Veins, Veins, Veins: Understanding Your Options

By Dr. Charles Ross, M.D

What to do about leg veins? Varicose veins, spider veins, and veins in between. At the Louisville Vein Care Institute, we see them all.

Venous problems are very common. About 40 percent of women and 25 percent of men have varicose veins, and most everyone has a spider vein or two. Varicose veins may be simply unsightly, or they may be associated with significant symptoms. In 2010, patients have more choices for minimally invasive and highly effective therapy.

Varicose veins are bulging, ropey, snaky superficial blood vessels that are visible in the tissues beneath the skin. Spider veins are smaller, tubular blood vessels that occur in tree-like, spider-web, and starburst patterns in the thighs, calves and ankles. Spider veins frequently are associated with larger varicose veins. Normal veins have valves that keep blood flowing in one direction: toward the heart. Varicose veins form when valves deteriorate, allowing blood to flow downhill and pool in the leg. Symptoms include leg fatigue, burning, throbbing, heaviness, and tingling discomfort around the bulging veins.

Swelling may occur. The most severe cases of varicose veins may be associated with skin pigmentation and chronic skin ulcers around the ankles.

Varicose veins are more common in women than in men. Women frequently report the appearance of varicose veins at the time of first pregnancy and worsening of varices with each additional pregnancy. Women often experience worsening of symptoms before and during menstruation. There is definitely a hormonal influence. Other risk factors for varicose veins include heredity, age, a history of blood clots, and a history of previous trauma. Whether or not occupations such as nursing, teaching, or being beautician causes varicose veins is a topic of debate, but prolonged standing certainly may worsen the symptoms.

Patients may pursue many options when varicose veins appear. Self-therapy should include the use of venous support hose made by companies such as Sigvaris or Jobst. These are available at drug stores but also on the Internet. Regular walking exercise should be pursued to allow the muscles to improve venous clearance of blood from the legs. Nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen may control the pain.

Patients also may seek medical evaluation by a vascular specialist. This is especially advised when varicose veins are associated with significant pain, blood clots, skin rashes, ulceration or significant swelling. A vascular specialist will take a detailed history, perform a careful examination of the legs with the patient standing, and will record the findings. A venous ultrasound will be done to rule out the presence of blood clots, to document reversal of blood flow through bad valves (reflux), and to measure the diameters of the affected veins. Insurance companies demand a trial of conservative management when simple varicose veins are first diagnosed. So patients should not be disappointed if they are first treated with prescription support hose. At the Louisville Vein Care Institute, evaluations are performed in a private and timely manner.

Today’s options available for therapy when conservative measures fail have revolutionized therapy for varicose veins. Many readers will recall parents or grandparents who endured extensive stripping procedures. Times have changed. We treat most cases of varicose veins through endovenous laser or radiofrequency therapy, and this often is performed in the office under oral sedation and local anesthesia. This therapy involves the introduction of a catheter into the vein under the guidance of ultrasound. The catheter then is activated and closes the vein – thus stopping the reflux. This therapy is highly effective. Branch varices are treated, when necessary, through micro-phlebectomies involving small incisions and plucking of the varices. Recovery times are brief — often less than 48 hours.

Spider veins are treated by injection of sclerosing solutions, applications of laser or thermal energies, or combinations of both. In general, when spider veins are associated with varicose veins, best results are achieved when the varicose veins are eradicated first. Temporary use of strong support hose is important for the achievement of best results with spider vein treatment. Strict cooperation with post-treatment care instructions produces best results.

Many women suffer from spider veins alone. While spider veins are not dangerous, their appearance can be unsightly. Spider veins also may cause burning or cramping pain. Large spider venous complexes may require multiple treatment sessions for the safest and best cosmetic results. Patients should discuss post-treatment care routines and expectations for the need for additional treatment sessions with their vein care physician.

We have recently introduced the “Veinwave,” a new technology for small spider veins and matted veins. Veinwave treatment is simpler than sclerotherapy and is effective for the tiny spider veins that can be difficult to treat with traditional sclerotherapy.

Options available for the correction of varicose and spider veins continue to improve. At Louisville Vein Care Institute, treatments are tailored to the needs and desires of each patient.

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Dr. Charles Ross is Chief of Vascular Surgery and Endovascular Therapeutics in the Department of Surgery at the University of Louisville School of Medicine, Medical Director of Louisville Vein Care Institute and a vascular surgeon with University Surgical Associates. A native of western Kentucky, Dr. Ross served as Director of Endovascular Surgery at Vanderbilt University from 2006 – 2009. Prior to that, Dr. Ross practiced vascular and endovascular surgery as a partner in Vascular Specialists of Surgical Group, P.S.C. and Medical Director of the Lourdes Vascular Center in Paducah, KY. To make an appointment with Dr. Ross, please call University Surgical Associates at 502.583.8303.




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