TREATMENT OF VARICOSE AND SPIDER VEINS
If you suffer from problems related to varicose and spider veins, you are not alone. More than 50 million Americans suffer from some form of venous disease. While some seek treatment solely for cosmetic reasons, others are looking for symptomatic relief. Which ever category you may be in, there is help available!
What are VARICOSE and SPIDER veins?
Varicose veins are enlarged and/or stretched veins which protrude in a rope-like manner underneath the skin. Normal veins, by virtue of one way valves, channel oxygen depleted blood back to the heart and lungs to become oxygen rich. When a valve becomes defective blood is permitted to flow both forwards toward the heart and backwards toward the feet. This abnormal backward flow of blood causes the veins to enlarge resulting in the development of varicose and spider veins.
Spider veins or broken capillaries, properly named telangiectasias, are small red, blue, or purple web-like or linear veins that are less than 2.0 mm in diameter. They can be either flat or raised and are situated on the surface of the skin.
Are VARICOSE and SPIDER veins symptomatic?
Symptoms often associated with varicose and spider veins include leg pain, heaviness, aching, burning, stinging, throbbing, itching, cramping and restlessness of the affected leg. Symptoms may often worsen with prolonged standing or sitting. In advanced cases, varicose veins can cause skin changes including swelling, discoloration, scaling, ulceration and bleeding.
Why me?
Heredity is the number one contributing factor in the development of varicose and spider veins. Women are more likely to suffer from these abnormal leg veins with up to 50% of American women being affected. Hormonal factors including estrogen, birth control pills, puberty, pregnancy, and menopause, have all been implicated as causative factors for the development of varicose and or spider veins. Additional contributing factors for the development of varicose and spider veins include leg trauma, obesity, lack of exercise, weight fluctuation, tight girdles and garter belts and prolonged periods of sitting or standing.
When, why, and how are varicose and spider veins treated?
Varicose and spider veins are often treated to relieve the symptoms associated with this venous abnormality. Additionally, treatment may be performed solely to improve the appearance of the affected extremity.
At Tulsa Vein Specialist a comprehensive evaluation will be performed to determine the best treatment for each individual patient. At the initial visit a medical history and physical exam will be performed followed by a noninvasive color duplex Doppler ultrasound of the veins of the affected leg. Pictures of your abnormal veins will then be taken. This thorough evaluation will assist the doctor in determining the cause of your venous abnormality (ie. dilated veins, faulty valves, and/or presence of clot). Based on this information an individual treatment plan will be formulated and reviewed with you. As previously mentioned, varicose and spider veins may be treated in an attempt to relieve symptoms and/or to improve the cosmetic appearance of the affected area. Generally speaking there are two treatment options available: 1). Supportive, including exercise, leg elevation, use of emollients (moisturizing lotion) and or use of graduated compression support hose and/or 2). Corrective, ranging from minimally invasive to invasive procedures such as sclerotherapy, topical laser ablation, ambulatory phlebectomy, endovascular venous thermal or laser ablation, venous ligation and stripping. If a corrective procedure is indicated, you will be measured for graduated support hose. These stockings are available in a range of colors, sizes and styles. They are designed to create more pressure at the foot and ankle and less as they go up the leg which helps in returning blood to the heart. One pair of hose will be provided with your first treatment session. Additional hose may be purchased if desired.
Corrective procedures for varicose and spider veins.
Sclerotherapy (injections) can be used to treat both varicose and spider veins. The procedure is relatively simple. A tiny needle is inserted into the abnormal vein, liquid or foam sclerosing agent is injected into the vein and the needle is then withdrawn. The sclerosing agent irritates the lining of the vein causing the vein to collapse and close down. This does not harm the circulation; rather it improves it by eliminating the abnormal unnecessary vessel. Since the blood flow in the varicose or spider vein was in an abnormal direction, by closing down this abnormal pathway, blood flow is redirected though either another abnormal varicose or spider veins which can subsequently be treated or more often blood flow is redirected through properly functioning veins. By closing down these abnormal veins, sclerotherapy often relieves the abnormal symptoms or appearance causing the patient to seek treatment.
Topical Laser treatment is used primarily in the treatment of the smallest spider veins or broken capillaries on the legs or face. On the legs, spider veins are usually treated with sclerotherapy with lasers therapy as a complimentary technique. Lasers function by emitting specific wavelengths of high energy light, delivered in variable durations. After the energy passes through the skin, the light is absorbed by the red blood cells within the abnormal vein. The energy is then converted to heat, thereby, injuring the cells that line the vein causing the vein to collapse and close. As with sclerotherapy the laser treatment does not harm the circulation, rather it improves it by eliminating the abnormal unnecessary vessel. By closing down these abnormal veins, sclerotherapy and laser therapy often relieve the abnormal symptoms or appearance causing the patient to seek treatment.
Ambulatory surgery: Surgical treatment to treat veins include: Ligation (tying off the vein), Stripping (removal of a long segment of vein by pulling it out with a special instrument), Ambulatory phlebectomy (removal of veins through tiny incision), and ELVS procedure (sealing the abnormal vein with endovascular laser). Surgery at our center may be performed using local anesthesia, or light sedation. Patients return home the same day as the procedure.
