Varicose Vein Treatment

You hear about them frequently. You can even see them through your skin, and if you have varicose veins, spider veins, or other venous disease you are probably painfully aware of them. Veins play an important role in the every day functions of the body and therefore your health and well-being. It is important to know normal vein function in order to understand how vein disorders occur, are treated and prevented. It is estimated that 80 million Americans suffer from some form of venous disease, so you are not alone.

Vein Function
Veins are the blood vessels responsible for carrying blood back to the heart from all parts of the body. Valves in the veins help move the blood back to the heart against the force of gravity. The valves act as one-way doors. The valves open as blood flows back toward the heart and close to prevent the backward flow of blood. They are spaced at various intervals along the inside of the veins. When valves are healthy, they close tightly and are Competent. When they do not close completely, blood can flow backwards, pool inside the vein and cause the vein to dilate or enlarge abnormally. These valves are now incompetent. This can lead to painful and sometimes serious medical problems such as varicose veins, spider veins, venous stasis ulcers, and thrombophlebitis.

Spider Veins
Spider veins are essentially smaller versions of varicose veins and are caused by pooling of blood in the veins from incomplete closure of the valves. Spider veins commonly appear during and after pregnancy as small purple or red cluster of veins just below the skin’s surface. Depending upon how large or dark they are, they may appear unattractive, but they generally don’t cause discomfort.

Varicose Veins
Varicose veins are much larger veins with increased pooling of blood. As the amount of pooling increases, the walls of the veins weaken and dilate. These can occur anywhere on the body, but are much more frequent from the ankle to the groin. In addition to being unattractive, they can cause pain and discomfort such as heaviness, fatigue, aching, restlessness, cramping, and/or swelling.

Venous Stasis Disease
Ultimately, venous insufficiency and pooling of blood in the veins can lead to venous stasis disease. This can result from long-term venous problems, deep vein thrombosis and/or phlebitis, which can affect the nutrition and oxygen levels in the skin. This can

Result in swelling and/or skin changes such as eczema, discoloration, hyper pigmentation, and ulceration.

Thrombophlebitis
Thrombophlebitis is an inflammation of the vein, which often occurs from a blood clot forming in the vein. This may partially or completely block the flow of blood in that area. It can be caused injury, stagnation of blood in the vein or an increased ability of the blood to clot easily. This is especially true in those taking birth control medication or hormones and smokers. .

Who Suffers from Venous Disease
Venous disease can affect anyone, but women are three times more likely to develop spider or varicose veins than men. Up to 50% of women may be affected. There is a strong tendency to run in families. Other risk factors include pregnancy, birth control pills, estrogen, progesterone, age, prolonged standing for long periods, trauma, prolonged sun exposure, obesity, and some Collagen vascular diseases such as Lupus.

Symptoms
With varicose veins the symptoms can depend upon the size and type of varicose veins present, but even spider veins may cause some discomfort. Symptoms can be made worse by prolonged standing. Symptoms also include feelings of fatigue in the legs, heaviness, burning, throbbing, itching, cramping, restlessness, and swelling.

Diagnosis
Varicose vein problems are diagnosed by one or more of the following: 1) history and physical exam 2) inspection and palpation of the legs while standing 3) hand held Doppler 4) imaging with Duplex ultrasound. Duplex Ultrasound is very useful to examine dynamic blood flow. It can demonstrate any reflux or incompetence in the venous system, and reveal if there is flow in a vein verses a blood clot.

Treatment Options
Do my veins need treatment and what treatment is best? Varicose and spider veins that are cosmetically unappealing or cause pain or other symptoms are prime candidates for treatment. There are two general treatment options. Conservative measures include compression stockings, which decrease the diameter or distension of the veins, and increases the pressure generated by the calf muscles, which help blood, return to the heart. Other methods for treating varicose veins include injection sclerotherapy, surgery and laser treatments

Sclerotherapy
Sclerotherapy is a nonsurgical treatment for spider and varicose veins that involves the injection of a sclerosing solution into the veins. A tiny needle is used to inject the medication into the vein. This causes an irritation and inflammation of the vein, which results in the closure of the vein. Compression stocking are worn to help improve the closure and the cosmetic result.

Ultrasound-Guided Sclerotherapy
Some of the incompetent veins cannot be seen visually, so they can be visualized with ultrasound and injected while monitored. This also is done as an outpatient procedure in the office.

Endovenous Laser Closure (ELAS)
For many years surgical stripping of the incompetent saphenous vein was the only way to treat severe varicosities. This required general or spinal anesthesia, a hospital stay, and significant pain post operatively. Fortunately, technology has greatly improved the option of treating venous disease and eliminated the need for surgery in most cases. Using local anesthesia, a small laser fiber is inserted in the incompetent vein thru a small needle under ultrasound guidance. The laser is “fired” while pulling back on the laser fiber. This collapses and “welds” the vein closed. This outpatient office procedure is followed by quick return to normal daily activity.

Surface Laser Closure
Lasers are also used for the treatment of small spider veins. The laser wavelength passes through the skin and is selectively absorbed by the targeted blood vessel which helps seal them off. The vein will gradually disappear.

• Dornier MedTech: Lasers

• American College of Phlebology