Frequently asked questions about varicose veins

What are varicose veins?

Varicose veins are twisted, enlarged veins, often dark blue in color, which are near or raised above the surface of the skin. Varicose veins are often a symptom of an underlying condition called venous insufficiency.

In healthy veins, one way valves direct the flow of the venous blood is upward and inward. Blood is collected in the superficial small veins and flows into the larger veins. The blood eventually passes through valves into the deep veins and then centrally to the heart and lungs. When one or more of these valves fails to function correctly or leaks, some blood flows down the leg, in the reverse direction. The blood tends to overfill and distend the branches of the superficial veins under the skin.

Over time the veins stretch, bulge and become visible. These engorged or rope-like veins, are called varicose veins. The valves inside these veins no longer close, allowing blood to leak back down the leg causing more distension of the vein.

How do I know if I have varicose veins?

Early symptoms of varicose veins include:

• Pain in legs with a feeling of tiredness and heaviness in the lower legs
• Swelling of the ankle and lower leg
• Discolored, brownish skin near the ankle
• A rash or skin ulceration at the ankle or lower leg
• Visible enlarged veins
• Knotted, twisted veins tending to be deep bluish in color
• Skin surrounding the varicose vein may itch or burn

Left untreated, varicose veins can lead to swelling, increased pain, skin discoloration, and ulcerations of the lower legs. These ulcerations are difficult to treat and can become easily infected and painful.

What factors can lead to varicose veins?

• Heredity
• Gender – Primarily due to the production of progesterone, a female hormone
• Age – As we age, elastic fibers in all tissues deteriorate leading to dilated and tortuous blood vessels
• Obesity – Excess weight increases the pressure on the vein valves and can lead to weakening.
• Hormones – Changes in hormone levels brought on by puberty, pregnancy, menopause, hormone replacement therapy and birth control pills
• Pregnancy – Increased volume of blood in the body and increased pressures on the pelvic veins are all contributors
• Occupation – Prolonged sitting during the job can lead to venous insufficiency

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Frequently asked questions about spider veins

What are spider veins?

Spider veins are red and purple blood vessels that occur in patches on the legs and face. Spider veins and varicose veins are not the same and one does not lead to the other. Whereas varicose veins are large, swollen and occur singularly on the legs, spider veins are delicate and then to develop in clusters. Although spider veins do not produce symptoms, the feeder veins deeper in the skin may cause discomfort.

Spider veins do not pose a health threat. Though they can cause aching and discomfort, spider veins are primarily a cosmetic problem.

How do I know if I have spider veins?

Common symptoms associated with spider veins may include:

• Dull generalized aching
• Throbbing pain
• Night cramps
• Tiredness
• Burning tingling
• Heaviness in legs
• Complaints may worsen with menstruation and warmer weather

Relief of these symptoms may come with walking or elevating the legs. It's important to remember that many people complain of no symptoms at all.

 What is factors contribute to spider veins?

• Heredity
• Occupations that involve prolonged standing
• Obesity
• Hormonal influences during pregnancy
• Use of oral contraceptives
• Post menopausal hormone replacement
• Prolonged sitting with legs crossed
• History of blood clots

Other minor factors are: topical steroids, trauma or injury to the skin, exposure to ultra violet rays

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Frequently questions about sclerotherapy

What is sclerotherapy?

Sclerotherapy is a technique which involves the use of a very fine needle to inject a solution directly into the veins. The solution causes the lining of the vein to swell, eventually sealing off the blood vessel and preventing blood flow. Prior to treatment a medical history is taken.

Larger veins are usually treated first. After the skin is thoroughly cleansed with alcohol, a syringe with a tiny needle is used to inject a small amount of sclerosing (hardening agent) into the vein. The solution displaces the blood within the vein, causing it to blanch or turn white. The solution then causes the vessel to become irritated and swell shut, prohibiting the blood from re-entering the vein. When the needle is withdrawn, pressure is immediately applied to the area. The skin may be kneaded to help disperse the solution and reduce bruising. Each vein may require 1-5 injections and most disappear in two weeks to several months.

Am I a candidate for sclerotherapy?

As long as someone is not on any blood thinners and does not have an allergy to the sclerosing agent, she is a candidate who has spider veins or varicose veins.

How many treatments will I need?

The number of treatments depends on the size of the area to be treated. It is unrealistic to expect 100% clearance of spider veins or reticular veins. Usually after 1-3 treatments you will see a visible improvement - but this varies from patient to patient.

Is sclerotherapy painful?

A very tiny needle is used to inject the solution into the vein. You may feel some mild stinging, burning, and/or an itching sensation after the sclerosing agent is injected into the vein.

How long will the treatment take?

Depending on the area to be treated, the procedure can take anywhere from 15-30 minutes. Generally a treatment does not last longer than 30 minutes.

When can I resume my normal activity?

You will be required to wear medical grade compression hose for 3-5 days. With the exception of weight lifting and jogging, you may resume your normal activities. You should avoid these types of activities for 5-7 days.

Will I need to take any pain medication?

