Varicose Veins

Varicose Veins and Spider Veins

Varicose Veins usually are the result of a breakdown of the Great Saphenous Vein, an internal vein on the inside of the thigh. The great saphenous vein is only visible with an ultrasound test, therefore, all patients with bulging varicose veins need ultrasound testing prior to treatment. This breakdown of saphenous vein one-way valves causes leakage of blood in the wrong direction. Blood leaks from the thigh into the calf and pools inside the calf veins. This pooling of pressurized blood causes veins to stretch, bulge, and become varicose. If left untreated, varicose veins can lead to dangerous blood clots or large ulcers inside of the ankle. Thanks to endovenous technology, both the saphenous vein and the varicose bulges are easily treated in the office with local anesthesia. Because varicose veins are a medical problem that can lead to complications if left untreated, the treatments are covered by most insurance carriers.

Spider veins: on the other hand, are purely cosmetic issues and pose no threat to a person's health. These are small red, purple and blue "threadlike" veins found on the surface of the skin. They are usually not associated with deeper vein issues, and therefore, ultrasound tests are not required for routine cases. These are treated with sclerotherapy and laser. Spider veins, unfortunately are a lifelong battle for most patients. Even after successful treatment, the body tends to continue producing them. For this reason, most patients need intermittent maintenance treatments to keep their legs vein free. Spider vein treatments are done for cosmetic reasons and are not covered by most insurance carriers.

Vein Disease

(venous Insufficiency)

Consider the venous system as a whole rather than as individual parts. The deep system of veins within the muscular compartments of the legs communicates with the superficial system of veins under the skin and fatty tissue (outside the muscles) through a network of communicating veins which act as bridges between the two systems. The deep system returns more than 95% of the venous blood from the legs to the pelvis, while the superficial system accounts for 5% or less. Since leakiness in the superficial veins is responsible for more than 95% of patients' problems seen, ultrasound evaluation of the lower extremity venous systems is an integral part of their comprehensive venous workup. This evaluation will ensure that any underlying vein problems are identified, and, if necessary, corrected before treatment of the external signs of venous disease is initiated. For example, prior to removing bulging veins in the calf, it is important to first identify the underlying leaky vein and seal it, thereby decreasing the chance that other bulging veins will develop in the future.

Approximately 30 million adults in the United States may suffer from treatable, symptomatic, superficial venous insufficiency. Many of these patients as well as their primary care or specialty physicians may not be fully aware of the advances made in the treatment of venous insufficiency in the last 5-10 years. Since 2000, vein stripping has been replaced by endovenous closure procedures as the preferred treatment of patients with symptoms related to saphenous vein and other superficial venous insufficiency. Many patients once thought to have untreatable venous problems may now be excellent candidates for endovenous closure.

May-Thurner Syndrome

(iliac compression syndrome)

May-Thurner Syndrom, also termed the iliac compression syndrome, is a syndrome named after the authors R. May and J. Thurner, who first described this phenomenon in 1957. It is a congenital narrowing of the left common iliac vein due to pressure from the overlying right common iliac artery.

This lesion is classically found in the left common iliac vein of younger females; but, it is not uncommon in males or in elderly patients, and may involve the right limb. At least 15% of the limbs with primary disease have been shown to have stenosis of both common and external iliac veins.

This squeezing of the left vein from the artery above it makes a person more likely to develop deep vein thrombosis (DVT), which if left untreated can be life threatening.

Thanks to the development of intravascular ultrasound (IVUS), this condition is now easily diagnosed and treated using catheter-based balloon angioplasty and stenting techniques.

Deep Vein Thrombosis

(DVT)

Deep Vein Thrombosis (DVT) affects nearly 2 million Americans each year, and causes 300,000 mortalities. It is a serious condition that occurs when a deep vein is blocked by a blood clot. DVT typically appears in the leg, usually in the calf, but has been know to materialize in other parts of the body.

DVT is often difficult to detect. The following signs and symptoms can occur: Pain, Swelling (unusual and sudden), Tenderness, Cramping, Aching, or No symptoms at all.

DVT are important and can lead to 2 important complications:

1. DVT, if left untreated can lead to pulmonary embolism (PE), which can be fatal. PE occurs when a blood clot travels through the veins and blocks a major blood vessel in the lungs.

2. DVT cause injury and scarring to the one-way valves in leg veins and lead to poor circulation called Post Thrombotic Syndrome.

Patients with a history of DVT should be evaluated by a vascular surgeon. Usually, conservative measures and patient education will suffice, however, some patients may benefit form the minimally invasive procedures now available.

Sclerotherapy

Sclerotherapy is the most commonly used treatment for small diameter (5mm) veins, such as spider 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.

Ultrasound Guided Sclerotherapy

Ultrasound Guided Sclerotherapy is used for the treatment of deeper veins that cannot be seen or felt and for larger superficial veins. Using ultrasound, a solution is injected into the veins causing the vein walls to collapse. Compression stockings are then used to make sure that the vein walls stay collapsed. Ultrasound guided sclerotherapy requires expert knowledge that conventional sclerotherapy does not. Once again, as the larger veins are treated, smaller spider and reticular veins will often disappear. The advantages are no scarring and smaller veins disappear, while the downside is brownish discolorations, allergic reactions and the rare development skin ulcers.

