FAQs About Venous Disease and Varicose Veins

What is superficial venous reflux?

Venous reflux or venous insufficiency develops when the valves of the main superficial veins that keep blood flowing up the legs and back to the heart become damaged and the blood refluxes down the leg. The pooling of blood in legs puts excess pressure on vein walls of the very superficial veins and leads to their expansion and the appearance of unsightly and bulging veins and symptoms associated with them.

What are the symptoms of venous insufficiency?

Venous insufficiency symptoms may develop very slowly and individuals may go years before being diagnosed with the disease. Symptoms of venous insufficiency vary, the most common ones are:

• Varicose and other unsightly surface veins
• Dull aching, heaviness, numbness, itching or cramping in legs
• Restless legs
• Leg pain that gets worse when standing or at the end of the day
• Leg pain that gets better when legs are raised
• Swelling of the legs
• Bleeding from superficial veins
• Redness of the legs and ankles
• Skin color changes around the ankles (blue and brown discoloration)
• Ulcers on the legs and ankles
• Thickening and hardening of the skin on the legs and ankles

What are the symptoms associated with varicose veins?

Varicose veins are initially painless, but with time can cause aching or discomfort in your legs. Symptoms of varicose veins may vary from person to person and are often worse just before a menstrual period, at the end of the day, or while on birth control pills or hormone-replacement therapy.

An itchy rash (venous eczema), leg restless, swelling of ankles, lumps and blue or purple coloring under your skin, cramping, fatigue, and ulcers are other symptoms associated with these veins. Occasionally, these symptoms may be caused by problems other than varicose veins. You should ask for your doctor’s advice.

Note that large varicose veins don’t always cause more discomfort or pain than smaller varicose veins. Moreover, some people with bulging large veins don’t have any symptoms.

Why do varicose veins and spider veins usually appear in the legs?

Compared with other veins in the body, leg veins have the toughest job since they have to carry blood from the bottom of the body up to the heart against the force of gravity and the pressure generated inside of chest and abdomen (coughing, straining, obesity). Hence, leg veins endure the most pressure. This pressure can be stronger than some genetically weakened one-way vein valves can handle.

Why does my vein doctor insist on treating my saphenous vein instead of my bulging lower leg veins?

If venous reflux is the root cause of your bulging varicose veins, as determined by a duplex venous scan, treating the varicose veins before shutting down the sources of reflux would not work. Such treatment would be ineffective, short-lived and plagued with high recurrence rates.

The saphenous vein, being the most common source of venous reflux, may well be the root cause of your varicosities. In fact, shutting down the saphenous vein will often lead to a dramatic improvement in the appearance and symptoms of the varicose veins within a few weeks. Additional improvement may be achieved then, with sclerotherapy, foam sclerotherapy or microphlebectomy, as needed.

I have bulging veins in my legs. Can they be removed without treating the saphenous vein?

Moderately bulging varicose veins can sometimes occur without any underlying venous reflux. In such cases, your vein doctor can treat these veins alone by any of the effective treatment methods, like sclerotherapy, foam sclerotherapy or microphlebectomy.

Does exercising help my varicose veins?

Venous reflux is often the root cause of visible bulging varicosities. Although there is no guaranteed way of preventing the occurrence of venous reflux, adoption of a healthy lifestyle like engaging in regular exercise, keeping your weight in check and wearing adequately supportive stockings, when indicated, may minimize your chances.

Your genetic predisposition, however, is the single most important contributing factor. In fact, many patients seeking treatment for bulging varicose veins are in great physical shape and lead athletic lives.

Once venous reflux is established, exercising does not necessarily improve the circulation in the varicose veins, since the venous reflux will channel the increased venous pressure in the deep veins (generated by the exercising leg muscles) back into the superficial varicose veins in a reverse flow pattern.

The only way to temporarily prevent the bulging and engorgement of these superficial veins and help ease the symptoms of venous congestion is to wear high compression stocking (20-30mm Hg pressure).

Do the deep leg veins form varicose veins?

The formation of varicose veins in the ‘deep’ veins is relatively rare because these deep veins are supported and surrounded by muscles. Superficial veins, on the other hand, have less muscle support; accordingly, congestion in these veins is much more likely to result in bulgy, dilated and twisted varicosities than in the deep veins.

Do varicose and spider veins serve any useful purpose?

