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Frequently
Asked Vein Therapy Questions
What are
varicose veins?
Varicose Veins are unusually 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.
It's thought that how
likely you are to get varicose veins depends on heredity. Women,
especially those who have had
children, seem to be mostly likely to develop them. Men
who spend a great deal of time standing also seem more likely
to develop them.
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What are spider veins?
Spider veins are small varicose veins that appear as bluish or
reddish lines just under the surface of the skin.
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What causes varicose and 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. If this is a possibility, it
may be recommended that you undergo further evaluation.
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How are varicose veins treated?
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 ligation or phlebectomy. All of these
procedures are done right in the doctor's office with no
restrictions afterwards and without surgery.
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How do I know if I need treatment?
Which treatment is best for me?
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.
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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.
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Does sclerotherapy work on 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 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.
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How long does sclerotherapy 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.
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Are there any side effects from vein
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.
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What should I do after I have received
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.
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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.
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Will my insurance pay for vein treatments?
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:
Superficial veins become more noticeable and there is pain or
discomfort over the involved area.
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.
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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.
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What is deep vein thrombosis?
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
Swelling in one leg
Increased warmth and redness in one leg
Shortness of breath and fainting
Pain in the chest
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.
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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.
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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
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