While varicose veins may not be life- or limb-threatening, they can be a dreaded nuisance. Just ask longtime sufferers. The bulging, ropey veins are ugly and uncomfortable, says Dr. Scott Westfall, a vascular surgeon with West County Surgical Specialists Inc. He regularly sees patients who have chronic symptoms caused by varicose leg veins, with aching, itching and burning the most common complaints.
If left untreated, varicose veins may cause more serious problems, such as swelling, hardening of tissues surrounding the vein, changes in skin color, and even skin ulcerations that may become painful and difficult to heal. “However, many people have minimal symptoms and can be treated conservatively,” Westfall says. In these cases, medication or invasive treatment is not needed. Treatment includes the use of support stockings, elevating the legs periodically and avoiding long periods of standing or sitting.
Varicose veins are caused by a problem with the valves that regulate blood flow through the veins, causing blood to pool in the vein, but there is rarely any indication of why the valves malfunction, Westfall says. The problem is most common in women, particularly those who have had children. “Varicose veins can get worse with each pregnancy,” Westfall explains. “They can occur in young women, but it’s more often a problem associated with age.” And there does seem to be a hereditary aspect to varicose veins, he adds.
‘Vein stripping’ used to be the most common treatment for serious varicose vein problems. The procedure involved general anesthesia and the removal of the vein through an incision. Today’s treatment is more often a high-tech approach called endovenous ablation, in which the vein is closed using a thin catheter tipped with a laser or radio-frequency device that heats and seals the vein.
“This procedure is less invasive than vein stripping and requires only local anesthesia or sedation,” says Dr. Michael Darcy, a diagnostic radiologist with Washington University Physicians. “Recovery is shorter and easier. In many cases there is almost no downtime as opposed to the week or so needed to recover from vein stripping,” he says.
Darcy says ablation is at least as effective as vein stripping and offers the benefit of allowing the physician to see the vein via ultrasound during the procedure, ensuring that the entire vein and its secondary channels have been treated. Endovenous ablation has been used for several years and is considered the new standard of care.
Insurance coverage depends on the symptoms. As with most medical procedures, cosmetic concerns alone typically will not warrant reimbursement, but treatment to alleviate troublesome symptoms or medical concerns is covered.
The smaller spider veins, which do not cause discomfort, are not considered varicose veins, and their treatment is different. “Sclerotherapy is still used to treat spider veins, although we now choose the sclerotherapy agent based on the size of the vein,” explains Dr. Timothy Jones, a plastic surgeon with Genesis Cosmetic Surgery Center and Medical Spa.
Jones is referring to a procedure in which the veins are injected with a solution that irritates them, causing them to close. A more concentrated solution is used on larger spider veins, and a new foaming solution is sometimes used. Spider veins disappear six to eight weeks after the treatment and may require more than one course of sclerotherapy, depending on how extensive the veins are and what degree of clearing the patient desires, Jones says.
Another type of related vein treatment, phlebectomy, involves making very small incisions in which portions of the vein are pulled out. This treatment is often used for problem veins in the calf as an adjunct to endovenous ablation of the larger vein in the thigh, Jones explains. “Phlebectomy produces 2 to 3-millimeter scars that fade nicely,” he adds. “The earlier you treat problem leg veins, the less complicated the procedure is,” Jones advises. “And since it’s a condition that can come back, you want to maintain regular follow-ups.”
With shorts and bathing suit weather just around the corner, this is the time to get those legs in shape.