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:

• Swelling

• Redness and heat in the irritated area

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