INTRODUCTION
If you
suffer from problems related to varicose and spider veins, you are not alone. It
is estimated that more than 80 million Americans suffer from some form of
venous disorder.
While
some people seek treatment for cosmetic improvement, many seek relief from
pain. Help is available.
This
on-line brochure contains useful information about the evaluation and treatment
of varicose and spider veins. Special attention is given to recent
advancements.
WHAT
ARE VARICOSE VEINS?
Arteries
bring blood from the heart to the extremities, veins, which have one-way
valves, channel blood back to the heart. If the valves don't function well,
blood doesn't flow efficiently. The veins become enlarged because they are
congested with blood. These enlarged veins are commonly called spider veins or
varicose veins. Spider veins are small red, blue or purple veins on the surface
of the skin. Varicose veins are larger distended veins that are located
somewhat deeper than spider veins.
Pain in
the legs is frequently related to abnormal leg veins. Symptoms, often made
worse by prolonged standing, include feelings of fatigue, heaviness, aching,
burning, throbbing, itching, cramping, and restlessness of the legs. Leg
swelling can occur. Severe varicose veins can compromise the nutrition of the
skin and lead to eczema, inflammation or even ulceration of the lower leg.
Vein
disorders are not always visible; diagnostic techniques are important tools in
determining the cause and severity of the problem. In addition to a physical
examination, non-invasive ultrasound is often used.
WHAT
CAUSES VARICOSE VEINS?
Heredity
is the number one contributing factor causing varicose and spider veins. Women
are more likely to suffer from abnormal leg veins. Up to 50% of American women
may be affected. Hormonal factors including puberty, pregnancy, menopause, the
use of birth control pills, estrogen, and progesterone affect the disease. It
is very common for pregnant women to develop varicose veins during the first
trimester. Pregnancy causes increases in hormone levels and blood volume which
in turn cause veins to enlarge. In addition, the enlarged uterus causes
increased pressure on the veins. Varicose veins due to pregnancy often improve
within 3 months after delivery. However, with successive pregnancies, abnormal
veins are more likely to remain. Other predisposing factors include aging,
standing occupations, obesity and leg injury.
WHEN
AND HOW ARE VEINS TREATED?
The most
commonly asked questions are: Do veins require treatment and What treatment is
best? Veins that are cosmetically unappealing or cause pain or other symptoms
are prime candidates for treatment. There are two general treatment options:
conservative measures, such as compression stockings, and
"corrective" methods such as sclerotherapy, surgery and light
source/laser treatment. In some cases, a combination of treatment methods works
best.
SCLEROTHERAPY
Sclerotherapy
can be used to treat both varicose and spider veins. A tiny needle is used to
inject the veins with a medication that irritates the lining of the vein. In
response, the veins collapse and are reabsorbed. The surface veins are no
longer visible. Sclerotherapy relieves symptoms due to varicose and spider
veins in most patients. With this procedure, veins can be dealt with at an
early stage, helping to prevent further complications.
You may
need anywhere from one to several sclerotherapy sessions for any vein region. Depending
on the type and number of veins being treated you may have one to many
injections per session. Generally, normal activities can be resumed after
sclerotherapy. Medically prescribed support hose and/or bandages may need to be
worn for several days to several weeks to assist in resolution of the veins. The
procedure, performed in the doctor's office, usually causes only minimal
discomfort. Bruising and pigmentation may occur after sclerotherapy. Bruising
typically disappears within 1-2 weeks. Although pigmentation almost always
fades, it can last for several months. Scarring and other complications are
rare.
ULTRASOUND-GUIDED
SCLEROTHERAPY
This is
an in-office treatment alternative to surgical stripping. With this technique,
sclerotherapy is done while the doctor visually monitors the vein on an
ultrasound screen. This enables treatment of veins that can't be seen because
they are below the surface of the skin and would otherwise require surgical
removal.
ENDOVENOUS
LASER TREATMENT
Endovenous
Laser Treatment is a treatment alternative to surgical stripping of the greater
saphenous vein. A small laser fiber is inserted, usually through a needle stick
in the skin, into the damaged vein. Pulses of laser light are delivered inside
the vein, which causes the vein to collapse and seal shut. The procedure is
done in-office under local anesthesia. Following the procedure a bandage or
compression hose is placed on the treated leg. Endovenous Laser Treatment is
FDA-approved for the treatment of the greater saphenous vein.
LASER/LIGHT
SOURCE TREATMENT
A variety
of laser/light source treatments are available today. A light beam is pulsed
onto the veins in order to seal them off and cause them to dissolve. Light-based
treatment is generally used only to treat small veins. Treatments may be
combined with sclerotherapy. Multiple treatments are usually required.
WHAT
RESULTS CAN YOU EXPECT?
With the
evaluation and treatment methods available today, spider and varicose veins can
be treated at a level of effectiveness and safety previously unattainable. Regardless
which treatment method is used, its success depends in part on careful
assessment of the problem by a knowledgeable phlebologist.