Varicose veins are raised, ropey, enlarged veins. They usually appear on the legs and can cause the leg to swell, itch, ache, and in severe cases, can cause ulcers. Normal vein valves close after blood travels up the vein, preventing blood from moving backwards (refluxing) down the vein. Varicose veins form when valves in the vein fail (become incompetent). Valves become incompetent for a variety of reasons, including trauma and pregnancy. Once a valve becomes incompetent, the vein below the valve is exposed to higher pressure and becomes dilated. This causes other valves to fail and other veins to dilate.

Varicose veins are dark blue in color and commonly appear on the backs of the calves or on the inside of the legs. But they can form anywhere on your legs, from your groin to your ankle. They protrude or bulge from under the skin and feel ropey. Varicose veins cause an achy or heavy feeling in the legs, and burning, itching, throbbing, muscle cramping and swelling in your legs. Prolonged sitting or standing makes your legs feel worse, while elevating your legs makes them feel better. Varicose veins can also cause skin ulcers near your ankle.

Both invasive and non-invasive methods are available to treat varicose veins. Non-invasive methods include wearing compression stockings, exercising, leg elevation, losing weight, not wearing tight clothes, avoiding long periods of standing or sitting and not crossing your legs while seated. Invasive treatments include endovenous therapy, ligation, and phlebectomy. Endovenous therapy is treatment from inside the vein using heat generated by lasers, radiofrequency devices or chemicals to irritate the vein walls and cause the vein to clot and then be reabsorbed by the body. Ligation is tying off a vein to cause it to shrink. Phlebectomy is removal of varicose veins.

Sclerotherapy is the injection of small amounts of dilute detergent solution into visible veins to cause inflammation in the vein wall. The patient then wears compression stockings for several days. The walls of the vein scar together and the vein is no longer visible. Multiple treatments are required (three to five sessions) and it takes up to six weeks for the veins to fade. Because sclerotherapy treats only visible veins, more may form later in life. So return appointments for rechecks are required on a yearly basis. Sclerotherapy is usually not covered by medical insurance, as it is a cosmetic procedure.

Endovenous laser therapy is a new technique that uses a laser to destroy the vein. It is an outpatient procedure and may be done under local anesthesia. It takes about 45 minutes. A laser fiber is inserted into the vein under ultrasound guidance. Next, the vein is anesthetized using local anesthesia. The fiber is then connected to the laser generator and slowly withdrawn from the vein, sealing it and stopping the venous reflux. Possible adverse reactions are numbness and tingling, and venous thrombosis (blood clots) in the legs. Patients may have bruising and mild pain for up to 4 weeks.

Radiofrequency ablation – the Closure Procedure – is similar to endovenous laser therapy. A radiofrequency probe is placed in the vein under ultrasound guidance. Then the vein is anesthetized using local anesthesia. Next, the vein is heated along its entire length by slowly withdrawing the probe from the vein. This causes the vein to clot and close, stopping the reflux. Radiofrequency ablation is an outpatient procedure, can be performed under local anesthesia, and takes about 45 minutes. Possible complications are numbness, tingling, and blood clots in the legs. Patients may have bruising and mild pain for up to 4 weeks.

Compression stockings or socks, which are now available in a variety of styles and fashion colors, are recommended for early treatment of venous insufficiency. They compress the lower leg and lessen the swelling and the formation of new varicose veins. They come in various strengths and are fitted by a trained person. The physician will tell you at your first visit the strength that is needed. They are worn as treatment of varicose veins and after treatment to assist in the healing process and maximize results.

A skin ulcer, caused by a venous reflux disorder is called a venous stasis ulcer. It is an irregularly-shaped wound with well-defined borders, surrounded by red or dark and thickened skin. Venous ulcers vary in size and location, but are usually found on the inside of the lower leg.

Patients with venous ulcers need compression treatment. Bandages, stockings and compression devices have been used for compression treatment. Bandaging is used short term to reduce swelling and stockings are used long term to keep swelling at a minimum. Compression devices are sometimes used as well. These are often worn at night.
Compression leads to increased venous flow, which leads to decreased swelling. In order to achieve maximum benefit from compression the patient needs to walk. Walking increases the action of the calf muscle pump, this also decreases swelling and edema.

Your initial evaluation will vary from physician to physician. They will question you about any vein-related symptoms. After carefully examining your legs, the physician may also examine the abdomen or pelvis to search for other abnormal veins.
After the initial exam is complete, your physician may decide that further testing is in order. These tests include duplex Doppler ultrasound exams of the legs. These non-invasive procedures use sound waves to evaluate the function of the valves in the veins of the leg. These tests are very important in diagnosis, and can improve the effectiveness of any treatment.

Spider veins are small red, blue or purple veins that appear on the surface of the thighs, calves and ankles. They may appear as a group of veins radiating outward from a central point, in a pattern that resembles branches on a tree or they may appear as thin separate lines. Spider veins may be isolated or associated with “feeder” veins. They can also be associated with larger underlying varicose veins.
Certain factors contribute to the development of spider veins, including heredity, pregnancy, hormonal factors, weight gain, occupations or activities that require prolonged sitting or standing, and trauma.

People often seek treatment for spider veins because of cosmetic concerns. However, it is also common for spider veins to cause symptoms, such as aching, heaviness, itching and night cramps. A common form of treatment for spider veins is Sclerotherapy. This is an in-office procedure where veins are injected with a solution, using small needles, which causes them to collapse and fade from view. The procedure typically improves not only the cosmetic appearance but associated symptoms as well. Generally three sessions are required to obtain maximum benefit and patients are required to wear compression hose for three weeks after treatment.

First, we encourage all patients to walk as much as possible after the procedure. However, while you are resting or if you plan to be stationary for an extended period of time, elevating your legs is important to help reduce swelling and prevent any remaining blood from pooling in the treated vein. If you are going to be sitting for a while, your legs should be elevated as much as possible for the first week after the procedure. You do not have to sleep with your legs elevated.

Compression stockings are essential to a successful recovery and prevent adverse side effects after surgery. You must wear compression stockings for the first 24 hours after the procedure. After that time, you should continue to wear them for the next 7 – 10 days at all times, except when sleeping.

FREQUENTLY ASKED QUESTIONS