Understanding & Treating Abnormal Leg Veins:
Simple Concepts and Satisfying Results
Dr. E. Jerry Cohn, Jr. M.D. F.A.C.S.
What would we do without gravity? Unfortunately, gravity not only keeps us firmly grounded on the earth, but it also subjects us to the development of abnormally dilated leg veins (called varicose veins). One of the most common office visits we see in our practice these days now that summer is here is the evaluation of varicose veins. In fact, as many as 40 million Americans, most of them women, have varicose veins. I hope this article sheds some light on what causes abnormal leg veins and how they may be easily treated.
WHAT CAUSES VARICOSE VEINS?
Varicose veins affect about half the population age 50 and older, and 15-25 percent of all adults. Heredity is the number one contributing factor causing varicose and spider veins. Women are more likely to suffer from varicose leg veins than men. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within three months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury.
HOW DO VARICOSE VEINS DEVELOP?
Veins and arteries, while both part of the circulatory system, function quite differently from each other. “Poor circulation” is a nonspecific term which often refers to arterial blockages. Arteries are “tubes” that bring oxygen-rich blood from the heart to the extremities. Veins, unlike arteries, have one-way valves and channel oxygen-depleted blood back toward the heart.
Walking and exercise effectively “pumps” the flow of blood in veins towards the heart against gravity. If the valves of the veins don’t function well (don’t close) however, blood doesn’t flow efficiently and pools in the lower leg. The veins become enlarged because they are congested with blood. When you walk and your leg muscles squeeze, the venous pump works well. But when you sit or stand, especially for a long time, the blood in your leg veins can pool and the pressure in your veins can increase. If you are a susceptible individual, your veins can stretch if you repeatedly sit or stand for a long time. This stretching can sometimes weaken the walls of your veins and damage your vein valves. Varicose veins may result.
WHAT ARE THE SYMPTOMS?
Pain in the legs is frequently related to abnormal leg veins. If you have varicose veins, your legs may feel heavy, tired, restless, or achy. They may also itch, swell, or throb, and is often worse by the end of the day. Standing or sitting for too long may worsen your symptoms. You may also experience night cramps. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower leg.
You may notice visible small clusters of veins in a winding pattern on your leg, or soft, slightly tender knots of veins. Sometimes, the skin on your lower legs may change color, become irritated, or even form sores. Spider veins are mild varicose veins. They look like a nest of red or blue lines just under your skin. Spider veins are not a serious medical problem, but they can be a cosmetic concern to some people. Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. In addition to a physical examination, non-invasive ultrasound is often used.
HOW ARE VARICOSE VEINS TREATED?
Varicose veins may sometimes worsen without treatment. The treatment of varicose veins often depends on which veins are abnormal and how severe the symptoms are to the patient. Conservative measures are always initiated first before procedures are considered. If you have a job that requires standing, periodic rest with leg elevation may help with mild to moderate symptoms; periodic flexing of the legs may also help move pooling blood back towards the heart. For more severe varicose veins, compression stockings are prescribed. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. Compression stockings also can help heal skin sores and prevent them from returning. For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problems.
When these kinds of treatments alone do not relieve your varicose veins, you may require a surgical or minimally invasive treatment, depending upon the extent and severity of the varicose veins. These treatments include vein ablation, ambulatory phlebectomy, and sclerotherapy. Physical exam and ultrasound guides a vein specialist to specifically identify the source of the varicose veins for each patient and a comprehensive treatment plan is then formulated to relieve symptoms and maximize aesthetic outcomes.
LASER CLOSURE PROCEDURE
Long straight superficial veins called axial veins are the most common source of varicose veins. They are accessory veins and can be removed or closed with no consequences to the circulation. Historically vein “stripping” was employed to treat these abnormal veins. This often requires general anesthesia, and causes significant pain and downtime following the procedure. A minimally invasive alternative is now available that effectively treats the abnormal axial veins with significantly less pain and recovery, and can often be achieved with only sedation and local anesthesia. Laser or radiofrequency are two methods of thermal therapy that achieves a closure of the leaking axial vein. It is an in office procedure employed very commonly and maintains over a 95 percent patient satisfaction rating in our practice. It has demonstrated effectiveness in the immediate relief of pain attributed to varicose veins, and also improves the visible contour of prominent varicose veins on the leg making them less apparent.
Large, bulging veins that remain symptomatic or aesthetically unpleasant for patients can be treated with ambulatory phlebectomy, or surgical removal. This can also be accomplished in an in-office setting with local anesthetic and sedation. It is performed by marking all bulging veins preoperatively, then systematically removing the veins with micro incisions to minimize scarring. More extensive procedures are often more comfortably performed under general anesthesia in the hospital, but recovery and discomfort is still much less than vein stripping and patient satisfaction is also very high following this procedure.
Sclerotherapy is the most commonly used treatment for small and medium diameter veins, such as spider veins and smaller varicose veins. In sclerotherapy, a liquid is injected with a tiny needle into the vein that causes inflammation of the vein walls and causes the vein walls to stick to one another, collapsing the walls together. This solution and the use of a compression stocking, effectively prevents the vein from working and it stops carrying blood. The vein therefore disappears with time.
Small veins are effectively removed by sclerotherapy but veins will often reappear if the underlying causes, incompetent blood vessels, are not treated.
Sclerotherapy is associated with brown discoloration of the vein that may take up to one year to disappear and usually requires repeated treatments. It rarely can cause skin ulcers and as with all medications, some patients may have an allergy to the solution.
For more information on leg vein issues, Dr. Cohn may be reached at Savannah Vascular Institute at (912) 352-VEIN or firstname.lastname@example.org.