Varicose Veins are veins that become abnormally swollen and large, usually due to defective valves in the vein. Varicose veins are sometimes bluish in color, protrude from the surface of the skin, and frequently have a winding or worm-like appearance.

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What causes varicose veins?

Increase in the diameter of a vein results in the malfunction of valves inside of the vein that are designed to prevent blood from flowing backward in the vein. An inherited weakness of the vein wall (genetic) and circulating hormones that relax the smooth muscle of the vein wall are the most common causes. Females have high levels of such a hormone, the hormone progesterone. Pregnancies, obesity, hormone replacement therapy, the use of female oral contraceptives as well as occupations that require a standing position are additional causes of varicose veins. Since females usually have multiple risk factors for the development of varicose veins, about three fourths of the persons who have varicose veins are women and 25% are men.

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Can I be cured of my varicose veins?

Varicose veins are a problem that can be successfully treated but the disorder cannot be permanently cured. The treatment of the abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need to return for maintenance treatments after their initial treatment is completed.

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How will the blood in my veins get back to my heart after all of the abnormal veins are removed or destroyed?

The backward flow of blood in varicose veins and main superficial trunks, the great saphenous vein (GSV) and lesser saphenous (LSV) vein actually interfere with the normal venous return of blood. Removal of these areas of abnormal circulation actually improves circulation of blood in the treated limb. It is this improvement in limb circulation that causes improvement of symptoms of tiredness and heaviness in the limb.

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Do I have to treat both legs?

The abnormal limb or limbs should be treated thoroughly for best results. They may be treated at the same time or after one another.

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What is a skin ulcer?

A skin ulcer is caused by a venous reflux disorder that is called a venous stasis ulcer. Early signs that a venous stasis ulcer may develop include a darkening of the skin in the area of the ankle. Gradually, the skin may become leathery or waxy in appearance.
Without treatment of the venous disease, the skin may breakdown and bleeding may occur.

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Treatment Methods

What is a duplex ultrasound examination?

The venous duplex examination permits your phlebologist to see the anatomy and check the flow characteristics of the veins beneath your skin. Useful information is gathered that your physician can use to adequately diagnose your specific vein problem and to plan and guide treatment.

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What is sclerotherapy?

Sclerotherapy is a common treatment for small (spider veins) and medium size (reticular) veins. A tiny needle is used to inject the veins with a solution (called a sclersant) that irritates the lining of the vein. In response, the veins collapse and are reabsorbed. The surface veins are no longer visible. Depending on the size and location of the veins, different types and strengths of sclerosants are used. With this procedure, veins can be dealt with at an early stage, helping to prevent further complications.
You may need anywhere from one to several sclerotherapy sessions for any vein region. Depending on the type and number of veins being treated you may have one to many injections per session. Generally, normal activities can be resumed after sclerotherapy. Medically prescribed support hose and/or bandages may need to be worn for several days to several weeks to assist in resolution of the veins. The procedure, performed in the doctor's office, usually causes only minimal discomfort. Bruising and pigmentation may occur after sclerotherapy. Bruising typically disappears within 1-2 weeks. Although pigmentation almost always fades, it can last for several months.
Possible complications of sclerotherapy include inadvertent intra-arterial injection, skin ulceration, hyperpigmentation (dark spots), telangiectatic matting (blush spots), superficial phlebitis, deep vein thrombosis (blood clots), and allergic reaction. Scarring and other complications are rare.

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What new treatment options exist for patients who have abnormal blood flow in the major vein trunks other than vein stripping?

In order to control the backward flow of blood in these large veins, the vein that is the source of the visible varicosities must be sealed shut or removed. The vein may be sealed shut using energy sources such as a laser, or radiofrequency energy electrical energy, or by ultrasound guided sclerotherapy injections.

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What is ultrasound guided sclerotherapy?

Visual sclerotherapy refers to injection of surface veins that are visible to the naked eye. Some veins that need to be treated are below the surface of the skin and cannot be injected safely without the aid of ultrasound imaging assistance.

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Is sclerotherapy safe?

Most patients do not experience any complications from sclerotherapy. However, some patients develop changes in skin pigment in locations where the veins are injected. Some patients may experience chemical burns of the skin while a rare patient may develop an allergy to the medication. Serious complications such as deep vein blood clots and unintentional arterial injection occur rarely.

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What are laser and radiofrequency sealing of veins?

Light energy (laser) or electrical energy (radiofrequency) may be used to seal shut abnormal main superficial trunk veins. Both treatments involve the application of heat energy to inside of the long or short saphenous veins. Usually treatment of the GSV starts at a location in the vein at or below the knee. The GSV is then treated from its junction to the deep system at the level of the groin down to the entry site near the knee. Ultrasound guided injections may also be used to seal the GSV or LSV.

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What are my treatment options?

Vein treatment programs are designed to treat visible varicose veins and to treat abnormal veins that may not be visible but that may be the source of the visible varicosities. If varicose veins are the only abnormality detected by the treating physician, the treatment involves surgical removal of the visible varicose veins (micro-incision phlebectomy) or the injection of chemicals (sclerosants) into the vein (sclerotherapy).

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Why can't I just have the branches injected or removed if the main superficial trunk is abnormal?

For the treatment of the visible veins to last a long time, the source that may not be visible to the naked eye must be controlled as well. From a practical standpoint some insurance carriers will not pay for treatment of branch varicosities if an abnormal main trunk is not treated at the same time or before the branches are treated.

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Why do doctors recommend gradient compression stockings?

The properly fitted gradient compression stocking can temporarily reverse the effects of vein disease and lessen the discomfort as well as skin damage. Many insurance companies require a trial of stocking use before approving definitive therapy.

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Copyright

The FAQs and Treatment Methods materials posted on this site are subject to copyrights owned by the American College of Phlebology (ACP) and are used by permission of the ACP. Further reproduction, retransmission or reprinting is prohibited without prior written permission from the American College of Phlebology.

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