Varicose Veins - What You Need to Know

What are varicose veins?

The circulatory system is made up of the heart, veins, and arteries. Arteries carry oxygen-rich blood from the heart to nourish your tissues, while veins have one-way valves which channel oxygen-depleted blood back toward the heart. If these valves are damaged, the blood pools in the leg veins and leads to feelings of fatigue, heaviness, aching, burning, itching, cramping, restlessness, swelling and even eczema and leg ulcers.

What causes varicose veins?

Heredity causes most varicose veins. If one of your parents has varicose veins, your risk of having them is about 70%. Other predisposing factors include obesity, leg injury, multiple pregnancies and standing occupations, such as nurses, teachers, and barbers.

Are varicose veins a threat to my health or are they just cosmetic?

Varicose veins indicate that the pressure in the veins of the legs is too high (a condition called venous hypertension). Longstanding venous hypertension can result in damage to the deep leg veins and to the overlying skin. Impairment to the deep veins can lead to blood clots and sometimes to sudden death from pulmonary embolism. Blood clots are especially frequent if you are confined on a long plane or car trip. Injury to the skin will result in stasis dermatitis, pigment changes, thickened skin and possibly, leg ulcers with scarring. In addition, venous hypertension can cause pain, fatigue and swelling of the legs. The presence of increasing numbers of spider veins may also suggest venous hypertension.

Can these veins develop in one leg and not the other? Most patients develop varicose veins in both legs. However, the severity of the varicosities will differ. Some may require treatment, while others may only require compression stocking therapy.

Are all varicose veins visible from the outside?

No. Varicose veins may be deep enough that they are not visible. A duplex ultrasound evaluation of your legs is the best way to detect all varicose veins. This is a painless, noninvasive test using sound waves to detect the size of veins and direction of blood flow.

What are the options for varicose vein treatment?

A new procedure called endovenous laser ablation, or EVLA, has been available to treat varicose veins for about seven years. EVLA involves a nonsurgical laser procedure in which the laser fiber is inserted into the damaged vein and it is switched on, permanently sealing the vein shut. The blood that normally flowed through that vein is redirected into normal veins which carry it back to the heart. EVLA is performed under local anesthesia while you are awake and is very comfortable. Most people return to work the next day. EVLA is a safe and effective procedure that is replacing the older technique of surgical vein stripping. Another way to treat varicose veins is called foam sclerotherapy. For this treatment, no anesthesia is required and a small butterfly needle is used to deliver an FDA-approved sclerosant chemical to the veins. They immediately shrink and are cleared by the body's metabolism over several weeks to months. This procedure is relatively painless and is very safe. Vein stripping surgery is not performed very often nowadays since these newer procedures are so safe and effective.

Do these treatments cure varicose veins? After all diseased veins are treated, most people have a remission of symptoms, leg swelling improves and the skin begins to heal, including leg ulcers. Many patients do not have problems again for years. Due to many factors including heredity, however, some people are predisposed to future problems. Since there is no way to prevent other veins from becoming damaged, varicose veins may be an ongoing challenge for some patients.

Will my varicose vein treatment be very painful?

The degree of pain that a patient experiences during vein treatments varies from patient to patient. The survey we conducted indicated that most patients thought the procedure to be pain-free, while a few reported experiencing a moderate degree of pain. The amount of pain is dependent on several variables, such as age, sex, weight, and pain tolerance level.

Are there any side effects of the treatments?

As with any invasive procedure, risks of vein treatments include allergic reaction to one of the medications, bleeding, postoperative pain, infection, blood clots or nerve injury. If any of these side effects occur, they are usually temporary if promptly treated.

How long after laser treatments will I be able to return to my normal routine?

Most patients return to their normal routine the next day, however, you should not resume aerobics, heavy exercise routines, running, sports or travel for at least a month after your laser treatment. It is very important to walk at least thirty minutes each day after the procedure to prevent blood clots from forming in the veins. Walking on a treadmill is fine. Extended plane or car travel should be postponed for a month after the procedure.



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