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WHAT ARE VARICOSE
VEINS?
Varicose Veins are abnormally enlarged blood vessels in which
blood has pooled. They usually are bluish in color, and may
appear twisted. They are very common on legs, especially among
women. The tendency to develop varicose veins is thought to be
linked with heredity. Women, especially those who have had
children, and men and woman who spend a lot of time standing
seem to be most susceptible to developing varicose veins.
WHAT ARE SPIDER VEINS?
Spider veins are small varicose veins that appear as bluish or
reddish lines just under the surface of the skin.
WHAT CAUSES VARICOSE & SPIDER VEINS?
Veins are the blood vessels through which blood flows back to
the heart. Blood that flows into the legs must circulate and
then return to the heart. Because the blood needs to flow
uphill and against gravity, the veins in the lower part of the
body must work hard to move the blood back to the heart.
Valves in the veins normally allow the blood to flow toward
the heart, and prevent the backflow of blood. If these valves
weaken and cannot perform their job, blood may pool in the
legs, causing veins to bulge and dilate. When blood pools in
the larger surface veins, the result can be the blue, bulging
type of varicose vein. When this happens to the tiny veins
just below the skin surface, the result can be spider veins.
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ARE VARICOSE VEINS DANGEROUS?
Varicose veins are not usually dangerous, and some people have
no symptoms. In many people, however, the varicose veins are
associated with pain, aching, itching, burning, a heavy or
tired feeling in the legs, swelling or cramps.
In rare
cases, varicose veins may signify serious underlying disease
of the deeper veins, and if this is a possibility, it may be
recommended that you undergo further evaluation. |
WHAT IS THE TREATMENT FOR VARICOSE VEINS?
Treatment for varicose veins can involve taking steps to
relieve the symptoms, or removing or eliminating the
troublesome veins. Anyone with varicose veins or with a family
history of varicose veins may want to consider wearing support
or compression stockings to provide support for the veins and
to keep them from dilating abnormally. The stockings will also
provide symptomatic relief. It is especially important to
provide this support when lifting heavy objects. In addition,
when possible, the legs should be elevated to keep blood from
pooling. Regular exercise, such as walking, will keep the
blood moving and will help squeeze blood up from the lower
legs. Although these suggestions may lessen symptoms or help
prevent new varicose veins from forming, they will not cure
varicose veins that have already formed.
Varicose veins can be eliminated or removed by several
methods. One treatment involves removing the veins during a
surgical procedure performed under anesthesia. The operation
involves surgically removing the troublesome veins from the
leg. This surgical removal is only necessary in extreme cases
when the veins are just too large or numerous to treat in the
office.
Another treatment that has grown very popular is sclerotherapy.
This is very successful in eliminating the spider veins and
many of the larger varicose veins. This may involve one or
more sessions of treatments.
If the varicose veins are large, bulging and grape-like in
nature there are several options for removing them. Depending
on the location of the veins and the size you may require EVLT
laser removal, ligation or phlebectomy. All of these
procedures are done right in the doctor’s office with no
restrictions afterwards and without surgery.
HOW DO I KNOW WHICH PROCEDURE IS BEST FOR ME OR EVEN IF
TREATMENT IS NEEDED?
Before undergoing any treatment or procedure a complete
medical history and examination will be done. Circulation and
vein structure in your legs will be assessed using
sophisticated non-invasive diagnostic or ultrasound
techniques. We will explain the disease process and the
circulation system. This consultation will help determine the
most effective method of treatment, if any, to eliminate your
varicose or spider veins. We will fully review the recommended
treatment, what results are expected, whether more than one
visit of treatment is needed, what the procedure entails and
what to anticipate along with post treatment instructions. If
you are not experiencing any pain or problems from your veins,
then treatment may not be necessary. Instead you may best
benefit from a more conservative approach. This will most
likely involve wearing some form of a compression or support
stocking. Patients noted a significant decrease in their pain,
swelling and symptoms while wearing these stockings. It will
not only help with any symptoms but it also supports the
venous system and helps prevent any further varicose veins
from developing. We will not recommend any treatment to any
patient who does not need it or if it is not warranted. If a
patient has a varicose vein but it doesn’t necessarily cause
any distress or complications then we may prefer a more
conservative method. In other words, if treatment is not going
to benefit you or provide a better lifestyle than we will not
perform any unwanted or unnecessary treatment. We pride
ourselves on doing what is best for the patient. We will
discuss any concerns or questions you may have.
WHAT IS SCLEROTHERAPY?
Sclerotherapy is a non-surgical procedure that involves
injecting a solution into the vein. This solution is called
Sotradecol and is FDA approved and has been extremely
effective for over 60 years. This solution causes the walls of
the veins to stick together, preventing the blood from pooling
in the vein and thus forcing the blood flow from the
dysfunctional vein to veins that are functioning efficiently.