In the vast majority of cases, spider and varicose veins do not serve any useful function; only in extremely rare cases, when the deep veins of legs are blocked, varicose veins of legs may carry useful circulation. In fact, the backward flow of blood in the varicose saphenous or perforator veins misdirects the deep vein blood flow backward and downwards towards the lower leg, instead of the heart. This “loop” circulation causes venous congestion, resulting in swelling and capillary leakage of fluid and blood components. Often, shutting down the source of venous reflux will dramatically reduce swelling of the leg, visibly reduce its circumference and re-establish a healthy circulatory pattern. It is this improvement in blood circulation that causes an improvement of symptoms, like tiredness and heaviness in the legs.

What are the factors that contribute to the formation of varicose veins?

There are many factors that lead to the formation of varicose veins. It is established that obesity, sedentary lifestyle, female gender, pregnancy, age, and localized trauma are contributing or precipitating factors. Family history, however, is probably the most important one. More than 70% of patients have a first-degree relative who has varicose veins.

Women get them 3-4 times more frequently than men due to hormonal differences and pregnancy. There are also “lifestyle” factors which can affect the veins. Standing for prolonged periods, lack of exercise, wearing tight clothing, birth-control pills, hormone-replacement therapy, or carrying excess weight, all contribute to the worsening of your varicose your veins. Exposure to the sun can also cause spider veins, particularly on the cheeks or nose of fair-skinned persons.

Will varicose veins associated with pregnancy disappear after delivery?

The appearance of varicose veins during pregnancy is caused by the pressure buildup in the abdominal cavity with the growing fetus and by the increased circulating blood volume. Moreover, a surge in the hormone progesterone makes vessel walls more elastic. The majority of women get some varicose veins during pregnancy.

Many, but not all swollen veins spontaneously improve within 3 months after delivery. A growing number of abnormal veins usually appear with each additional pregnancy. Pregnant women are advised to exercise regularly to ensure proper blood flow through the body. Wearing support hose can help keep circulation flowing in the legs, especially if they swell during the final months of pregnancy.

Why do doctors recommend compression stockings?

Compression stockings can temporarily reverse the effects of vein disease and relieve the swelling and aching of your legs but they won’t prevent more varicose veins from developing. These thick elastic leggings provide support for surface leg veins and help the blood in your veins flow up towards your heart. Some people won’t need any other treatment.

In fact, many insurance companies require a trial of stocking use before approving definitive therapy. Take the advice of your doctor to find out which type of compression is the right one for you.

What are the perforator veins?

Perforator veins are blood vessels that connect the superficial venous system to the deep vein network. These veins allow blood to drain from the skin into the deep veins. The number of perforator veins in each leg is around 150, and their concentration is the highest in the lower part of the leg. When valves inside the perforator veins malfunction, blood is pushed back into the superficial veins causing varicose veins, thread veins, brown stains, and possibly leg ulcers.

What is a Duplex Ultrasound diagnosis?

The only way to determine whether you suffer dysfunction of the major veins as a cause of visible varicosities is with the use of the Duplex Ultrasound diagnosis. This technology uses ultrasound vibration with a computerized system attached to a monitor. A Duplex Ultrasound diagnosis shows a detailed picture of the anatomy and function of the venous network of the legs and helps your doctor detect the presence of truncal/saphenous insufficiency, perforator incompetence, and determine the type of treatment that suits bests to your condition.

Which lasers are used for varicose vein removal?

There are two kinds of lasers that are used in vein treatments. The first type is the surface lasers, used for superficial vein laser treatment. With these, laser energy is directly applied to the skin to target superficial blue and spider veins. These lasers are ideal for facial veins, but for leg veins, they are far less effective and more painful compared to sclerotherapy injections.

The second class of lasers is used for varicose vein laser treatment. With these, the laser energy is channeled through a laser fiber that is inserted into a major superficial vein (like the saphenous Vein) of the leg. After injecting numbing medicine around the targeted vein, laser energy is turned on, generating heat at the tip of the laser fiber inside the vein. This heat then shuts the vein from the inside (i.e. endovenously) as the laser fiber is slowly pulled out).

There is a variety of FDA approved laser devices with different frequencies that are currently available in the US market. We use the Sciton Joule laser device with a 1319 nm Nd Yag laser for the endovenous treatments and the Cutera Xeo system with a 1064 nm wavelength Nd Yag laser for surface laser treatments. Not all lasers are created equal. We at Nu Vela Laser and Vein Center have selected these devices after careful consideration because they represent the best in their class in terms of range, power, reliable performance, effectiveness, flexibility, and safety.

What can happen to varicose vein disease if left untreated?

Having varicose veins doesn’t necessarily mean that you will get any of the specific complications listed above. If left untreated, abnormal veins may increase in number and symptoms associated with varicose veins are worsened.

