How do Varicose Veins Happen?
Usually trauma or failed vein valves lead to a pooling and bulging of blood inside the vein. In women this can occur following pregnancy due to extensive hormonal shifts. Commonly patients report the problem seems to “run in the family”. Patients that spend a lot of time on their feet (i.e. mail carriers, nurses, doctors, cashiers) or chronic sitters (i.e. drivers, pilots etc.) are also at increased risk of varicose veins due to chronic pooling of blood in the leg veins.
What are the symptoms?
Typically patients notice the swollen or lumpy veins. At first they are not particularly painful but with time and usually at the end of the day patients’ report either a dull ache or outright pain. Some even develop restless leg syndrome while trying to sleep in bed at night.
What can be done?
Think of you leg calf muscle as the “heart” of you leg. Whenever you flex it you pump blood out of the leg. Especially if you are traveling long distances or driving a long time (over 1/2 hour) take a moment to flex your calves periodically to help drain the leg. Women that wear heels over 3 inches are especially at risk of developing varicose veins since the “heart” of the leg is in a constant stuck position. It is healthier for a woman to use flat heeled shoes for daily use and pumps for special occasions. Compression stalkings can also help resolve or decrease varicose vein symptoms. But usually veins tend to get worse with time and eventually an injection or surgery is required. Injections with schlerosants are mild chemicals that cause the veins to seal shut. Alternatively larger vessels need either foam sclerotherapy or endovenous laser therapy. Please note and be careful here as superficial skin lasers (NOT endovenous lasers) do NOT work on large ropey veins. Superficial skin lasers will only work on fine “spider” like veins! (So don’t waste your money!!!)
How do I know I need surgery?
Large ropey variose veins required a formal ultrasound of the leg to determine there is a patent or “open” deep system to take over after the superficial veins are shut down. The other reason is to document the existence of venous reflux of failure of the vein valve such as the greater or lesser saphenous vein. If there is significant venous reflux found on ultrasound and you have bulgy varicose veins with symptoms you may need EVLT. Dr. Wu is a diplomate of the American Board of Phlebology specializing in Venous and Varicose disease. He can provide preliminary ultrasound diagnosis and EVLT treatment.
Will insurance cover the procedure?
Potentially yes for EVLT, but NOT for cosmetic reasons. Insurance cases require a separate independent ultrasound from a radiologist or venous lab and written prior authorization with the truthful symptoms from the patient. Dr. Wu encourages the patient to always have direct, open and honest conversation with their insurance company to determine if their symptoms are significant to warrant surgery.
Is vein therapy painful?
Dr. Wu uses polidochanol for his injections which is a close cousin to lidocaine a numbing medicine which allows for less painful injections. Patients that had received injections many years ago may have been subjected to sodium morhuate or concentrated hypertonic saline, which can be very painful. Dr. Wu does not use those older compounds. For EVLT Dr. Wu will use plenty of tumescent fluid to keep your leg numb. He will test your leg to determine you are fully numb prior to initiating the EVLT procedure. If you have pain the anesthetist will give you more pain medications to keep you comfortable. Most patients report the pain post procedure is more so a dull ache than start stabbing pain and tends to feel better with the compression stocking.
How long does it take to recover?
EVLT requires you to be back on your feet immediately after surgery. Gone are the days of sitting with your leg elevated taking a vacation. Patients that are back to a normal routine immediately tend to heal better and have less complications. Typically you will have to wear a compression stocking for at least 2-4 weeks depending on the extent of your varicosities.
How long do the results last?
Potentially forever if the vein seals shut. In rare cases (less than 5%) the varicose veins can re-open, in which case additional ultrasound may be necessary to determine if there are any “perforators”. For smaller veins additional sclerotherapy may be required which is quite common and the reason for selling packages for sclerotherapy than individual injections.
Which is better endovenous RF (aka VNUS) or laser (EVLT)?
More data on long term success and beneficial outcomes is found with EVLT as opposed to endovenous RF, commonly referred to as the VNUS procedure. Though there may be less pain involved in the VNUS procedure, the long term outcomes for EVLT seems to be better thus far as confirmed by many published studies.
Are there any side effects?
Yes, if you are a dark skin type you could experience slight darkening of the overlying skin where the vein was d/t inflammation. But don’t worry, use of lightening creams and other lasers at the _________ center can be used to remedy the hyperpigmentation. Sometimes skin can be damaged if an arterial injection occurs. Please note that Dr. Wu does not perform deep sclerotherapy injections with transillumination as arterial injection can occur during this procedure. If an arterial injection, though rare, were to occur there are SEVERAL immediate remedies that Dr. Wu will use to fix the problem immediately.
Injection of a mild chemical to remove fine and small varicose veins.
The direct surgical removal of medium sized varicose veins. Laser Venous Ablation or Endo Venous Laser Therapy: If you have ropey leg veins you could have a problem with you major vein valves. This can occur with the greater saphenous vein in terms of varicose veins on the inside of your thigh; or the lesser saphenous vein in which case the varicosities are on the back of your leg. Both conditions can be treated by either foam schlerotherapy (by ultrasound guidance) or EVLT. EVLT is usually reserved for larger varicose veins or those that failed foam schlerotherapy. The procedure involves as small pin sized hole placed in the leg to introduce a small catheter with a later at the tip to “seal shut” the abnormal vein. This procedure is preferred over the old fashioned leg vein “stripping” as recent research over the last 20 years show very clearly that “stripping” can lead to greater recurrence of NEW varicose veins, whereas EVLT does not have this problem.