IS SCLEROTHERAPY PAINFUL?
One of the benefits of sclerotherapy is that it is a virtually
painless procedure. Because the veins that are to be injected
lie just beneath the surface of the skin, tiny needles can be
used for the treatment. You may feel a slight pinch or sting
during the injections, similar to pulling a strand of hair.
IS SCLEROTHERAPY EFFECTIVE FOR ALL VARICOSE VEINS?
Sclerotherapy alone will be effective for spider veins and
many varicose veins. In many cases with the larger varicose
veins a recommendation will be to ligate, (tie off) excise or
remove the larger veins. This procedure, performed by a
surgeon, enhances the effect of sclerotherapy. Again, this is
a simple office procedure without restrictions or surgery. In
some cases however, the vein is just too large or there are
too many to remove comfortably in the office. It is best, in
these few cases, that surgical removal would be best and most
comfortable to the patient.
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WHAT IS EVLT LASER?
EVLT is the latest laser procedure. It is a minimally invasive
laser procedure performed right in the office. It is used to
eliminate the larger varicose veins located in a specific
area. The veins are located via ultrasound guidance. |
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After local
anesthetic is applied a thin laser fiber is inserted through a
tiny entry point, usually around the knee. Laser energy is
delivered to seal the faulty vein. If you are a candidate for
the EVLT laser procedure we will discuss this with you at your
visit
WHAT IS LIGATION OR PHLEBECTOMY?
Also a non-invasive office procedure, ligation and/or a
phlebectomy is used to disrupt or tie off a vein. Simple
office testing will determine if you require any ligations or
phlebectomy. It is done to disrupt the flow of blood feeding
into other areas. The procedure consists of marking your leg
at the areas where there are points of maximum reflux. (Reflux
means the backflow of blood down the leg.) A local anesthetic
is used and then the area is tied off, excise, or stitch at
the perforating vein.
HOW LONG DOES THE PROCEDURE TAKE?
The initial consultation usually takes about an hour. For
sclerotherapy, in most cases, take just 20 minutes. For the
larger varices the office procedure may take anywhere from ½
to 1 hour. The length and number of treatments needed to
complete the therapy depend, however, on the number and size
of the veins. In most cases treatment can be completed after
just a few visits.
ARE THERE ANY SIDE EFFECTS FROM THE TREATMENT?
Side effects from sclerotherapy are very rare and are almost
always mild if they occur. Possible side effects may include
slight itching, skin discoloration at the injection site, a
firm or hard lump beneath the skin, especially in the larger
varicose veins, slight tenderness or redness over the treated
area. Some patients have an adhesive or latex allergy that may
cause a reaction either with the procedure, the gloves or
sutures used in some procedures or sometimes with the
compression stocking. If you have or feel you may have
sensitivity to these products please inform the office so we
can take the appropriate measures to avoid any possible
reaction.
WHAT SHOULD I DO FOLLOWING THE TREATMENT?
When spider veins are treated using sclerotherapy, a stocking
or ace wrap bandage is applied over the leg and will remain
for 24-48 hours. For larger varicose veins, with sclerotherapy,
you may need to wear the compression stocking for a period of
5 days up to 2 weeks. This length of time will depend on the
size of the varicose vein. If you undergo an office ligation
or phlebectomy then the stocking will remain on for one week.
This stocking is crucial in the healing process and success of
the treatment. You will be able to resume your normal work and
recreational activities immediately.
HOW LONG WILL IT TAKE FOR THE TREATED VEIN TO DISAPPEAR?
Veins that have been injected will fade gradually as the
solution causes them to shrink, harden, and then disappear.
The length of time necessary to see results will depend on the
size of the vein and the pigmentation of the skin. With the
larger veins requiring ligation or phlebectomy patients noted
a remarkable difference in the size of the vein usually within
2-3 weeks. In some cases, after a patient undergoes ligation
or phlebectomy, sclerotherapy is not even needed or perhaps
just a few tiny injections are required. Over the next few
months the vein will disappear as it is being reabsorbed.
WILL MY INSURANCE PAY FOR THE TREATMENT?
Insurance companies vary widely on coverage so it is best to
check with your insurance carrier to see if treatment is
eligible. Most insurance companies cover the cost of the
initial consultation and testing, even if the treatment is
not. Generally, for problematic varicose veins insurance
companies will cover the cost of treatment. Once you are
evaluated through the office we will review medical necessity
and insurance policies regarding coverage for treatment. We
will let you know if we feel your insurance will cover the
treatment and whether or not any type of prior authorization
or pre-certification is needed. If we feel your treatment may
not be covered by your insurance we will review any possible
fees for treatment.
