
What are the Symptoms of Varicose Veins?
Some people with varicose veins do not experience any discomfort from the condition. When signs and symptoms do occur, they may include:
- Achy or heavy feeling in the legs.
- Burning, throbbing, muscle cramping,
- or swelling in the legs.
- Prolonged standing or sitting makes the legs feel worse. They also feel worse at the end of the day.
- Itching around the veins.
- Recurrent phlebitis or cellulitis (inflammation or infection).
- Dark brown discoloration near the ankle.
- Skin ulcers near the ankle
What causes Varicose Veins?
Arteries bring blood from the heart to the legs. Veins then bring the blood from the legs back to the heart. Varicose veins result from problems in the veins. When you stand, gravity pulls the blood to the feet. In order to prevent the blood from rushing to your feet, the veins have one-way valves in them. When you stand, the valves close and do not let the blood move backwards to the feet. In some people, because of the reasons listed above, these valves become worn out. Over time, the blood backs up in the veins, and pressure builds up. This increased pressure leads to the heavy feeling you experience, and causes the veins to enlarge. The branching veins to the skin also become dilated, and these appear as the varicose veins.
How are Varicose Veins Diagnosed?
Your doctor will examine your legs while you are standing. He will also ask you about your symptoms. More importantly, an ultrasound examination will be done to look for the underlying cause of your condition. The ultrasound technologist will test the valves in your veins to see if they are leaking.
Do I need treatment?
If you are unhappy with the way your legs look, or if you are having significant symptoms, you should seek medical attention. Varicose veins can be a sign of an underlying condition, venous insufficiency that can lead to serious medical problems such as ulcers and blood clots.
How are Varicose Veins Treated?
- Support stockings – Wearing compression stockings is an important part of any vein treatment. They are worn from the time you get up in the morning to the time you go to bed. You should be measured and purchase stockings that are of the appropriate size. The staff at the Milford Vascular Institute can provide this service for you
- Anti-inflammatory medication. Medications like Ibuprofen (Motrin) can help alleviate your symptoms.
- Watch your weight and diet. Shedding excess pounds can take pressure off your veins. Follow a low-salt, high-fiber diet to prevent the swelling that may result from water retention and constipation.
- Elevate legs.
If conservative therapy fails, venous intervention is warranted. Many patients are nervous because they are familiar with a procedure called vein stripping surgery. This procedure was historically done in the operating room under general anesthesia. It involved multiple incisions, a long hospital stay, and a long post operative recovery. Thankfully, this procedure is now rarely done. Today’s interventions are minimally invasive, done in the doctor’s office, and have very little in the way of pain or recovery. The type of intervention is dependent on the type of veins and the presence of underlying venous insufficiency. It is common for a patient to require multiple types of interventions during the treatment period.
In this procedure, your doctor injects small- and medium-sized varicose veins with a solution that scars and closes those veins. In a few weeks, treated varicose veins should fade. Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly. Sclerotherapy doesn’t require anesthesia and is done in the doctor’s office. Dr. Davis has performed hundreds of these procedures, with excellent results. [/column]
Endovenous Laser Therapy (EVLT):
Endovenous Laser Therapy (EVLT)As mentioned above, the underlying cause for many patientsEndovenous Laser Therapy (EVLT) with varicose veins is venous insufficiency.
In order to truly get a long term solution to your problems, these leaky valves must be fixed. By fixing these leaks, the venous pressure can return to normal, alleviating your symptoms, and allowing future procedures to have a chance for long term success. EVLT is how your doctor fixes these leaks.
EVLT is done in the doctor’s office. For anxious patients, a light sedative, Valium, is given. Your lower leg is numbed with a local anesthetic. Using ultrasound, your doctor finds the abnormal vein and punctures it with a small needle.
A long plastic tube, called a catheter, is then passed through the vein up to the leaking valve, which is usually in the groin. Through the catheter, the laser is passed. The laser is activated and slowly pulled out of the vein, closing it down so it will no Before and After Endovenous Laser Therapy (EVLT)longer leak. This procedure lasts less than an hour, and other than the pinches from the local anesthetic, is relatively painless. After the procedure, the leg is wrapped and you will walk out of the office. You will need to wear a support stocking for at least 2 weeks. You can return to normal activities immediately. The main possible complication from this procedure is a blood clot, but fortunately this is exceedingly rare. Because of this, you will be instructed to return to the office in one week for examination and a quick ultrasound to ensure that a blood clot has not developed. Both Dr. Esposito and Dr. Davis have been performing this procedure since it was first introduced. They have performed hundreds of the procedures in the office with excellent results. They have also served as instructors, teaching the technique to physicians from Connecticut, Rhode Island, Massachusetts, New York, and New Jersey.
Ambulatory Phlebectomy (AP):
Some veins are too large to be treated with sclerotherapy and need to be completely removed. Far different than traditional vein stripping, ambulatory phlebectomy (AP) is a minimally invasive procedure done in the doctor’s office. It is often done at the same time as Before and After Ambulatory Phlebectomy EVLT. For anxious patients, a light sedative, Valium, and/or a pain killer, Percocet is given. The doctor marks the veins on your legs while you are standing, and then places you on the exam table. The procedure is done under sterile conditions with a local anesthetic. Tiny stab incisions, less than 1/8 inch in size, are made near the enlarged veins. Using special instruments, the veins are removed completely through these incisions. There are no stitches. Once the veins are removed, the leg is wrapped with an Ace bandage. This bandage is left in place overnight. The next day, you can shower and begin wearing a compression stocking. The stocking will be worn for a minimum of 2 weeks. There is very little pain associated with this procedure, and normal activity can be resumed immediately. There is some bruising for the first week, but once the bruising resolves, the veins are gone. The incisions heal completely without any scarring.
4.) Transilluminated Power Phlebectomy:
Transilluminated Power PhlebectomyThis surgical procedure was popular a few years ago, but with the arrival of EVLT, it is now reserved for only the largest, more severe varicose veins. This procedure is done in the operating room, usually under general anesthesia. A small incision is made and a light is placed under the skin to transilluminate the abnormal veins. Through a second incision, a device with a rotating blade attaches to the vein and literally chews it up and removes it completely. Anesthetic solution is then infused into the area. The patient goes home after the surgery, wears a compression stocking for 2 weeks, and returns to normal activity right away.. This is a very well tolerated procedure, with excellent success rates. With the newer techniques that can be done in the doctor’s office, however, it has become a much less used procedure.
Will the Varicose Veins come back after treatment?
One of the biggest worries that patients have is that after the treatments, the veins will simply return. Everyone knows someone who has had “injections” into their veins, only to have them return within a few months. At Milford Vascular Institute, we pride ourselves on treating the underlying cause of the disease process. We aggressively investigate your veins initially with ultrasound to find out the underlying cause, use the most advanced techniques to treat the cause, and provide close, long term follow-up to catch any problems before they return. Because of this comprehensive approach to the treatment of varicose veins, we expect that varicose veins treated at the Milford Vascular Institute will rarely return.