Ligation and Stripping: Ligation and stripping procedures are performed within a hospital, by making two incisions, one in the pubic area and the other on the inside of the leg by knee or rarely at the ankle. This procedure is more invasive than the newer ELVS procedures which has largely replaced ligation and stripping. If it is determined that you need to have this procedure performed, you will be referred to the appropriate physician if desired.
Microphlebectomy: Microphlebectomy is a minimally invasive surgical technique performed under local anesthesia. Punctures are tiny (sutures are generally not necessary) and typically leave nearly unperceivable scars. The procedure is performed on an out-patient basis in the office setting.
ELVS: ELVS is a minimally invasive outpatient procedure. It is an alternative to a surgical ligation and stripping. This procedure is performed through a small catheter that is inserted into the damaged vein using ultrasound to guide its placement. The laser fiber is then inserted through this catheter and positioned within the vein needing treatment. The physician then numbs the vein throughout the length requiring treatment. As the laser is pulled through the vein needing treatment its targeted energy heats and seals the vein closing it shut. This procedure is performed using a local anesthetic and usually takes an hour. Patients may experience some bruising and tightness over the area treated which usually resolves over days to weeks. Rarely clot in the deep veins may form. The deep veins are therefore evaluated pre-procedure and within the first week following the procedure.
Before your planned ELVS treatment you should discontinue the use of blood thinners or aspirin for 1 week. You may want to discuss this with the doctor who placed you on this medication prior to holding its use. Do not shave your legs for 2 days prior to your appointment and do not apply any creams or lotions the day of your procedure. You may eat a light breakfast or lunch one hour prior to your appointment. Wear loose fitting clothes for the procedure and bring your support hose with you. If our office ordered your hose for you, call 2-3 days prior to your visit to make sure they have arrived. You may want to bring pants with you to wear home to cover up the bandages/support hose following the procedure.
In order to adequately treat your varicose or spider veins, you may need one to several treatment sessions. For sclerotherapy, typically 5 to 25 injections will be performed per session depending on the number and size of veins requiring treatment. Each vessel usually requires 1-3 treatments however the same area should not be retreated for 3-4 weeks to allow for complete healing prior to re-treatment. Different areas may be treated on a weekly basis. The vessels usually disappear over 2 weeks to 3 months. Recurrence may occur. Vessels that appear as a mat of very fine radiating veins tend to have a higher recurrence rate. Large veins may also not respond well to injections or topical laser and may require other types of treatment (ambulatory phlebectomy, ELVS). Sclerotherapy, laser therapy and ambulatory phlebectomy do not prevent new varicose or spider veins from forming. Always remember that the treatment sites will definitely look worse for a few weeks before they begin to look better!
Side effects and complications can occur with all forms of varicose or spider vein therapy. Stinging and burning may occur with injection of certain types and concentrations of sclerosing solutions. Patients may also experience allergies to the sclerosing solution. Severe allergic reactions, although described, are very uncommon. Clots may also develop at or near veins treated particularly if the compression stockings are not worn as directed. These clots will usually resorb on their own however, removal of the clot within the first 2 weeks of occurrence will speed the healing process. Removal is usually simple requiring only a minute incision. Clots may also form in the deeper veins. Although this is uncommon, if it occurs it usually occurs following treatment of larger veins. Deep vein clots can have minimal to severe life threatening consequences. Rarely, arterial clot resulting in shun and deep tissue injury may also occur. Swelling over the treatment area may also occur following treatment. This is commonly seen in patients that are required to stand for prolonged periods of time. The swelling is rarely dangerous but occasionally requires treatment with elevation of the leg and continued use of compression dressings and or support hose. Superficial thrombophlebitis is an irritation of the veins close to the surface of the skin. It occasionally occurs following vein treatment and is typically treated with anti-inflammatory medication and compression stockings. 10-30% of patients may develop areas of discoloration around the vessels treated. In over 80% of these patients improvement or resolution of these areas occurs within 3 to 6 months, others take up to a year and few will have some permanent discoloration. A small superficial ulceration of the skin overlying the treated vessel rarely may occur. This usually heals without permanent scaring over 6-8 weeks. Sometimes the body replaces the injected vessel with a mat of very fine vessels causing an apparent darkened area on the skin. This may require follow up injections. Your doctor should be notified immediately if any of these complications occur.
Post procedure instructions are important to follow to obtain the best possible results. Since venous blood flow in the legs is enhanced with contraction of the calf muscle, walking is encouraged for at least 30 minutes following treatment. If you have a long ride home keep your legs moving tensing and relaxing your calf muscles as much as possible. If your ride home is over an hour, try and stop every 20-30 minutes and walk. Maintain your normal daytime activities and walk as much as possible throughout the day. Avoid standing without moving. If you must stand in one place flex and relax your calf muscle periodically. Avoid hot baths or hot tubs for at least 2 weeks. Since prolonged heat exposure causes veins to dilate this will interfere with the healing process designed to close off and shrink the veins that were treated. Make sure to wear the medical support hose as instructed. Support hose should be worn when not lying down for at least 2-3 weeks following most treatments. Since sclerotherapy only treats the symptom, whatever caused your veins to become abnormal likely persists after your treatment. Because of this, new abnormal veins can form and may recur over the years. Wearing support hose as much as possible may help to reduce the recurrence rate of varicose and spider veins. Avoid strenuous physical activity (aerobics) for at least 72 hours, as this can also cause veins to dilate, opposing the desired affect of the treatment (ie. shrinking/closing off the vein).
