Frequently Asked Questions About Varicose
Veins
How do healthy veins work?
Veins are the blood vessels that carry
blood back to the heart as it circulates through the body.
In healthy leg veins,
one-way valves keep the blood flowing in one direction and
prevent backflow. Superficial veins in the legs lie close
to the skin. Deep veins carry blood within the leg muscles.
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What are spider veins and varicose
veins?
Small veins in the skin that appear web-like
and red, blue or purple in color, are called spider veins,
sunburst varicosities,
telangiectasia or venous stars. Varicose veins are enlarged,
bulging, twisted, and often darker in color than spider
veins.
Varicose veins and spider veins can affect women and men
of any age, but they are most common in women of childbearing
age or older.
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What causes them?
Varicose veins and spider veins occur when the one-way valves
in the blood vessels no longer work right, which lets blood
collect in the veins instead of flowing back to the heart.
This makes the veins widen, becoming unsightly and uncomfortable.
Most commonly, varicose veins near the skin surface are
caused
by leaky valves in veins deeper in the leg. Untreated, varicose
veins typically worsen over time.
The most common site for the origin of vein problems
in the leg is the saphenofemoral junction (SFJ), where
the
great
saphenous vein that lies fairly close to the skin joins
the common femoral vein that runs deep in the leg. Failure
of
valves high and deep in the leg often have a domino effect,
increasing pressure in nearby veins and leading to failure
of valves in those veins.
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What symptoms indicate a problem?
People with spider veins and varicose veins often describe
their legs as feeling heavy and tired, and may be bothered
by throbbing, swelling, burning, aching and itching. The
ankles or legs may swell if fluid leaks into surrounding
tissue. Severe varicose veins can affect the skin, leading
to itching, inflammation or leg sores, called ulcers.
Because varicose veins have thin walls and protrude from
the surface of the leg, they are more prone to being
injured.
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Can I do anything to lessen the problem?
You may relieve your symptoms by elevating your legs,
wearing support compression stockings, and avoiding long
periods
of sitting or standing. In addition, we recommend exercise
to keep blood flowing through the veins, and controlling
your weight, which reduces pressure in the legs.
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What medical treatments are available?
Medical treatment aims to correct the condition causing
varicose veins, rather than simply relieve symptoms or
smooth over
a cosmetic problem. To fix the underlying cause, doctors
close down or remove veins with faulty valves that are preventing
efficient circulation of the blood. Newer medical treatments
to eliminate spider and varicose veins provide good results
with faster recovery, minimal discomfort and little disruption
of your normal daily activities.
These minimally invasive treatments include closing the
veins by injecting them with an irritating foam or fluid
(sclerotherapy)
or by heating them with a laser (laser endovenous catheter
ablation). Both procedures can be performed in the doctor’s
office. For some patients, sclerotherapy is used alone, but
in most cases, a combination of treatments will provide the
best results.
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How does laser treatment work?
Endovenous Laser Therapy, also called laser endovenous
catheter ablation (laser EVCA), uses laser energy to
heat the vein
wall, causing it to shrink and close off. The procedure is
performed in the doctor’s office. Typically only a single
laser treatment is required. Laser therapy is usually combined
with sclerotherapy to fully treat varicose and spider veins.
Before the procedure, you will be given a mild sedative
to relax you, and local anesthesia will be used to numb
the area.
You’ll wear special eye goggles to protect against
accidental exposure to laser light.
During the procedure, a small laser fiber is inserted
into the faulty vein and positioned with ultrasound guidance.
Laser treatment requires just a tiny puncture or incision,
so there’s
minimal risk of scarring. Patients report only very mild
discomfort.
Following treatment, you can resume normal daily
activities
immediately, except to avoid aerobics, jogging or prolonged
periods of sitting and standing for the first 48 hours.
Compression stockings should be worn for two weeks. During
the healing
process, while the vein collapses and closes off completely,
the skin will appear discolored and bruised, which may
last three to six weeks.
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What should I expect with sclerotherapy?
Sclerotherapy, or injection therapy, is a common treatment
for spider veins and smaller varicose veins that remain
after any larger problem veins have been eliminated with
laser therapy or surgery. In sclerotherapy, foam injected
into a faulty vein causes scar tissue to form and close
off the vein. As a result, surface veins are no longer
visible, and symptoms subside.
A small needle is used to inject the foam, which irritates
the varicose vein, causing scar tissue to form and close
off the diseased vein. The Vein Clinic uses polidocanol
foam,
which is more effective than other solutions at closing
off diseased veins, and causes less discomfort, allowing
higher
doses and longer sessions. The result is fewer treatments
for patients. In most cases, two or three sessions are
required to treat an affected area.
The injection needle is tiny and causes minimal discomfort.
In light-assisted sclerotherapy, a special light is
placed over the skin to illuminate veins near the skin
surface.
In echosclerotherapy, ultrasound is used to locate and
treat varicose veins deeper in the leg.
Following treatment, your legs may be wrapped to compress
the vein and compression stockings will be prescribed
for a few weeks. You can go about your normal daily
activities as desired, except that for the first 48
hours you should
avoid prolonged sitting and standing, aerobics or
jogging. Your legs may be tender and possibly intermittently
painful for several days after treatment, which can
be eased with
walking.
The skin will appear discolored and bumpy during the
healing process, while the vein completely closes
off, which may
last as long as six weeks. In some patients, residual
pigmentation of the skin in the area of the vein
remains after treatment.
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What does surgery involve?
Surgery performed in an Operating Room or Surgical Clinic
is another option for treating varicose veins.
Ligation involves tying off a diseased vein and its branches.
