Varicose veins are bulging veins in the back or front of your legs which are due to incompetent valves which have no way to drain the blood back to the heart.
Weak or damaged valves in the veins can cause varicose veins. After your arteries and capillaries deliver oxygen-rich blood to your body, your veins return the blood to your heart. The veins in your legs must work against gravity to do this.
One-way valves inside the veins open to let blood flow through, and then they shut to keep blood from flowing backward. If the valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell.
Weak vein walls may cause weak valves. Normally, the walls of the veins are elastic (stretchy). If these walls become weak, they lose their normal elasticity. They become like an overstretched rubber band. This makes the walls of the veins longer and wider, and it causes the flaps of the valves to separate.
When the valve flaps separate, blood can flow backward through the valves. The backflow of blood fills the veins and stretches the walls even more. As a result, the veins get bigger, swell, and often twist as they try to squeeze into their normal space. These are varicose veins.
Normally, blood circulates from the heart to the legs via arteries and back to the heart through veins. Veins contain one-way valves which allow blood to return from the legs against gravity. If the valves leak, blood pools in leg veins which can become enlarged.
Although this procedure may be used for cosmetic purposes, it is more commonly used to help alleviate symptoms. Symptoms are typically due to enlarged nonfunctional veins that cause circulatory problems (venous insufficiency). Leg symptoms can include:Endovenous ablation is an image-guided procedure that uses heat generated by radiofrequency or laser energy to seal off these faulty vessels, diverting blood flow immediately to nearby healthy veins.
To check for varicose veins in your legs, we will look at your legs while you're standing or sitting with your legs dangling.
Diagnostic Tests and Procedures:
Often a duplex ultrasound is ordered to check blood flow in your veins and to look for blood clots. Duplex ultrasound combines traditional with Doppler ultrasound. Traditional ultrasound uses sound waves to create a picture of the structures in your body, in this case the blood vessels and anything that may be blocking the flow of blood. Doppler ultrasound uses sound waves to create pictures of the flow or movement of the blood through the veins. The two types of ultrasound together paint a picture that helps your doctor diagnose your condition.
During this test, a handheld device called an ultrasound probe will be placed on your body and passed back and forth over the affected area. The device sends and receives sound waves. A computer will convert the sound waves into a picture of the blood flow in your arteries and veins.
Venogram: Although it is not very common, sometimes a venogram may be performed to get a more detailed look at the blood flow through your veins.
For this procedure, dye is injected into your veins. The dye outlines your veins on x-ray images.
An venogram can help confirm whether you have varicose veins or another condition such as a blood clot in the deep venous system which is connected to your heart and lungs.
Varicose veins are treated with lifestyle changes and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, treat the underlying cause and improve appearance.
If varicose veins cause few symptoms, you may simply suggest making lifestyle changes. If your symptoms are more severe, we recommend one or more medical procedures. For example, you may need a medical procedure if you have a lot of pain, blood clots, or skin disorders caused by your varicose veins.
Some people who have varicose veins choose to have procedures to improve how their veins look.
Although treatment can help existing varicose veins, it can't keep new varicose veins from forming.
Lifestyle changes often are the first treatment for varicose veins. These changes can prevent varicose veins from getting worse, reduce pain, and delay other varicose veins from forming. Lifestyle changes include the following:
- Avoid standing or sitting for long periods without taking a break. When sitting, avoid crossing your legs. Keep your legs raised when sitting, resting, or sleeping. When you can, raise your legs above the level of your heart.
- Do physical activities to get your legs moving and improve muscle tone. This helps blood move through your veins.
- If you're overweight or obese, try to lose weight. This will improve blood flow and ease the pressure on your veins.
- Avoid wearing tight clothes, especially those that are tight around your waist, groin (upper thighs), and legs. Tight clothes can make varicose veins worse.
- Avoid wearing high heels for long periods. Lower heeled shoes can help tone your calf muscles. Toned muscles help blood move through the veins.
There are three types of compression stockings. One type is support pantyhose. These offer the least amount of pressure. A second type is over-the-counter compression hose. These stockings give a little more pressure than support pantyhose. Over-the-counter compression hose are sold in medical supply stores and pharmacies.
Prescription-strength compression hose are the third type of compression stockings. These stockings offer the greatest amount of pressure. They also are sold in medical supply stores and pharmacies. However, you need to be fitted for them in the store by a specially trained person.
Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn't cause problems with blood flow because the blood starts moving through other veins.
You may be treated with one or more of the procedures described below. Common side effects right after most of these procedures include bruising, swelling, skin discoloration, and slight pain. As an aside I usually prescribe a homeopathic remedy called Arnica Montana which is a form of energy medicine in order for the cells to vibrate at a frequency to heal.
The side effects are most severe with vein stripping and ligation (li-GA-shun). Rarely, this procedure can cause severe pain, infections, blood clots, and scarring.
Sclerotherapy uses a liquid chemical to close off a varicose vein. The chemical is injected into the vein to cause irritation and scarring inside the vein. The irritation and scarring cause the vein to close off, and it fades away.
This procedure often is used to treat smaller varicose veins and spider veins. It can be done in the office, while you stand. You may need several treatments to completely close off a vein.
Treatments typically are done every 4 to 6 weeks. Following treatments, your legs will be wrapped in elastic bandaging to help with healing and decrease swelling.
Microsclerotherapy is used to treat spider veins and other very small varicose veins.
A small amount of liquid chemical is injected into a vein using a very fine needle. The chemical scars the inner lining of the vein, causing it to close off.
Endovenous Ablation Therapy:
Endovenous ablation therapy uses lasers or radiowaves to create heat to close off a varicose vein.
We make a tiny incision in your skin near the varicose vein. We then insert a small tube called a catheter into the vein under ultrasound image guidance. A device at the tip of the tube heats up the inside of the vein and closes it off.
You'll be awake during this procedure, but we will numb the area around the vein. In addition; I give you some medication through your IV to help keep you comfortable. The medications we usually use are called benzodiazepenes (antianxiety meds) and opoids ( short acting forms of morphine like meds). You go home the same day as the procedure.
Endoscopic Vein Surgery:
For endoscopic vein surgery, a vascular surgeon will make a small cut in your skin near a varicose vein. He or she then uses a tiny camera at the end of a thin tube to move through the vein. A surgical device at the end of the camera is used to close the vein.
Endoscopic vein surgery usually is used only in severe cases when varicose veins are causing skin ulcers (sores). After the procedure, you usually can return to your normal activities within a few weeks.
Ambulatory phlebectomy is when we will make small cuts in your skin to remove small varicose veins. This procedure usually is done to remove the varicose veins closest to the surface of your skin.
You'll be awake during the procedure, but your doctor will numb the area around the vein. You can go home the same day that the procedure is done.
Vein Stripping and Ligation:
Vein stripping and ligation typically is done only for severe cases of varicose veins. The procedure involves tying shut and removing the veins through small cuts in your skin.
You'll be given medicine to temporarily put you to sleep so you don't feel any pain during the procedure.
Vein stripping and ligation usually is done as an outpatient procedure. The recovery time from the procedure is about 1 to 4 weeks.