Varicose Veins

Questions and answers from Dr Fleck about how Varicose Veins form:

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 sudden death from pulmonary embolism. This is 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.

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.

Can varicose 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 therapy.

What treatments are available for varicose veins?

A new procedure called endovenous laser ablation, or EVLA, has been available to treat varicose veins for about seven years now. 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 same day. EVLA is a safe and effective procedure that is replacing the older technique of surgical vein stripping. A similar procedure is also very useful called ClosureFast which uses radiofrequency instead of laser heat.  This procedure is often done for smaller perforating veins of the lower legs. 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 a 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.  For this reason, your doctor may recommend you wear knee high compression hose while at work, especially if you are employed in a standing occupation.

Will my varicose vein treatment be very painful?

The degree of pain that a patient experiences during varicose 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 only pain that is felt are several needle sticks.  The laser fiber is not painful even during heating of the vein since your vein is numbed with local anesthesia before the procedure.  The amount of pain is dependent on several variables, such as age, sex, weight, and pain tolerance level.

If you suffer from “needle phobia” let your doctor know you would prefer to be medicated with an antianxiety drug like Valium before the procedure.  You will be unable to operate a motor vehicle for 24 hours after the procedure if you take Valium.

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.   Blood clots and nerve injury are extremely rare occurrences after this type of treatment.

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

Most patients return to their normal routine the same day, however, you should not resume aerobics, heavy exercise routines, running, sports or travel for at least a month after your laser treatment. It’s 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.

Extreme exercise workouts should not be resumed for 4-6 weeks after these procedures so that your veins have time to heal.

Long car rides or air travel should also not be undertaken for at least a month after these procedures.  It is recommended to take a baby aspirin before air travel and walk about the plane every thirty minutes to improve the circulation in the leg veins.

Does insurance cover the procedures?

Yes. These are medically necessary procedures. Without treatment, you may be at risk for worsening symptoms of pain, blood clots, and skin changes including leg ulcers.

For further questions, contact our office at 928-778-7000.