Role of Veins
Our heart pushes blood through arteries to carry oxygenated blood to the body. In return, the veins collect the deoxygenated blood and return it to the heart. Veins in the leg, unlike arteries, carry blood back to the heart against the force of gravity. They rely on leg muscle contractions and one-way valves inside the veins to carry the blood back up against gravity. Valves inside the vein allow for blood to flow up, but close to prevent flow backward toward the feet. In the legs, about 85% of the blood is returned to the heart in the deep veins. These large veins are deep in the muscles. As the leg muscles contract, the veins are squeezed and blood flows up and out of the leg. The remaining 15% of blood is returned in the superficial vein system. These systems lie just beneath the skin. Varicose veins are part of the superficial vein system.
What are Varicose Veins?
Varicose veins are enlarged, weakened, dilated veins that have permanently lost their ability to carry blood from the legs back up to the heart against the force of gravity. This is usually a result of valve failure or excessive dilation of the vein. Consequently, blood in these veins cannot overcome the force of gravity and backward flow results. We refer to this flow as venous reflux. As the blood falls back down the leg and pools due to gravity, the veins overfill giving them their typical unsightly bulging appearance. Varicose veins cause tired, heavy, aching, throbbing, swollen legs which are typically worse at the end of the day. Nighttime leg cramps and leg restlessness (sometimes called Restless Leg Syndrome) are also very common problems caused by varicose veins. Treatment of the diseased veins will often eliminate these symptoms. If left untreated, varicose veins always worsen over time, and may lead to the formation of blood clots (thrombosis), inflammation of the vein (phlebitis), inflammation of the skin (dermatitis), and finally skin ulceration.
What Causes Varicose Veins?
Up to 25% of the adult population suffers from varicose veins. Heredity is the number one contributing factor. A genetic tendency causes veins to dilate over time leading to valve failure. The greater this genetic tendency the sooner it will happen. So regardless of treatment, if you have a strong hereditary predisposition, you will probably form new problems as time goes on. Women are three times more likely than men to suffer from abnormal leg veins. Other contributing factors include pregnancy, obesity, hormone-containing medications, standing for long periods, and traumatic injury to the leg. In most cases, little can be done to prevent varicose veins from forming, but if effective treatment is given early in the course of the disease, complications can be prevented and symptoms relieved.
How are Varicose Veins Treated?
The procedure or combination of procedures recommended is based upon the extent of your specific condition and your overall health and age. The treatment plan is determined by patient symptoms and history, physical exam findings, and duplex ultrasound findings. The doctor will perform a duplex ultrasound examination to assess the severity and extent of your vein disease, most of which may not be visible on the surface of the leg. Without an accurate ultrasound map of your veins we cannot determine the source of your problem or treat it effectively. Please refer to the sections on Duplex Ultrasound and Treatment for more information.
Normal leg veins work against gravity taking blood from the legs back to the heart. One-way flow valves in leg veins help prevent blood from flowing backwards, or refluxing, toward the feet. When these valves malfunction and backward flow occurs, it is called venous reflux or venous insufficiency. A superficial vein that refluxes is called a varicose vein. This backward flow causes veins to bulge and become symptomatic. Reflux causes legs to feel heavy, achy, tired, and swollen, especially at the end of the day. Other symptoms include burning, itching, and throbbing. After years and years of reflux, the chronic high pressure in the veins may cause skin changes such as increased pigmentation, skin texture changes, and even venous ulcers.
Your individualized treatment plan will be specifically designed and tailored for the extent and severity of your specific condition. Here are a few important aspects to remember. First, most patients require a combination of treatment options for thorough treatment. Second, if the endovenous laser ablation and/or ambulatory phlebectomy are recommended, only one leg can be treated at one time. Third, a series of treatments over several appointments may be necessary. Finally, all treatments are performed in our office. Some procedures are performed under local anesthesia while others require none. Patients should return to normal activity the same day, or the following day..
We use the following varicose vein treatments:
EndoVenous Laser Treatment (EVLT (R))- The Endovenous Laser Ablation procedure is performed right in the office under local anesthesia. This procedure eliminates the same veins (saphenous veins) that were previously treated with surgical stripping. With ultrasound guidance, a thin laser fiber is inserted into the vein through a tiny incision in the calf and advanced to the top of the vein. After placement of local anesthetic around the vein, the laser is turned on which delivers heat to the vein wall, causing it to heat, collapse, and seal shut. Patients are able to walk immediately after the procedure and most patients return to work the next day. In some cases, other treatments including ambulatory phlebectomy and endovenous chemical ablation are used in combination with endovenous laser ablation to achieve the best possible results. Following treatment, patients wear prescription-strength compression stockings for three weeks.
Endovenous Chemical Ablation - Also known as ultrasound-guided sclerotherapy, endovenous chemical ablation is another treatment alternative to surgical removal of varicose veins. This procedure aims to eliminate varicose veins that are hidden from the naked eye and only seen by ultrasound. Here, a chemical irritant, called a sclerosant is injected into the vein while the doctor observes the injection process on the ultrasound screen. The sclerosant damages the lining of the vein wall, collapses the vein, and eventually leads to the body reabsorbing the destroyed vein. The sclerosant can come in a liquid or foam form. Patients are required to walk immediately after the procedure and return to normal activity that same day. Following treatment, patients wear prescription-strength compression stockings for three weeks.
Ambulatory Phlebectomy- Ambulatory Phlebectomy, microphlebectomy, or “hook” phlebectomy is a micro-extraction procedure used to remove bulging varicose veins, both large and small, which are close to the surface through very small (1/16-1/8 inch) micro-incisions. The micro-incisions are so small that they seldom require a stitch. Once healed, they are rarely visible. Bruising will occur and will take a few weeks to go away. A compression stocking is worn for 21 days after the procedure. Once removed, patients are amazed how good the leg looks with the “ropey” veins gone. Patients can return to normal daily activities including work the next day and walking is encouraged.Pictures courtesy of the Society of Vascular Surgery (VascularWeb.org) and Society of Interventional Radiology (SIRweb.org).