What causes varicose and spider veins?
- Heredity is a major factor in developing varicose and spider veins. Other conditions that can further aggravate the problem are obesity, pregnancy, hormone replacement therapy, injury or an occupation in which you are standing or sitting for long periods of time.
What can I do to prevent them?
- Although you cannot entirely prevent varicose and spider veins, there are certain lifestyle changes and conservative measures that can improve the overall health of your veins. Physical activity, which can pump blood up the legs against gravity and improve venous circulation, is important. This can be accomplished with walking, cycling and swimming. Additionally, wearing compression stockings will prevent blood from pooling in the veins in your legs.
Are varicose veins dangerous?
- Venous insufficiency tends to be progressive. If left untreated, it becomes gradually worse over time and leads to more complications such as skin discoloration, varicose vein pain, swelling and venous ulcers which could bleed.
Why do I need an ultrasound scan?
- Finding the source of blood flowing in the wrong direction (reflux) is an essential step in treating diseased veins. A color Doppler ultrasound scan provides a visual and functional map of your veins and blood flow. It allows your doctor to pinpoint the root cause of the reflux in the diseased vein, deep below the skin surface. The ultrasound is painless and is performed by an experienced vascular ultrasonographer. Results are reviewed and confirmed by your interventional radiologist.
Are the treatments painful?
- The treatments are well tolerated by patients with adequate local anesthesia, a comforting environment and our supportive staff. On occasion, patients are given a mild oral sedative to mitigate anxiety and help with relaxation.
What can I expect during these vein treatments?
- A brief, targeted ultrasound will be performed and the appropriate markings will be placed on the lower extremity as needed. The lower extremity will be prepped in a sterile fashion and local anesthesia will be administered for ambulatory phlebectomy and endovenous laser procedures. Sclerotherapy utilizes such tiny needles that no local anesthesia is generally required. At the end of the procedure, the appropriate dressings are placed followed by application of compression stockings, which must be brought with you to every appointment and procedure. You will walk around our office for 15 to 20 minutes and are then discharged with comprehensive discharge instructions and a follow-up plan.
How many treatments do I need?
- This will depend on your history, physical exam and ultrasound results. The general principle is to treat the source of the reflux first and address the consequences of the reflux second. A typical treatment approach involves performing endovenous laser treatment to close the main refluxing vein. This will typically be followed in a separate session by ambulatory phlebectomy to remove the superficial varicose veins, if present. Lastly, sclerotherapy is performed to address spider veins and their feeding reticular veins. Typically, sclerotherapy sessions are at least 4 weeks apart (if multiple sessions are needed).
Will my varicose veins come back?
- It is important to realize that vein disease is not curable but manageable. Development of new varicose and spider veins within months to years after successful treatment does not constitute treatment failure. Rather, it demonstrates the reality that venous insufficiency is a chronic condition.
When can I go back to my normal activity after treatment?
- You can return to work the next day, but will be asked to walk and avoid sitting for long periods. Vigorous exercise and weight lifting are discouraged for the first week after treatment. Long periods of immobility such as those that occur with flights and long car rides are discouraged for a couple of weeks post treatment. Sun protection after ambulatory phlebectomy and sclerotherapy is advised to reduce the chance of skin discoloration.
Are there side effects from these treatments?
- The vast majority of side effects and complications are minor and include skin discoloration, skin blistering, local pain and discomfort, and local superficial phlebitis. More serious complications such as infection, deep vein thrombosis, hematoma, ulcer and nerve injury are very rare.
How will it affect my circulation if these abnormal veins are removed or sealed off?
- The veins we are treating are diseased and malfunctioning. By eliminating them and reducing the pooling of blood, your venous circulation will improve through your remaining healthy superficial and deep veins.
Many years ago, I had varicose vein surgery but my varicose veins came back. What treatment can be offered to me now?
- After surgical ligation and stripping, the body may form new venous channels that can lead to new visible and symptomatic varicose veins and spider veins. Treatments that can be offered include ambulatory phlebectomy and sclerotherapy (visual and ultrasound guided) depending on the location and extent of the recurrence.
Will insurance cover these vein treatments?
- Most insurance companies will cover the cost of treatment of symptomatic vein disease as long as medical necessity is documented based on your medical history, physical exam and ultrasound. Some may require a defined period of conservative management before they cover the treatments. Our knowledgeable office personnel will work with your insurance company to secure precertification for the treatments. If the procedure is deemed cosmetic, most insurance companies will not cover the treatment. Our office will work with you on a suitable payment plan as needed.
What are Interventional Radiologists?
- Interventional radiologists are board-certified, fellowship-trained physicians who specialize in minimally invasive, targeted treatments. They offer the most in-depth knowledge of the least invasive treatments available coupled with diagnostic and clinical experience across all specialties. They use X-rays, ultrasound, CT and MRI scans to advance a catheter in the body, an artery or a vein, to treat the source of the disease non-surgically. Interventional radiologists pioneered minimally invasive modern medicine. Today, many conditions that once required surgery can be treated non-surgically by interventional radiologists.
Interventional radiology treatments offer less risk, less pain and less recovery time compared to open surgery. Interventional radiologists have a wealth of experience in treating veins. The broad range of procedures includes placing specialized venous catheters, venous angioplasty and stenting, dissolving venous clots, and thermal and chemical ablation of diseased veins.
Would you like to learn more about your veins?
- These professional organization websites offer excellent, reliable information:American Venous Forum: www.veinforum.orgAmerican College of Phlebology: www.phlebology.orgSociety of Interventional Radiology: www.sirweb.org
Only after such a thorough examination can your physician tailor an appropriate venous insufficiency treatment plan. This may include different treatment modalities that complement each other and will likely be performed over a few sessions.