Varicose Veins

These are superficial veins located close to the surface of the skin that have become stretched and dilated (bulging in appearance). These are located predominately in the legs.

What causes Varicose Veins?
Weak vein valves allows blood to collect in the veins. This collecting of the blood causes the veins in the lower leg to stretch, becoming thinner, and twist. Fluid may eventually seep out of the veins into surrounding tissues and cause leg swelling.

Signs and Symptoms of Varicose Veins:

  • Purple, bulging, or uneven appearance of superficial surface veins in the legs.
  • Dull heavy ache in the legs after standing for a long period of time.
  • Leg swelling
  • Pain with standing
  • Dark pigmentation changes around ankle area.

What are the Risk Factors for Varicose Veins?

  • Family history of varicose veins
  • Obesity
  • Pregnancy
  • Prolonged Standing
  • Deep vein thrombosis (DVT) – blood clot in the deep vein
  • Trauma to the vein

Treatment of Varicose Veins:

  • Avoid prolonged standing – if you must stand, flex your feet and move your ankles in a circle.
  • Elevate your lets about the level of your heart.
  • Wear support stockings or filled elastic support stockings prescribed by your physician.
  • This will relieve symptoms and prevent the conditions from becoming worse.
  • Weight control – extra pounds cause increased pressure on the venous system in the lower extremities.

Laser Ablation
Endovenous laser ablation (ELA) is a technique for treating saphenous vein reflux without a major operation.  Like vein stripping, Laser ablation eliminates reflux through the saphenous vein and is considered a permanent fix.  Unlike stripping, this new procedure does not require general anesthesia: it is done through a skin puncture so small it doesn’t even require a stitch.

How does it work?
The word “endovenous” means inside the vein. An endovenous procedure is one that is done from the inside, rather than from the outside. Laser Ablation uses the same type of laser energy we’ve all seen in penlights and pointers. When this energy is delivered to the inside of a vein, it heats the vessel wall and seals it closed.

Step-by-step
After the skin is numbed with local medications, a tiny laser fiber (the size of a piece of spaghetti) is introduced into the saphenous vein near the knee.  It is guided through the vein to the groin using an ultrasound machine (you can’t feel this).  The vein is then surrounded with a small amount of fluid, again using ultrasound guidance and a small needle.  The laser is turned on and pulled back through the vein, treating the entire length of the abnormal vessel in approximately three minutes.  A band-aid is placed on your knee and you will be assisted in applying your compression garment.

Is it painful?
The area is numbed for the procedure which should eliminate any pain you may experience. Placement of the fluid around the vein requires a needle placed through the skin. However, the skin is first treated with local numbing, so this is not particularly painful. The fiber inside the vein is completely painless, as is the laser treatment itself. During recovery, which takes about two weeks, you may have some bruising and cramping. This is usually mild and responds well to over-the-counter medications like ibuprofen or Tylenol. Most people are able to return to work immediately.

Don’t I need my vein?
In a normal leg, the greater saphenous vein carries less than 10 percent of the blood going to the heart. When it starts flowing backwards, the saphenous vein carries no blood to the heart. In fact, by carrying blood the wrong way, it actually makes other veins work harder. Closing the saphenous vein actually makes blood return better, not worse.

What if I need a vein for bypass surgery?
Most surgeons will not use a refluxing saphenous veins for bypass. The vein is enlarged and scarred, and generally makes a poor choice for use as a bypass graft.

Will it work for me?
Nothing of course is guaranteed. However, if you have large, painful varicose veins, swollen legs, or leg wounds that are slow to heal, you may very well be a candidate for vein ablation. In order to know for sure, you will need to have an ultrasound examination of your veins. This is an important step in evaluation venous disease, and will be useful no matter what kind of vein treatment you have.

Does it treat spider veins?
If your symptoms are limited to small spider veins, Laser ablation may be more than you need. However, if your spider veins are caused by saphenous veins reflux, and the saphenous vein is not treated, the spider vein will likely come back. Again, ultrasound examination is a very useful study in deciding the best course of therapy. You may need separate treatment for the spider veins after the completion of the laser ablation.

Who does the procedure?
Laser ablation is performed by our physicians of the Vascular Group, who are trained to do the procedure.  These physicians perform many Laser ablation procedures every year.

Will my insurance cover it?
Almost all insurance companies will cover vein treatments that are medically necessary. That is, those conditions that cause pain, bleeding, non-healing wounds, or that significantly impact the patient’s quality of life. Some insurance companies will only cover surgical vein stripping, but many will also cover laser ablation. Some insurance companies will only cover surgery if there was a trial of six months of compression therapy. If vein ablation is right for you, our staff will work with you to determine your coverage.

Surgical Treatment for Varicose Veins

Step-by-step

Vein Excision
For this procedure you will have multiple incisions along the vein. Every 2-3 inches or so a very small incision will be made and the vein removed. These will not require stitches.

Vein Stripping
An ultrasound is usually performed prior to this procedure to determine in your main superficial vein the greater or lessor saphenous vein have reflux. This means the valves do not close properly, thus allowing blood to flow back down the leg. If this is the case, they would need to remove these veins as well as obvious varicosities. The other superficial veins are branches of these, and if they are not working properly, they will cause new varicose veins to form.

