A: Varicose veins are dilated superficial veins in the legs. The word “Varicose” comes from a Latin word that means “twisted.” Veins of the legs contain one way valves that allow the blood to flow upwards toward the heart from the feet and from the superficial veins into the deep veins. When these valves don’t function properly, the blood slips past these leaky valves and flows backwards toward the feet and into the superficial veins. The highly pressurized blood pools in the superficial veins causing the veins to stretch and become larger. Varicose veins are usually lumpy, twisted, bulging, and sometimes bluish in color. They sometimes look like cords. Sometimes, varicose veins can lie deep in the leg and cannot be seen with the eye. Ultrasound imaging is used to determine if you have this type of varicose veins.
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Q: What causes Varicose Veins?
A: Varicose veins occur when the valve in the vein does not function properly. This can be due to the destruction of the valve, or merely, the fact that the vein is dilated so much that the edges of the valve do not meet allowing the blood to slip past. There are several factors that increase your chances of having varicose veins.
Genetics - this is the most common cause of varicose veins. Varicose veins tend to run in families.
History of Blood Clots - blood clots in the veins destroy the valves and cause them to not function properly.
Age - as we age, the valves in our veins lose their ability to function properly.
Obesity - being overweight increases abdominal pressure, resulting in an increase in the pressure of the leg veins. This increase in pressure can cause dilation and leakage of the valves in the veins.
Sex - woman are more likely than men to develop varicose veins. Female hormones during pregnancy, pre-menstruation, menopause, and hormone replacement can relax the walls of the veins causing them to become dilated.
Standing - standing for long periods of time allows blood to pool in the lower extremities. Some occupations such as teachers, nurses, factory workers, hair dressers, and physicians are more likely to develop varicose veins due to extended periods of standing.
Q: What are symptoms of Varicose Veins?
A:
An achy or heavy feeling of your legs (often worse at night or after exercise)
Burning or throbbing of your legs
Itching in the lower part of your legs or around a vein
Swelling of your legs
Easily tired legs
Color changes of the legs with skin darkening
Skin ulcers or sores near your ankle
Restless leg syndrome
Q: How are Varicose Veins Treated?
A: At the Vein Center of Texas, we are pleased to offer the Venous Closure procedure. The Closure procedure is a minimally invasive procedure that is designed to treat superficial venous reflux. Using ultrasound guidance, a small catheter is inserted into the vein through a small opening. The catheter delivers radiofrequency (RF) energy to the vein wall, causing it to heat, collapse, and seal shut. Once the vein is closed, the blood is immediately diverted to other healthy veins. The radiofrequency closure procedure is performed in the office under local anesthesia. A sclerosing agent called Sodium Tetradecyl Sulfate is also utilized in the smaller varicose veins. The solution causes a reaction with the vein wall causing the vein to close.
In prior years, vein stripping was the preferred method of treating varicose veins. During a stripping procedure, the surgeon would make an incision in your groin to tie of the great saphenous vein, then threads a stripper tool through the vein so the he can pull the vein out through a second incision above your calf. This method requires hospitalization and a lengthy recovery time. With today’s technology, vein stripping is rarely needed.
Q: How long does the procedure take?
A: The venous closure procedure takes from 30-60 minutes, though patients normally spend several hours at the office on the day of the procedure.
Q: Is the Closure procedure painful?
A: Patients report feeling very little, if any pain. We routinely prescribe a mild sedative that is taken by mouth to help relax the patient during the procedure. We use a local anesthetic, as well as a solution that we call tumescent anesthesia around the vein being treated. It is done as part of the procedure and will numb the area up so that the patient feels nothing as the vein is being closed. Some patients have a temporary burning sensation when the Sodium Tetradecyl Sulfate is being used for the smaller varicose veins. This “burning” is alleviated as soon as compression is applied to the patients leg.
Q: What is the recovery time?
