VARICOSE VEINS (BULGING TRUNCAL VEINS)
The term “Varicose Veins” is loosely applied to the whole spectrum of diseases we see in our clinic. When we say you have varicose veins, what we most often mean is that you have truncal varicose veins that are associated with poorly functioning valves and dilation of one or more veins in the superficial vein system (outside of the muscles). The inefficient vein subsequently causes dilation in the large branches and these bulges are what we see. These can be quite painful and occasionally can cause serious complications.
Varicose veins are a common medical condition, says James Schlotter, M.D., a board certified surgeon with Coastal Plains Surgical Care who has been practicing general and vascular surgery in San Marcos since 1992. “This disorder affects about 25% of all adults and 50% of people over the age of 50. A growing number of people are concerned about the medical and cosmetic issues associated with their varicose veins.”
True bulging varicose veins can cause pain, aching, swelling, itching, fatigue, cramps, restless legs, skin changes (darkening), severe stasis, ulceration and thrombosis. They often enlarge with pregnancy, weight gain and aging. Failure to treat varicose veins can result in more serious medical problems such as: venous stasis (skin changes), ulceration, thrombophlebitis and/or deep vein thrombosis. Patients may suffer from skin changes and ulcerations for years before they seek medical attention. Timely treatments can dramatically improve appearance and may control or reverse the more serious complications seen. Most patients have been told that there was nothing they could do except to wear compression stocking to help alleviate the pain. This solution does not fix or reverse varicose veins.
Dr. Schlotter states “In the past my enthusiasm for treating varicose veins has been limited by the pain, scarring, and extended recovery which accompanied vein stripping. Today, new technologies and applications are available which overcome these limitations.” The newer therapies are less invasive, more effective, and cost efficient. As a result, more people are seeking treatment.
Modern treatment eliminates the blood flow through the affected vein. These abnormal veins can be safely removed or treated because the blood continues to flow through the many remaining veins, and overall circulation is actually improved. The clinic utilizes duplex ultrasound scanning in the office to assess the major veins for valve incompetence and reflux. This imaging provides a more accurate identification of the source of increased pressure. The scan produces active color images of the blood vessels on a screen. “People really enjoy watching. They think it’s cool to see ‘inside’ their veins. And it certainly impresses them to see the reflux.
TREATMENTS FOR VARICOSE VEINS
Laser Assisted Saphenous Endoablation (LASE)
Since 2004, we have used lasers for ablating large veins. This procedure LASE uses laser energy to obliterate the interior portion of the vein. This procedure is a minimally invasive procedure that treats varicose veins and their underlying cause, venous reflux, with little or no pain. Larger varicosities may be treated with the LASE procedure. During this procedure, a small incision is made into the varicose vein, which has been numbed with a local anesthetic solution called Tumescent Anesthesia. A very thin laser fiber is then inserted into the vein and directed to the desired treatment location. When the laser is activated, thermal energy is delivered, causing the vein to close. The laser fiber is gradually withdrawn until the entire diseased vessel is treated. The whole procedure lasts less than one hour. Most patients can drive themselves home and return to normal activity in a few days.
Venefit (formally known as the VNUS Closure procedure)
The Venefit procedure is also a minimally invasive procedure that treats varicose veins and their underlying cause, venous reflux, with little or no pain and is also performed in the office. The patient’s leg is numbed using a local anesthetic solution called Tumescent Anesthesia. Venefit uses radiofrequency (RF) energy to deliver delivers controlled heat to the vein wall causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood will re-route itself to healthy veins. The average patient typically resumes normal activities within a few days.
Some problems, such as large varicose veins, may call for ligation, a procedure in which the connections between the damaged veins and the normal vein systems are interrupted. Ligation is usually done under local anesthesia in an outpatient setting, often in combination with other procedures. Your initial consultation will give you and your physician an opportunity to discuss which treatment program may be best for you.
Miniphlebectomy is a procedure that can be used on small and large veins. In this procedure, tiny pinpoint holes are made with a small 1 cm punch. The patient’s leg is numbed using local anesthetic solution call Tumescent Anesthesia. Using specialized instruments, segments of the vein can be removed through these small openings. The tiny wounds heal with nearly invisible scars that are quite cosmetically acceptable. No stockings are required after the surgery. Patients have little discomfort and are able walk right away. In most cases patients are able to resume normal activities within a day or two. Most insurance companies provide medical benefits for the treatment of symptomatic varicose veins.
Most Insurances require the following conservative therapies prior to authorizing surgical treatment:
- Cold Packs
- Heat Packs
- Leg Elevations
- Leg Soaks
- Pain Medication: Advil, Ibuprofen, Tylenol
- Stockings: Must be medical grade (prescription) compression stockings: Sigvaris
- Weight Loss
RETICULAR VEINS (GREEN VEINS)
Reticular veins, also known as feeder veins, are the dilated blue and green veins beneath the skin surface. These veins are enlarged due to an increase in pressure. They are generally hereditary. Reticular veins can exist independently but can also be the underlying problem that gives rise to surface spider veins. They are usually considered a cosmetic problem since these medium size veins do not lead to substantial medical symptoms or complications.
Sclerosants Used to Treat Reticular Veins
Spider veins are clusters of tiny blood vessels that develop close to the surface of the skin. They are often red, blue, or purple; and they have the appearance of a spider web. They are commonly found on the face and legs. Treatment of spider veins is considered cosmetic and insurance companies will not pay for their treatment.
Sclerosants Used to Treat Spider Veins