What are veins?
Veins are blood vessels that carry blood back to the heart. The leg contains two sets of veins, the deep veins inside the muscle and the superficial veins that lie just under the skin. There are two main superficial veins; the greater or long saphenous vein which runs down the inside of the thigh and calf; and the short or lesser saphenous vein which runs down the back of the calf. There are also innumerable superficial veins that drain into these two veins. Valves in the veins prevent the blood from falling back to the feet in the standing position.
What are varicose veins?
If the valves are weak or break, blood collects in the veins in the lower legs. The pressure of this blood distends the veins making them bulge and become tortuous. When this happens to veins in the superficial system we refer to the as varicose veins. Varicose veins can be located anywhere but are usually found in the legs.
Common Questions about varicose veins
What causes varicose veins?
The cause of varicose veins remains unknown. Standing for long periods of time may contribute to varicose veins. As women are affected more often than men are, female hormones may play a role. A strong family history of varicose veins may also be a factor.
Do varicose veins cause pain?
Many patients with varicose veins remain symptom-free, or at most, have a sense of fullness and discomfort after standing for a long time. Some varicose veins may become painful during the menstrual period. Swelling of the ankles, itching and bleeding are much less common symptoms. Some patients ultimately develop serious swelling and a brown discoloration of the lower ankle sometimes associated with an ulcer. This complication is more commonly the result of a previous phlebitis (blood clot) in the veins. Sometimes phlebitis can occur in a varicose vein. Unlike such blood clots in the deep veins of the leg, a superficial phlebitis in a varicose vein usually does not pose a risk to the patient’s health.
Is it safe to remove the varicose veins?
Most blood flow takes place in the deep veins. Varicose veins involve the superficial system so treatment to remove the veins is very safe. Even the main saphenous veins can be removed without any functional impairment. This is the reason that these veins are used by vascular and heart surgeons as artificial arteries for coronary or leg artery bypass operations.
What are “spider veins”?
Spider veins are not true varicose veins; rather, they are large and ugly skin capillaries. Most patients seek treatment of spider veins for cosmetic reasons.
Can I do anything to prevent varicose veins?
You probably will not be able to prevent varicose veins if you are predisposed to getting them, for example:
– A family history of varicose veins
– Prolonged standing
However, you may help alleviate the discomfort caused by varicose veins by:
Avoiding prolonged standing. If you must stand, flex your feet or stand on your toes 2-3 times per minute.
– Elevating your legs above your heart for 1/2 hour 2-3 times daily.
– Controlling your weight.
Can varicose veins cause ulceration of the ankles?
Open sores of the ankle region can result from varicose veins although this is unusual. Usually, this problem only occurs when the patient also has leaking valves in the deep veins of the leg. The treatment for these ulcerations involves compression to squeeze the blood back to the heart. Dr. Samson has developed a new treatment for these ulcers. It is called the Jobst UlcerCare® and is used worldwide.
How are varicose veins and spider veins treated?
This operation used to be the standard method of treatment for varicose veins. These days it is very rarely required. In this procedure the entire saphenous vein is removed. The procedure requires general anesthetic and some days’ recuperation. It is generally reserved for patients who have such severe varicose veins that they develop discoloration or ulceration of the skin at the ankle or if the visible varicose veins are the saphenous itself. All of these circumstances are unusual. Some surgeons will always remove this vein as part of vein treatment whereas others will try to spare it so that it can possibly be used by heart or vascular surgeons in the future as an arterial substitute.
This procedure also known as Ambulatory Stab Avulsion Phlebectomy (ASAP) is a revolutionary new treatment. In this simple procedure varicose veins are removed through 1/8″ incisions. No stitches are necessary. Surgery is performed on an outpatient basis under local anesthesia and scarring is minimal or non-existent. Results are immediate and normal activity can be resumed promptly. Procedures take from 15 minutes to 2 hours.
Saphenous Vein Ligation
Sometimes the main superficial vein, the saphenous vein, has a leaking valve. In order to get maximum benefit of other vein treatments this vein must be tied. This procedure is performed in an outpatient surgery center under local anesthesia with or without mild sedation. The incision is only about an inch long and is placed just above the groin crease so that it cannot be seen. Plastic surgery techniques with absorbable stitches are used to close the incision. It takes 20 minutes and patients can return to normal activity immediately. It does not result in any pain and the stitches are absorbable.
Laser Ablation (ELVS®, VenaCure®)
This new treatment has revolutionized our ability to treat varicose veins where the main superficial vein (the greater saphenous vein) is contributing to the continued enlargement of the varicose veins. Previously, this would have involved a stripping operation or saphenous ligation. However, with this technique the saphenous vein can be obliterated in the office. The laser fiber is inserted using a simple injection technique often without any incisions. Under ultrasound guidance it is pulled back out of the vein with the tip of the laser fiber heating the blood. The heated blood causes the vein to scar down and ultimately disappear. The procedure is performed in the office under dilute local anesthesia which not only prevents pain but also cools the surrounding tissue so that the laser energy does not damage surrounding tissues. Patients can drive themselves home after the procedure. They do have to wear a surgical stocking for a week and there may be some bruising but discomfort is minimal and responds to anti-inflammatory medicines such as Celebrex® which is routinely used for one week after the procedure. Most patients return to work the next day. Most insurance carriers will pay for this procedure if it is medically necessary. Complications of blood clots or numbness on the inside of the leg are very rare.
The injection of an irritant solution into the varicose vein. The solution causes the vein walls to “stick together”. Blood flow is routed to other veins, and the body absorbs the varicose vein. Stockings are worn, for two days after spider vein injection and three weeks after varicose vein treatment, to compress the vein walls together during the healing phase.
A new treatment involving light to obliterate the veins. It is also useful in removing age spots, tattoos, and unwanted hair. A special machine uses brief bursts of intense light to destroy the vein wall. Although advertised by many as painless most patients state that it feels like they are being hit by a rubber band. It is best used to treat very small veins or those that are left over after injection therapy.
Venous Ablation (VenaCure™, Venefit™, VenaSeal™)
Saphenous Vein Ligation
Are there any complications?
New techniques have made the treatment of varicose and spider veins very safe. Although life-threatening complications such as blood clots or allergic reactions are theoretically possible they are exceedingly rare and none of our patients has ever suffered one of these events. After vein injections, troublesome brown staining may result. Sometimes tiny new spiders in the form of a blush can occur.
Both of these can be treated but in some cases they may be permanent. A very rare complication is a painful open sore at the injection site that may heal with a pale scar. Photoderm® can burn the skin or decrease the amount of pigment in the skin causing pale marks. Microphlebectomy may be followed by a painful superficial, not dangerous inflammation of the saphenous vein. Before you undergo treatment, the doctor will explain all side effects and discuss potential risks with you.
How much will it cost?
Treatment of varicose and spider veins begins with an initial consultation. This first visit will include a review of your symptoms, examination of the veins and a full explanation of the treatment options available. You will receive a written cost estimate of the treatment options. Varicose vein treatment costs range and may be covered by insurance.
Spider vein treatment varies per session. Because the procedure is cosmetic, insurance may not cover spider vein treatment.
Regardless of treatment method or type of veins treated, a surgical compression stocking will be required. Ultrasound scanning of the venous and/or arterial systems may also be needed. This is usually covered by insurance.
Rarely, patient treatment will need to be performed in an outpatient surgery center. This will add to the cost. This will be covered by insurance if the entire procedure is covered.