A: We encourage you to stay active beginning the day of your procedure. We encourage you to walk at least 15 minutes out of every waking hour. No heavy lifting or strenuous activity is allowed. We will dress your leg in a compression wrap or your compression stocking that you will leave on for 48 hours. You may then shower and wear your support stockings 24 hours a day, taking them off only to bathe. We recommend you wear them, even at night, until your post op visit. Most patients return to work and normal activity the following day.
Q: Will I be able to continue working while having the procedures done?
A: Most patients take off only the day of their procedure. You will be able to continue normal activity the following day.
Q: What can I expect after my procedure?
A: The day of the procedure, you may have some pinkish fluid that leaks from your leg. This is the tumescent anesthesia that has been injected around the vein during the procedure. You will most likely feel “knots” on your legs after the procedure. This is simply the closed vein. Once the vein is closed, instead of being soft, it becomes hard and cordlike. Some inflammation is common. Bruising is not an abnormal occurrence and we expect this to happen. You may have a pulling or tugging sensation on the inner area of your thigh for the first 5-7 days as the treated vein continues to shrink.
Q: How many procedures will I need?
A: During your initial visit, you will have a detailed diagnostic ultrasound. This will allow Dr. Rodman to see exactly which veins need to be treated. Depending on the veins involved, there may be 1-5 treatments required. These are done on one week intervals, usually alternating legs.
Q: What happens to the treated vein that is left in my leg?
A: Overtime, the vein will simply shrink and become fibrous tissue. Depending on the initial size of the vein, some treated veins cannot be seen on ultrasound at the one year follow up.
Q: I had a vein stripping surgery 15 years ago and I have most of my veins back. What do I do now?
A: Some years ago, stripping of the saphenous vein was done. During a stripping procedure, the surgeon would make an incision in your groin to tie of the great saphenous vein, and then thread a stripper tool through the vein so the he can pull the vein out through a second incision above your calf. After vein stripping, it is common to see recurrent varicose veins. It is important to have an ultrasound examination to show exactly what has been done in the past and to determine which veins are now the problems. In this situation, the radiofrequency closure procedure work very well to treat the new veins.
Q: I have am finished with my procedures and my legs feel great. Am I cured or can other veins become affected?
A: This procedure is an effective treatment for your varicose veins. It does not cure the underlying problem that may cause new veins to appear. Hereditary factors, prolonged sitting or standing, pregnancies, trauma, and several other factors may contribute to the development of new veins.
Q:I have had vein surgery and my leg is numb from nearly the knee to the ankle. The surgery was done 10 days ago.
A:You have described a bruising of the nerve that accompanies the long saphenous vein. This is a disturbing complication that may take many months to clear. For the most part, it will clear entirely. However, the occasional patient suffers continued numbness, which is not important medically but is annoying.
A: Spider veins are thin threadlike veins that lie very close to the skin and are often purple or red in color. Spider veins grow from reticular veins that have can have a blue or green appearance beneath the skin.
Q: How are spider veins treated?
A: An ultrasound is performed to determine if you have underlying venous insufficiency. If the underlying veins and valves are normal, then we will proceed to treat the spider veins. This procedure is called Sclerotherapy. Sclerotherapy is a microinjection procedure to treat spider veins. The procedure involves injection of a sterile solution (called a sclerosing solution) into the small veins using a very fine, thin needle. This solution irritates the vein lining causing it to undergo fibrosis and eventually disappear. Multiple veins can be injected at each session. The sclerosing solution we most commonly use is sodium tetradecyl sulfate.
Q: What results should I expect from Sclerotherapy?
A: Sclerotherapy can enhance your appearance and your self confidence, but it's unrealistic to believe that every affected vein will disappear completely as a result of treatment. After each sclerotherapy session, the veins will appear lighter. Two or more sessions are usually required to achieve optimal results. Sclerotherapy treats the visible spider veins, but it does nothing to permanently alter the venous system or prevent new veins from surfacing in the future.
We are always happy to answer any questions that you may have! Please feel free to call us at 409-832-8323.
Q: What are Varicose Veins?