ALL ABOUT VEINS

Frequently asked questions

This page has been provided for your information and to answer frequently asked questions about a variety of venous problems. However it does not replace a formal consultation with a vascular specialist, who will be in a better position to answer your questions fully.

VARICOSE VEINS

Q: What are varicose veins?

A: Varicose veins are tortuous dilated superficial veins. They can be extremely prominent and range from minor dilations of a vein to a large bunch of grape-like structures. They can be associated with discoloration of the skin and ulceration around the ankle.

Q: What causes varicose veins?

A; Increase in the diameter of a vein results in the malfunction of valves inside the vein. The valves are designed to prevent blood from flowing backward in the vein. An inherited weakness of the vein wall ( genetic) and circulating hormones that relax the smooth muscle of the vein wall are the most common causes. Females have high levels of such hormone, the hormone progesterone.

 Pregnancies, obesity, age, hormone replacement therapy, the use of female oral contraceptives as well as occupations that require a standing position are additional causes of varicose veins. Since females usually have multiple risk factors for the development of varicose veins, about three fourths of the persons who have varicose veins are women and 25% are men.

Q: Are varicose veins considered purely cosmetic?

A: No, varicose veins can be unsightly, but most patients complain of not only the appearance, but of symptoms relating to them. These symptoms include aching, throbbing,  tingling, tired legs, pain while standing, ankle swelling and cramps.

VARICOSE VEIN TREATMENT

Q: Who should receive treatment for varicose veins?

A: Anybody with varicose veins should receive treatment, irrespective of whether their complaint is simply cosmetic or a combination of cosmetic and symptoms. Varicose veins are a slowly progressive condition and will get worse with time. Although the veins may be causing very little trouble at this stage they will with time. They may eventually lead to significant skin changes, and in a few patients, ulceration.

Q: Can I be cured of my varicose veins?

A: Varicose veins are a problem that can be successfully treated. However the underlying disorder cannot be permanently cured. The treatment of the abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need to return for maintenance treatments after their initial treatment is completed.

Q: What does treatment of varicose veins involve?

A: Before you undergo treatment you will require a formal assessment. This involves a clinical examination and a noninvasive venous ultrasound (no needles). The venous ultrasound involves looking at the flow of blood through the legs, checking to see if the valves in the veins are functioning normally and identify where the underlying anatomic cause for the varicose veins have arisen.

Once you have been formally assessed the treatment option will be presented to you. These include wearing elastic stockings, injection treatment or minimal invasive surgery options. Early varicose veins can be managed very successfully by injection treatment. Injection treatment involves injecting an irritant substance into the veins, such that vein walls stick together. Following the injection you will be asked to wear elastic stockings for up to 2 weeks to assure a permanent closure and successful outcome.

If you have bigger veins or veins that are filling because of incompetent valves you would be better treated with one of the minimal invasive treatment options. These include either laser ablation ( EVLT) or VNUS closure followed by miniphlebectomy. You will be given a choice and the final decision remains yours.

Q: How will the blood in my veins get back to my heart after the varicose vein procedure?

A: Normal blood flow direction in the veins is towards the heart. The backward flow of blood in varicose veins and main superficial trunks, the great saphenous vein (GSV) and the small saphenous vein (SSV) actually interfere with the normal venous return of blood. Removal of these areas of abnormal circulation improves circulation of blood in the treated limb. The blood will then be rerouted back to the heart through the remaining healthy veins. It is this change in limb circulation that causes improvement of symptoms of tiredness and heaviness in the limb.

Q: What are laser and radiofrequency sealing of veins?

A: Light energy (laser) or electrical energy (radiofrequency) may be used to seal shut abnormal main superficial trunk veins. Both treatments involve the application of heat energy to the inside of the great or small saphenous veins. Usually treatment of the great saphenous vein (GSV) starts at a location in the vein at or below the knee. The GSV is then treated from its junction to the deep system at the level of the groin down to the entry site near the knee.

Q: Why can’t I just have the varicose vein branches injected or removed if the main superficial trunk is abnormal?

A: For the treatment of the visible varicose veins to last a long time, the source that may not be visible to the naked eye must be treated as well.