This procedure is done using general or spinal anesthesia.  It is done as an outpatient.  For stripping of the greater saphenous vein you generally will have an incision in your groin and possibly down by your ankle where the vein will be removed.  For the lesser saphenous vein you will have an incision on the back of your leg below your knee.  You will note bruising and hardened areas along the area where the vein was removed.  This is normal, and will be absorbed by your bode over the next month or so.

Subfacial Endoscopic Perforator Vein Surgery (SEPS)
This type of surgery is generally done if you have a history of stasis ulcers and an ultrasound demonstration incompetent perforating veins. This will be done under general (you will sleep) or spinal anesthesia. Two to three incisions will be made in the upper calf. One of the incisions is for the endoscope to be inserted. Carbon dioxide is inserted through the scope to cause better visualization of your veins.

The second incision is for the doctor to perform the surgery.  In this procedure, the incompetent perforated veins are clipped.  If the surgeon is unable to perform the procedure endoscopically it can be done open.  In this case the surgeon will make an incision along the posterior or medial aspect of the leg.  The perforating veins are directly ligated.

What will happen post-operatively?
After these procedures are performed, your leg will be wrapped with a gauze bandage and then an ace bandage. You will need to be on bed rest for two days following this surgery, with the ace bandage in place. You may get up and use the bathroom but when you are lying or sitting down your leg should be elevated. After two days the gauze and ace bandage may be removed to shower, but then the ace bandage needs to be reapplied daily for one week.

You will need to make an appointment for a postoperative visit two to three weeks after the operation.

Is this painful?
You will not feel anything during the procedure. Post operatively you will be given pain medicine to make you comfortable. When you leave the hospital you will receive a prescription for pain medicine as well.

Don’t I need my veins?
In a normal leg, the superficial veins carry less than 10 percent of the blood going to the heart. When it starts flowing backwards, the saphenous vein carries no blood to the heart, in fact, by carrying blood the wrong way, it actually makes other veins work harder. Closing the saphenous vein actually makes blood return better, not worse. As far as the other veins are concerned, for every vein you see there are probably ten others that you don’t.

What if I need a vein for bypass surgery?
Most surgeons will not use a refluxing saphenous vein for bypass.  The vein is enlarged and scarred, and generally makes a poor choice for use as a bypass graft.

Will it work for me?
Nothing of course is guaranteed. However, if you have large, painful varicose veins, swollen legs, or leg wounds that are slow to heal, you may very well be a candidate for vein ablation. In order to know for sure, you will need to have an ultrasound examination of your veins. This is an important step in evaluation venous disease, and will be useful no matter what kind of vein treatment you have.

Does it treat spider veins?
If your symptoms are limited to small spider veins, Laser ablation may be more than you need. However, if your spider veins are caused by saphenous veins reflux, and the saphenous vein is not treated, the spider vein will likely come back. Again, ultrasound examination is a very useful study in deciding the best course of therapy. You may need separate treatment for the spider veins after the completion of the laser ablation.

Who does the procedure?
Laser ablation is performed by our physicians of the Vascular Group, who are trained to do the procedure.  These physicians perform many Laser ablation procedures every year.

Will my insurance cover it?
Almost all insurance companies will cover vein treatments that are medically necessary. That is, those conditions that cause pain, bleeding, non-healing wounds, or that significantly impact the patient’s quality of life. Some insurance companies will only cover surgical vein stripping, but many will also cover laser ablation. Some insurance companies will only cover surgery if there was a trial of six months of compression therapy. If vein ablation is right for you, our staff will work with you to determine your coverage.

Sclerotherapy

Step-by-step
This is an outpatient procedure that is done in the doctor’s office. A chemical is injected into the vein causing the walls of the vein to stick together. Cotton balls are put over the injection sites, and then the leg is wrapped with an elastic bandage or ace wrap. This is done by a physician or nurse practitioner.

You may drive home after the procedure.  Once you are home you are to remain on bed rest with bathroom privileges for 2 days with your leg(s) elevated.  After that time you may remove the bandage, shower, and resume your normal activity.  You should reapply the bandage and wear for 5 more days.  You may experience some degree of swelling.  If you do, you may loosen the elastic bandage to relieve the pressure, when you reapply it, be sure it is snug, not loose.  The vein that was sclerosed may be felt as a hard cord.  This is normal and may take a few months to disappear, so be patient.

Is it painful?
Depending on the solution used you may experience some burning during the procedure.  The only thing we ask is that you do not move your leg while we are injecting.  If you need a break we will stop for a while.

What are the potential side effects of Sclerotherapy?
You may develop skin pigmentation (brown/yellow color) in most cases this fades over time but you may have this indefinitely. Skin ulcerations (sores on the skin) may occur. These are not common and will heal, however you may have a tiny scar. You may be allergic to the solution that is injected, however this is very rare.

Will it work for me?
Nothing, of course, is guaranteed. However, we hope that it will improve any symptoms that you have and get rid of the veins you would like to have dissipated. The important thing to remember is that although your “troubled” veins may be gone that does not mean you will not get another varicose vein.

Does it treat spider veins?
Spider veins are varicose veins and sclerotherapy does treat them.

Who does the procedure?
A physician or nurse practitioner.

Will my insurance cover it?
Almost all insurance companies will cover vein treatments that are medically necessary. That is, those conditions that cause pain, bleeding, non-healing wounds. Some insurance companies will only cover surgery if there was a trial of six months of compression therapy. Our staff will work with you to determine your coverage.

Comments are closed.