WHAT IS
PHLEBITIS?
Phlebitis is the inflammation of a vein wall, and is the most
common problem associated with varicose veins. Symptoms
include:
This can be easily
treated at our office. If you feel you have or may have a
phlebitis do not hesitate to contact our office for an
appointment.
WHAT IS SUPERFICIAL THROMBOPHLEBITIS?
Superficial Thrombophlebitis is a blood clot in a superficial
(surface) vein that can be caused by irritation or are similar
to, but more severe than those associated with phlebitis. Our
office can also treat this condition. Sometimes an ultrasound
or other venous testing will be recommended to rule out a DVT
or to evaluate for reflux or abnormalities. If you are
concerned or feel you may have this symptom do not hesitate to
call us for an appointment.
WHAT IS DVT?
A Deep Vein Thrombosis or DVT is a blood clot in one of the
deep veins, which can have life-threatening consequences.
About 25% of DVTs move away from the deep veins where they
form and flow through the bloodstream to the lungs. This is
known as a pulmonary embolism, and can cause death. Symptoms
can include:
Pain and
tenderness in one leg
DVTs can also
occur with no symptoms. If you are concerned that you may have
a DVT please contact either our office, your primary-care
physician or local Emergency room. An ultrasound and
evaluation can diagnosis this condition. Sometimes
hospitalization is required so do not hesitate if you feel you
may have a DVT. If you have a history of DVT it is highly
recommended that you wear a special compression stocking while
flying or during long trips to prevent a DVT from developing.
WHAT IS CHRONIC VENOUS INSUFFICIENCY?
Chronic venous insufficiency is a condition in which the veins
are constantly congested with pooled blood, causing
circulation to be significantly impaired. Some symptoms may
include one or more of the following:
Edema (swelling)
Feeling of
heaviness in the legs
Pain or cramps in
the calves
Uncomfortable
puffiness of the feet and or ankles that subsides during the
night
Skin
discoloration, dermatitis (skin problems)
Dry or weeping
eczema
Venous leg ulcer
Venous
insufficiency is the disease that leads to varicose veins.
However some patients can have venous insufficiency but not
exhibit any signs of varicose veins. Wearing compression
stockings helps to support this venous insufficiency,
alleviate symptoms and help prevent varicose veins or new
varicose veins from developing.
WHY & HOW DO COMPRESSION STOCKINGS WORK?
Compression therapy means wearing socks or stockings that are
specially designed to support your veins and increase
circulation in your legs. The socks or stockings are normally
put on in the morning upon arising, and removed at night.
Throughout the day the compression they provide prevents blood
from pooling in leg veins, thereby helping overall
circulation.
Remember that the heart attempts to pump blood against gravity
in the veins of the legs, and as a person walks, the regular
contraction and relaxation of the calf muscles around the
veins are necessary to help the heart move blood up the legs
efficiently. But, it is unlikely that a person will walk
continuously throughout the day-most of us sit or stand some
of the time. Also, some people have inherited weakness of the
vein walls or valves, which create additional challenges to
venous circulation. This is why wearing compression socks or
stockings is vital for the treatment or prevention of varicose
veins and other circulatory problems, especially for
individuals who are at risk.
There are several brands, sizes and styles of compression
stockings. They are available in socks, knee-hi's, calf high,
thigh high, full length and pantyhose. They come in a variety
of colors and materials. There are different levels and
strengths of compression, from the mild to heavy surgical
strength.
We can determine the degree of compression that you require
based on your condition. Compression stockings:
Support distended
or stretched veins
Prevent blood from
pooling in the veins
Speed up a
sluggish blood flow
Force fluid out of
swollen legs and ankles and back into circulation
Are versatile,
comfortable and attractive
ARE THERE WAYS
I CAN GET BETTER BLOOD FLOW?
Yes, you can play your part with these six easy steps to
better blood flow:
1. Avoid sitting or standing for long periods of a time.
Exercise, especially walking, contracts and relaxes the calf
muscles. The regular contraction and relaxation of these
muscles act like a "second heart" as the veins are alternately
squeezed and released, causing blood to be pushed towards the
heart, thereby improving blood flow.
2. When is it
necessary to sit or stand for a long time, rock your feet up
and down. This exercise simulates the beneficial effects of
walking and promotes venous circulation.
3. Elevate your
feet. Elevating your feet above the level of the heart several
times each day helps venous blood fight the effects of
gravity.
4. Avoid excessive
heat, such as sunbathing and very hot baths. Heat dilates
veins, reducing effective circulation and increasing the
pooling of blood.
5. Control your
weight. Excess weight burdens the entire circulatory system.
6. Wear graduated
compression socks and stockings. This improves venous
circulation and can prevent and treat venous problems.
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