Check with your vein doctor if you notice a tender, reddened area on the surface of a vein, experience leg pain, your legs are significantly swollen, or if there are sores on the veins that won’t heal. These symptoms indicate a more serious circulation problem. Other complications include spontaneous bleeding, phlebitis, thrombosis, and skin ulcers.

What are venous leg ulcers?

Venous leg ulcers represent the end result of an untreated and advanced form of chronic venous insufficiency or venous reflux disease. Venous ulcers represent a disabling condition that may start as gradual darkening of the skin in the area of the ankle. These ulcers are usually located in the lower third of the leg and are characterized by a cyclical pattern of healing and recurrence. The wound, often surrounded by discolored skin, is shallow, leathery or waxy in appearance, leaks lots of fluid and isn’t very painful.

An Arterial ulcer on the other hand, which usually occurs lower in the leg back and the foot, may be painful and deep, with unhealthy tissue at its base. These wounds can deteriorate rapidly with possible infection and may need surgery in severe cases.

Compression stockings and low stretch bandages may help heal these venous ulcers, at least temporarily. There is some evidence that people wearing high rather than moderate compression are less likely to get a new ulcer. Untreated underlying reflux, however, leads to a high recurrence rate of venous ulcers.

The most reliable way of preventing recurrence is to eliminate any underlying venous reflux, caused by not only the incompetent saphenous veins but also perforator veins. In fact, undiagnosed and untreated perforator veins remain one of the most common reasons for persistent or recurrent venous ulceration. Dr. Dishakjian, the vein doctor at our vein center, has the technology and equipment to diagnose and treat incompetent saphenous and perforator veins alike.

Can I be cured of my varicose veins?

For many people, the tendency to develop varicose veins persists for life, as it is due to genetically predetermined weakness in venous valves. Although the disorder cannot be permanently cured, it can be successfully treated and controlled with many minimally invasive vein treatment options.

Could varicose veins reappear after being treated?

Current, minimally invasive treatments have very high success rates compared to traditional surgical treatments. Over a period of years; however, new abnormal veins tend to show up, and patients need to return for maintenance treatments after their initial treatment is completed.

Recent studies have clearly shown that although recurrence of successfully treated saphenous veins is uncommon, the formation of new incompetent perforator veins is not. In fact, there is a clear association between having incompetent perforating veins (veins that take blood from the deep veins to the superficial veins in reverse flow direction) and the recurrence of varicose veins.

It is important to remember that a normal leg has numerous normally functioning perforator veins along its length and any of them can fail over time and become incompetent. Accordingly, ablation of the large superficial saphenous veins alone will not correct the leg vein pump, and the incompetent perforating veins should also be carefully identified and treated as part of the vein therapy.

How do I prepare for vein treatment?

In the week before your treatment, avoid taking NSAID medications, such as ibuprofen (Advil, Motrin).

Is coronary bypass surgery possible after saphenous vein removal?

A significantly dilated, incompetent and varicose saphenous vein cannot be used for coronary artery bypass surgery, and permanently shutting it would not present future problems.

Fortunately, the lower part of the saphenous vein is sometimes mostly unaffected, whereby venous insufficiency from the groin is channeled into varicose side branches, sparing the lower saphenous vein (below the knee) from forced dilation. This part of the vein is often left untreated and can be used for future vascular bypass procedures.

There are also other alternatives to the saphenous veins for coronary bypass surgery, like arm veins or internal mammary arteries, which, incidentally, have shown the best long-term results.

Are there any medicines or home remedies for varicose veins?

Over the years, many different medicines and creams have been tried for the treatment of varicose veins. Currently, there are no FDA approved medications that effectively treat varicose or spider veins or prevents their appearance.

However, a certain class of medications, commonly used in the European market, known as bioflavonoids, provide some symptomatic relief. These medications act by decreasing capillary leakage of fluid that results in leg swelling, rather than addressing the mechanical plumbing issue that is the root cause of chronic venous insufficiency. Paroven, Venoruton, and Daflon are such examples.

Homeopathic remedies claim to help relieve some symptoms of varicose veins or help prevent their worsening. Homeopathy is a form of alternative medicine that attempts to treat patients with extremely diluted preparations which are thought to cause symptoms similar to that presented. Homeopathic medicine suggests the uses of Arnica Montana, Calcarea Carbonica, Carbo Vegetabilis, Hamamelis, Lycopodium, Pulsatilla, Causticum, and Zincum Metallicum as remedies for varicose veins. The choice as to which of the preceding remedies is good for you depends on the symptoms associated with your varicose veins and your constitution. Individuals with serious cases may benefit from a constitutional remedy prescribed by an experienced homeopath.