From a practical standpoint some insurance carriers will not pay for the treatment of branch varicosities if an abnormal main trunk is not treated at the same time or before the branches are treated.

Q: What is a duplex ultrasound examination?

A: The venous duplex examination permits your doctor to see the anatomy and check the flow characteristics of the vein beneath your skin. Useful information is gathered that your physician can use to adequately diagnose your specific vein problem and to plan and guide treatment.

Q: What is sclerotherapy?

A: Sclerotherapy is the treatment of varicose veins by injection of medications that cause destruction of the veins. The treatment is simple. A tiny needle injects the veins with a medication that irritates the lining of the vein. Over a short time, in response to the irritation, the vein closes and is reabsorbed.

Q: What is ultrasound-guided sclerotherapy?

A: Visual sclerotherapy refers to injection of surface veins that are visible to the naked eye. Some veins that need to be treated are below the surface of the skin and cannot be injected safely, without the aid of ultrasound imaging guidance.

Q: Is sclerotherapy safe?

A: Most patients do not experience any complication from sclerotherapy. However, some patients develop changes in skin pigment in the location where the veins are injected. Some patients may experience burns of the skin while a rare patient may develop an allergy to the medication. Serious complication such as deep vein blood clots and unintentional arterial injection occur rarely

Q: Why do doctors recommend compression stockings?

A: The properly fitted compression stocking can temporarily reverse the effects of vein disease and lessen the discomfort and prevent any further skin damage. Many insurance companies require a trial of compression stocking use before approving definitive therapy.

Your physician will often after treatment, both surgery and injection therapy, recommend compression stocking to assure a successful outcome of your procedure.

Q:  Is treatment for varicose veins covered by my insurance?

A: Most insurance companies will cover the treatment for varicose veins, as long it is not done for cosmetic reasons only.

SPIDER VEINS

Q: What are spider veins?

A: A tiny varicose vein that may be blue or red color that does not protrude above the skin surface. They often look like spiders. Telangiectasias and telangiectatic veins are other common used terms for spider veins. Slightly larger veins that protrude above the skin are called reticular veins.

Q: How do I get my spider veins treated?

A: First it is important to exclude an underlying cause. In particular if you have spider veins at the ankle your vascular specialist may request a venous ultrasound. The ultrasound will determine if the blood is flowing in the wrong direction because of damaged valves in the bigger veins. Treating the surface veins in the presence of underlying vein problems result in them returning quite quickly. If you have a problem with the underlying veins then this should be treated first, to ensure that you get the best possible result following the treatment to your surface veins.

Q: What treatments are available for surface veins?

A: Both microsclerotherapy and laser can be used to treat spider veins.

Q: What is microsclerotherapy?

A:  Microsclerotherapy involves an injection using a very fine needle. The needle is inserted into the small vein and an injection of a sclerosant solution is given. The sclerosant solution damages the vein wall and makes the vein walls sticky. In response to this irritation, the vein closes and is reabsorbed. This process often takes several months.

Q: How does laser work for spider veins?

A: Laser treatment is used primarily in the treatment of the smallest spider veins or broken capillaries on the leg or face. Lasers emit a specific wavelength of high energy pulsed light, delivered in variable durations. After the energy passes through the skin, the light is absorbed by the red blood cells in the spider vein. The energy is then converted to heat, thereby injuring the vein wall. Within a few weeks the spider vein seals and disappears from site. 

TRAVELERS THROMBOSIS

Q: Am I at risk for development of blood clot while flying and how can I prevent them?

A: Passengers who fly long distance are at risk of developing small clots in their legs. In a recent study researchers detected small leg vein clots in 12 out of 100 passengers flying long distance. All these clots were small and in most passengers dissolved without treatment. We still do not know how many passengers will go on to get a larger clot, either affecting the leg on a long term basis, or traveling to the lung. In the same study another 100 passengers were fitted with Class 1 elastic compression stockings and none of these passengers developed any blood clots.

In summary, passengers who fly long distance are at risk of developing small clots. The use of elastic compression stocking is an effective way of reducing this risk.