Dr. Joseph M. Perlman Advanced Plastic Surgery Centre

What are the symptoms of varicose veins?

Some people with benign varicosities do not experience discomfort, but those with long-standing varicose veins experience the following symptoms: · Throbbing or aching pain and heaviness in the legs · Visibly enlarged blue or purplish veins · Mild swelling of ankles · Muscle cramping · Itching around the veins · Skin discoloration at the ankles · Skin ulcers near the ankle in severe cases

What causes varicose veins?

Varicose veins are swollen veins that bulge to the skin’s surface. They sometimes become tortuous or twisted. They occur due to weak valves in the veins (valves prevent blood from flowing backward), which can no longer “open-shut” properly when the leg muscles pump the blood back to the heart. This results in the pooling of blood in the veins, causing them to get larger. Although varicose veins occur in other parts of the body (varicose veins in the groin, hemorrhoids, and spider veins in the face), the feet and legs are subject to greater pressure and weight due to gravity. Standing and walking increase pressure in the veins in the lower half of the body. This is why they are most common on the backs of the calves or on the inside of the leg.

What increases the risk of varicose veins?

More than 80 million Americans suffer from varicose veins of unknown origin or for having the following risk factors: Defective valves from birth. This usually happens when the family has a history of defective blood vessel valves. Prolonged standing. The weight of the body puts great pressure on the veins and gravity weighs down on blood flow. Long periods of sitting and crossing of the legs. Blood flow is impeded due to the inactivity of the muscles during prolonged sitting and pressure with the frequent crossing of the legs while sitting down. Sex. Varicose veins are more common in women than in men. Roughly 25 percent of women and 15 percent of men are affected. Pregnancy increases pressure in the abdomen and obstructs blood flow within the pelvis. The extra weight further imposes a load on the legs. Female hormones are said to relax the veins. Hormonal changes that occur during menstruation, menopause, and pregnancy increase blood flow and volume of blood. Obesity. Larger body mass means greater load and pressure on the lower extremities. Age. The valves eventually become loose and weaker as health deteriorates and the body ages.

What can be done to prevent varicose veins?

Prevention early in life and keeping the varicose veins from worsening may avoid complications such as leg ulcers, vein rupture, and chronic (persistent) inflammation of the veins. Exercise. Good circulation and muscular activity enhance normal blood flow in the veins. Ankle pumping exercise, which mimics calf movement during walking, is good for recirculating body fluids in the feet. It is done by flexing your ankles (up and down) at least 10 times from time to time during long periods of sitting or standing. Avoid standing or sitting for prolonged periods. Change positions from time to time and move around at least every 30 minutes. Don’t cross your legs when sitting down. Making crossing legs a habit will eventually lead to varicose and spider veins (small varicosities). Elevate the legs as often as possible. This aids venous return of blood. Take short breaks and elevate the legs above the level of the heart. Elevation also provides temporary relief. Pregnant women can lie on their left side with their legs elevated on a pillow. Lose weight and watch your diet. Avoid a high-salt diet because it promotes water retention and bloating. Avoid tight-fitting clothes and high heels as much as possible. Loose clothing allows for better circulation and imposes no pressure on the blood vessels. High heels make for overworked calf muscles that are supposed to pump blood back up to the heart. Find alternatives to birth control pills/hormone replacement. Female hormones such as estrogen can contribute to the formation of varicose veins.

Will compression stockings really treat varicose veins?

Compression stockings do help with the treatment of varicose veins. Wearing elastic support stockings, hose or socks do not remove the varicose veins but they prevent the worsening of symptoms and alleviate discomfort from pain and swelling. They also reduce the risk of blood clot formation (thrombophlebitis) due to prolonged sitting, such as in long planes and car rides. The stockings apply gradient pressure with the highest compression around the ankles and loosen pressure gradually as they go up the leg. This reduces the pooling of body fluids in the lower extremities.

What are my varicose vein treatment options?

If you have leg pain or discomfort that does not improve with self-care (such as wearing compression stockings, leg elevation, and other conservative techniques), skin ulcers or sores, sudden leg swelling or you want to improve the appearance of your legs, you have surgical and noninvasive options. Surgical treatments include · Vein stripping – Removal of the problematic vein, which may involve its main trunk. · Phlebectomy – A minimally invasive removal of the varicose veins through tiny punctures or incisions (2mm to 3mm) in the skin above the veins. · Vein ligation – Shutting off the problematic vein by tying around it, cutting off blood flow and making it shrink. Nonsurgical treatments do not involve surgery: · Sclerotherapy – A common treatment for varicose and spider leg veins in which a solution is injected into the veins to make them shrink and disappear. · Laser ablation – Also called endovenous laser treatment, an optical fiber is inserted into the vein, and light is shone on its interior causing it to heat up, collapse and shrink. · Radiofrequency ablation – An ultrasound-guided catheter (small tube) is inserted into the vein and then soundwave energy is used to burn up and destroy the abnormal vein, which will eventually disappear.

Is it OK to postpone varicose vein treatment?

If you have varicose veins due to pregnancy, wait and see after you gave birth. The enlarged veins generally improve within a few months after delivery. Please take note, however, that worsening symptoms like persistent pain and swelling may be a sign of a serious underlying venous disorder. Also, varicose veins are a precursor of critical circulatory conditions like embolism, a dislodged blood clot that could cause heart blockage or stroke.

Do varicose veins have to be treated in a hospital?

Because of modern, minimally invasive treatment techniques that are now available, procedures can be performed in the doctor’s office or in an outpatient clinic. State-of-the-art technology has made vein treatment simpler and faster. And there’s minimal to no downtime, less chance of scarring, and little discomfort.

How many treatment sessions are required?

For most varicose veins treatments, one treatment session is enough. However, for noninvasive treatments like sclerotherapy, patients may desire further injections for optimal results. The number of sessions required depends on the depth, number, and size of the veins and the kind of treatment used.

Are there any side effects?

With nonsurgical or minimally invasive treatments, complications are uncommon and any discomfort after treatment will disappear quickly. Some mild bruising, itching, or swelling at the injection site is normal but will resolve in a few hours. Over-the-counter medications or topical anesthesia can be used for any pain and compression bandages for any swelling.

How long will the treatment session take, and will I be able to return to normal activity immediately?

With vein stripping, the surgery takes about 1 to 1-1/2 hours and you can resume normal activity in 2 weeks. Most nonsurgical or minimally invasive procedures, on the other hand, take only about 15 to 30 minutes to perform. The patient is able to walk after the procedure and is usually discharged after an hour. Walking after treatment is encouraged to prevent blood clots and promote blood flow, although lifting or strenuous activities are not recommended for a few days.

Is it possible to cure or remove the varicose veins in my arms and spider veins in my face?

Yes, sclerotherapy and laser and pulsed light treatments are used for the removal of spider veins and smaller varicose veins. However, prominent arm veins are generally not recommended for varicose vein treatment if they are normal. Prominent normal veins in the arms and hands are often taken for varicose veins. It is thus important to find out if the enlargement is due to varicosity before treatment is performed.