You may experience an itching and burning sensation which should diminish by the next morning. Tylenol is usually sufficient to ease the pain.

Are there any complications?

You may experience bruising which can range from mild to large dark purple areas which may take several days to weeks to disappear. You may also notice a red streak or redness at the injection site- this is called phlebitis and can be treated with Tylenol and an ice pack. You may, after the procedure, get hemosiderin staining, a brownish discoloration of the skin along the vein that was injected. If you experience this, please avoid direct sunlight and use an SPF of 20. Hemosiderin staining can be treated with Intense Pulse Light(IPL) treatments which will lighten the discoloration. You may experience trapped blood which is old blood that is retained in the veins after the injection of the sclerosing agent. The area may feel hard and lumpy and may be tender to touch, and is usually associated with mild bruising. If this condition persists, it can easily be treated at the follow-up visit by removal of the old blood by needle prick.

What can I expect after the procedure?

Patients are usually advised to resume normal activity immediately, although vigorous activity is discouraged for 24 hours. You will be required to wear compression hose for 3-5 days.

Most patients experience no adverse effects; however some minor side effects have been reported. These might include slight blistering which occurs when small amounts of the solution seep into the surrounding area. Some patients experience staining which is a discoloration of the skin where the veins were injected. This may resolve in time or respond to bleaching agents or treated with Intense Pulsed Light treatments. Occasionally there are allergic reactions to the solution which are treated immediately with antihistamines and other medications.

In some cases, spider veins recur and new spider veins present themselves. When large veins are treated, wearing support hose is recommended to prevent their recurrence.

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Frequently asked questions about Endovenous Laser Therapy (ELT)

What is the ELT procedure ?

ELT stands for Endovenous Laser Therapy, usually performed on the Great Saphenous Vein. A 940 diode laser system is used to deliver laser energy and heat to the Saphenous Vein, causing damage to and immediate closure of the vein.

What are the benefits of ELT?

• A simple procedure performed under local anesthetic
• Minimally invasive
• Very small risk of scarring and postoperative infection
• Less than one hour examination and treatment time
• Rapid recovery with reduced postoperative pain.
• Normal activities can be resumed immediately
• Excellent clinical and aesthetic results

What do I need to to prior to the procedure?

You will receive a prescription for an antibiotic and, if needed, a mild relaxant to be taken one hour before the procedure.

What can I expect during the procedure?

The procedure can last 45 minutes to 2 hours. You may find it relaxing to bring a book to read or a walkman to listen to.

A limited ultrasound evaluation will be done to locate the vein on the leg. Your leg will then be washed with an antiseptic soap and covered with sterile drapes. It will be important for you not to touch the drapes once applied.

The physician will use a tiny needle to inject a numbing solution just below your knee. Once numb, a needle will be inserted to access the vein. A tiny catheter will be placed in the vein. The position of the catheter will be verified with ultrasound and then the laser fiber will be inserted through the catheter. The area surrounding the laser fiber will then be anesthetized. This involves multiple injections of a saline solution which contains an anesthetic.

The laser procedure will begin when the area is sufficiently anesthetized. You will be required to wear special glasses to protect your eyes although you will not see the laser light. As the laser is fired you will hear a series of beeps. If you may feel a hot or burning sensation, let the physician know and more anesthetic will be given in the area that is painful. The actual laser treatment only takes several minutes. After the laser fiber is removed, a small amount of pressure will be applied, the drapes will be removed and your leg will be cleaned.

The treated leg will have absorbant pads, compression stockings and ace bandages applied.This dressing will need to remain on for 72 hours. Once the dressing is removed, you may shower and apply the compression hose. These need to be worn daily until your follow-up appointment, they may be taken off to shower and at bedtime.

What can I expect after the procedure?

Most patients describe a dull ache or tugging sensation in the thigh of the treated leg. You may also experience some bruising in the thigh. You will receive a prescription for Celebrex, which is an anti-inflamatory. A follow-up appointment is required in one week. You may resume light walking immediately; however, strenuous activity such as jogging and weight lifting cannot be resumed for at least two weeks.

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Frequently asked questions about Ambulatory Phlebectomy

What is the Ambulatory Phlebectomy procedure ?

Ambulatory phlebectomy micro-extraction is a procedure which allows for the removal of large surface varicosities through very small incisions that frequently need no stitches. Skin incisions or needle punctures as small as one millimeter are used to extract veins with a phlebectomy hook. A section of the vein is inserted into a micro-incision in the leg. A section of the vein is hooked and then removed through the incision.

With this procedure an ace bandage needs to be worn for 24 hours. Then a medical grade compression stocking should be worn for 1 week.

What are the benefits of Ambulatory Phlebectomy?

• Walk in – walk out
• Office procedure
• Minimally invasive - pinholes only
• Local anesthesia
• No stitches and scars
• No down-time
• Excellent cosmetic results

What can I expect after the procedure?

Most patients are not at all uncomfortable and need no pain medication. Patients may stand, walk and return to work on the day following surgery. For any discomfort, take the prescribed medication. You may also take Tylenol for discomfort. Strenuous activity is limited for two weeks.

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