In stripping, a surgeon removes a long segment of the
diseased vein. Any remaining varicose veins are then eliminated
using
traditional hook-like instruments or a small electrically
powered surgical device. The latter procedure, called
transilluminated powered phlebectomy, allows the surgeon
to view the vein
with a light passed under the skin.
Surgery may be performed under spinal or general anesthesia,
and does not require a hospital stay. Only a single
treatment is needed. Typically the vein can be removed
with fewer
incisions than in traditional surgery, allowing a faster
recovery and
better cosmetic results.
Within a week or two following the stripping surgery,
most patients resume their normal activities. Compression
dressings
or stockings are required. You should avoid jogging or aerobics
or long periods of sitting or standing for five to seven days.
Patients may see bruising and lumpiness beneath the incisions
and experience some numbness, tingling, or intermittent pain,
which will resolve during the next 12 to 16 weeks.
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What’s involved in planning my treatment?
To thoroughly diagnose your problem, we’ll take a
medical history, asking questions about your symptoms and
lifestyle
and listening to your concerns. A doctor will then examine
the affected areas.
We use duplex ultrasound to develop a
map of your veins that will guide any needed treatment. Ultrasound
evaluates
blood
flow in your veins to determine the direction and speed
of its movement through various veins.
Your treatment plan will depend on careful diagnosis of
your condition, the size and number of veins to be treated,
and
your medical history. Any problems with larger, deeper
veins must be treated first, or treatment of surface
veins will
not succeed. Photos will be taken before and after every
treatment session.
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How do I know which treatment is right for me?
During your appointment, we’ll explain the treatment
options, their risks, benefits and costs, and what to expect
during the treatment and recovery period. We encourage you
to ask questions and express any concerns you may have.
Our board-certified surgeons are trained to diagnose underlying
causes of your problem and provide the best medical care,
not just cosmetic treatment for the surface condition.
Because The Vein Clinic at Vascular Associates, P.S. has experience
with a full range of treatments for vascular problems,
we
will advise the therapy that offers you the best possible
results.
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What experience does The Vein Clinic have in treating these
problems?
During their many years of experience, Dr. Brian Lange and
Dr. Roman Wong have treated thousands of patients. The surgeons
have been recognized by their peers as tops in their field
in both national and local publications, such as Seattle
magazine and “Guide to Top Doctors” published
by the national consumer watchdog group, the Center for Study
of Services.
Dr. Brian Lange has been performing vascular surgery since
1990 and serves on the teaching staff of Swedish Hospital
Medical Center. Dr. Lange is a fellow of the American College
of Surgeons and is certified by the American Board of Surgery.
He earned his medical degree from the University of Washington
School of Medicine in 1984, followed by his general surgery
residency at UW Medical Center and Swedish Hospital Medical
Center. Dr. Lange completed his vascular surgery fellowship
at Lahey Clinic Medical Center in Boston in 1990.
Dr. Roman Wong has focused his practice exclusively on vascular
surgery since 1984. A member of the faculty of Swedish Medical
Center’s Surgery Residency Program, Dr. Wong is certified
by the American Board of Surgery and is a fellow of the
American College of Surgeons. After earning his Medical
Degree from
the University of Maryland School of Medicine, Dr. Wong
completed his general surgery residency in 1983 at Swedish
Hospital
Medical Center and his vascular surgery fellowship in 1984
at St. Paul’s Hospital in Vancouver, B.C., affiliated
with the University of British Columbia.
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What results can I expect?
After the faulty veins are eliminated, the remaining healthy
veins take over carrying blood from the legs, which relieves
symptoms such as pain, fatigue and itching. The appearance
of your legs improves because the swollen, twisted veins
are eliminated. The number of treatments and rate of skin
clearing varies with each patient and depending on the
particular procedure. Please refer to the description of each
procedure
for details.
Treatment results in noticeably clearer skin, enabling
patients to once again enjoy wearing shorts and swimsuits.
While no
treatment can return your legs to their appearance at
age 16 or prevent new spider or varicose veins from appearing,
the risk of recurrence is minimized by treating the underlying
cause.
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Does insurance cover these treatments?
Insurance coverage is generally limited to diagnosis of
a condition and to procedures that are considered medically
necessary. Typically, this includes catheter ablation
and
surgery, but not sclerotherapy. We will work with you
to determine whether this applies in your case.
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Can I be treated during pregnancy?
Varicose veins that develop during pregnancy are usually
caused by hormonal changes and the pressure of the growing
fetus,
and generally improve on their own after childbirth. They
should be evaluated, however, to rule out the possibility
that a blood clot deep in the leg is causing them. A blood
clot would require immediate treatment.
During pregnancy, the recommended treatment for varicose
veins is to wear compression stockings. After childbirth,
the veins
can be evaluated to determine whether medical treatment
is advised.
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Are there treatments for varicose veins that The Vein Clinic
doesn’t offer?
The Vein Clinic at Vascular Associates, P.S. does not perform
ambulatory phlebectomy (removing surface varicose veins
through many tiny punctures). The doctors’ experience
shows that endovenous laser treatment combined with sclerotherapy
provides better results for patients with minimal pain and
less downtime.
We no longer offer endovascular catheter ablation using
radiofrequency energy, sometimes called the closure procedure.
The Vein Clinic
has achieved better results for patients with laser endovenous
catheter ablation than with radiofrequency.
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Does The Vein Clinic treat facial blemishes with these techniques?
No. In some cases, the same procedures used to treat spider
veins in legs can be used on birthmarks and facial blemishes.
Because The Vein Clinic’s expertise is with the vascular
system and not dermatology, however, we will refer you to
a skin specialist or plastic surgeon with the experience
to provide the best care for your particular condition.
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