Saphenous Vein Ablation

(ultrasound guided)

Saphenous Vein Ablation minimally-invasive treatment is an outpatient procedure performed using ultrasound guidance. After applying local anesthetic to the vein, the surgeon inserts a thin catheter into the vein and guides it up the great saphenous vein in the thigh. Then laser or radiofrequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed. Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing nor

Endovenous Laser Treatment

EVLT

Principle The EVLT%u2122 Procedure deals with the incompetence of the greater saphenous veins. Unlike surgical stripping, EVLT permanently closes off the vein while leaving it in place. It uses the energy from an 810 nm diode laser delivered by a fine fiber-optic probe. As it is only the probe and a slim sheath which need to enter the vein the whole procedure is performed via a tiny skin nick, so there will be no post operative scarring. The probe is guided into place using ultrasound and the procedure is performed under strictly local anesthetic of a similar type used by dentist to numb the treatment area.

Ambulatory Phlebectomy

(microphlebectomy)

Ambulatory Phlebectomy (also referred to as Microphlebectomy) is a minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. During this procedure, tiny incisions are made (less than 2 - 4mm or 1/16 to 1/8 inch) over the varicose vein and a special instrument is used to remove the vein through the opening in the skin. The procedure itself usually takes less than an hour.
Recovery is rapid with patients promptly returning to normal activities following the procedure. Most patients experience little to no scarring with excellent clinical and cosmetic results.

Radiofrequency Closure

Principle: Local or regional anesthesia is used to numb the treatment area. A thin catheter is then inserted into the vein through a small opening. The catheter delivers radiofrequency (RF) energy to the vein wall, causing it to heat, collapse, and seal shut. Once the diseased vein is closed, other healthy veins take over and empty blood from your legs. Your symptoms should also improve noticeably following the procedure. After the catheter is removed, a bandage is placed over the insertion site and your leg may be wrapped for a day to aid healing. Dr. Almeida may also ask you to walk, wear compression stockings and to refrain from long periods of standing for a few weeks following the procedure to help speed your recovery. Most patients can resume normal activity immediately.

Causes of Venous Disease

2 main causes: heredetary and pregnancy

Veins are an important part of the vascular system. Arteries deliver blood to bodilytissues, while veins transport blood back to the heart using one-way valves. Varicose veins occur when the valves in your veins malfunction. As one gets older, veins lose elasticity, causing them to stretch out. When that happens, blood that should be moving toward the heart may flow backward. Blood pools in leg veins, and subsequently enlarge and become varicose. Varicose veins have lost their normal function and the ability to transport blood. Varicose veins can be more than unsightly. Varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower leg. They can be quite painful. To improve circulation and muscle tone, follow these tips: Exercise: Get your legs moving. Walking is a great way to encourage blood circulation in your legs. Ask Dr. Almeida to recommend an appropriate activity level customized for you. Control your weight: Shedding excess pounds takes unnecessary pressure off your veins. Watch what you wear: Avoid high heels. Low-heeled shoes work calf muscles more, which is better for your veins. Don't wear tight clothes around your calves or groin. Tight panty-leg girdles, for instance, can restrict circulation. Elevate your legs: To improve circulation, take three or four 10- to 15-minute breaks daily to elevate your legs above the level of your heart. For example, lie down with your legs resting on three or four pillows. Avoid long periods of sitting or standing: Make a point of changing your position?frequently to encourage blood flow. Don't sit with your legs crossed: This position can aggravate circulatory problems.

symptoms

Patient satisfaction results from identifying and properly treating the patient's primary concerns, i.e., medical and/or cosmetic issues. Not all symptomatic patients are aware of their symptoms because the onset may be insidious. Symptoms may include leg heaviness, pain or tenderness along the course of a vein, pruritus, burning, restlessness, night cramps, edema, skin changes, and paresthesias. After treatment, patients are often surprised to realize how much discomfort they had accepted as normal. Pain caused by venous insufficiency is often improved by walking or by elevating the legs. The pain of arterial insufficiency, conversely, is worse with ambulation and elevation. Pain and other symptoms of venous disease may worsen with the menstrual cycle, with pregnancy, and in response to exogenous hormonal therapy (eg, oral contraceptives).

Risk Factors

These factors increase your risk of developing varicose veins: Age: Varicose veins usually appear between ages 30 and 70 and get progressively worse. Sex: Women are more likely than men are to develop the condition. Hormonal changes during pregnancy, or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins. Genetics: If other family members had varicose veins, there's a greater chance that you will too. Obesity: Being overweight puts added pressure on your veins. Standing for long periods of time: Your blood doesn't flow as well if you're in the same position for long periods of time.

These factors increase your risk of developing varicose veins: Age: Varicose veins usually appear between ages 30 and 70 and get progressively worse. Sex: Women are more likely than men are to develop the condition. Hormonal changes during pregnancy, or menopause may be a factor. Female hormones tend to relax vein walls. Taking hormone replacement therapy or birth control pills may increase your risk of varicose veins. Genetics: If other family members had varicose veins, there's a greater chance that you will too. Obesity: Being overweight puts added pressure on your veins. Standing for long periods of time: Your blood doesn't flow as well if you're in the same position for long periods of time.

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