Varicose Veins

These are dilated or swollen veins usually in the leg. They appear as bulged and twisted veins under the skin. They are more common in women (25% of all women). They can be hereditary. Varicose veins are caused by poor function of valves on the inside of vein walls. Blood then flows in the wrong direction or refluxes and causes bulging of smaller veins causing them to become varicose veins. Varicose veins can cause an aching or discomfort in the legs. Rarely, they can become tender or clot and very rarely they may bleed. They are also rarely the underlying cause of chronic leg swelling (Chronic Venous Insufficiency) and even ulcers or wounds. Treatment options are leg elevation, pain medications, compression stockings, sclerotherapy or injections, laser vein ablation or vein stripping.

 

SCLEROTHERAPY:

A small varicose vein (2-4 millimeters) is injected with a solution (Sotradecol) that causes the vein to clot. A tiny needle containing the solution is injected into the vein. The vein is then compressed, clots and resolves. The procedure is done in the office and as the needle is tiny no anesthesia is necessary. It is recommended that compression stockings be worn afterwards for 4 weeks. No time off work is necessary. Vigorous exercise should be avoided for one week. Complications are rare but include skin discoloration, blood clots skin ulceration and allergic reaction. Most insurance companies do not cover this procedure.

COMPRESSION STOCKINGS:

These are moderately tight elastic stockings that are used for patients with varicose veins, chronic venous insufficiency, lymphedema, etc,. Compression stockings are designed to be tighter at the ankle than at the knee and thus push blood towards the heart. They come in a range of pressures: 8-15, 16-20, 20-30 and 30-40 millimeters of mercury. They come in different lengths: Knee high, thigh high and pantyhose. They also come in a range of colors. Many patients do not tolerate them during the summer. However in the last several years they have become sheerer for women and look like dress socks for men.

BEFORE

AFTER

LASER VEIN ABLATION:

This is the most popular procedure used to treat large varicose veins (>5millimeters). It is done instead of vein stripping. No cut/incision is made in the leg. A needle is inserted into the main vein under the skin called the saphenous vein, after giving some local anesthesia. A thin wire followed by a laser catheter is then inserted through the saphenous vein and passed up to the groin. Ultimately, the laser is turned on and used to burn the vein from within. Clots, shrivels up and dissolves. This treatment prevents the pooling of blood within this vein that contributes to the development of varicose veins. The varicose veins shrink over four to six weeks. The procedure is done in the office with mild sedation only. The patient is advised to take off work for a few days up to one week.

VEIN STRIPPING:

This is an open surgical procedure wherein an incision is made at the groin and at the ankle or knee. A device (the stripper) is passed inside the main subcutaneous vein called the saphenous vein. The vein is then pulled out under the skin. The leg is wrapped to prevent leg swelling or bleeding. This is sometimes done in conjunction with excision of the varicose veins (stab avulsion or phlebectomy) and results in resolution of the varicose veins. It is done in the Operating Room and requires a general or spinal anesthetic.

CHRONIC VENOUS INSUFFICIENCY:

This is a condition where blood pools in the veins of the legs due to poor function of the valves within the veins. It can result in discomfort or pain, leg swelling, skin color changes, hardening of the skin or breakdown of the skin resulting in ulcers. It can occur in patients who have had a previous blood clot or DVT. Patients who are significantly obese are also at risk of developing this. It is diagnosed with a Doppler Ultrasound. Treatment includes compression stockings, moisturizers to treat /prevent dry and cracked skin, treatment of any varicose veins if present as outlined above, treatment of wounds as outlined in the wounds segment, vein bypass or venous valve repair are rarely performed. Angioplasty/stenting of occluded or narrowed veins is also very occasionally needed.

TREATMENTS