National Center of Excellence for Vein Disorders
What Are Varicose Veins and How Are Varicose Veins Unhealthy?
If you experience bulging leg veins, aching and pain in the legs, heaviness, tiredness of the legs, itching and burning along bulging veins, restless legs or leg swelling, you may have symptomatic varicose veins that warrant evaluation and treatment.
Varicose veins can become enlarged and in some cases quite prominent. They can be seen in some individuals as serpiginous (snakelike), raised lumps in the thighs, legs, calves and ankles.
The first reference to the treatment of varicose veins is credited to Hippocrates in the 4th Century BC. He used a "slender piece of iron" to traumatize varicose veins and thereby cause clotting of the vein. Another description is of historical note with removal of a varicose vein in the Roman Consul member Caius Marcus by Plutarch - of note, no anesthesia was used and when the surgeon went to do the same operation on his other leg, he is noted to have said " I see the cure is not worth the pain". Things have changed a lot since that time and the procedures done today are done in the comfort of an office setting with little or no discomfort! Over 98% of patients who have vein procedures at the Vein Treatment Center return to work within 24 hours. We encourage all of our patients to resume ALL physical activities immediately, including using the treadmill, walking, jogging, running, elliptical machines, yoga (traditional and hot), zumba, bicycling and so on ...
The major superficial veins in the lower extremities include the greater and lesser (short) saphenous veins. Other veins include the superior epigastric vein, superior external pudendal vein (groin area), posterior arch vein, anterolateral branch of the greater saphenous vein, anterior tributary vein and dorsal venous arch. As well, the posteromedial vein, vein of Giacomini, intersaphenous vein and posterior lateral tributary veins. All of these veins and their branches can become varicose.
I often remind my patients that the only place in the lower extremities where a vein should be visible is near the inner ankle bone (medial ankle), where the skin is thin and almost everyone can see the saphenous vein cross it as it heads toward the upper body. This is seen in children and teenagers and is normal. However, any other veins that develop as we get older are ACQUIRED veins, that is they are not present when we were young but develop as we get older! As they enlarge and become varicose, the overlying tissues can get inflamed and the skin can change color once blood seeps out of the veins and stains the fatty (subcutanous) tissue and skin. These hemosiderin depostis are responsible for the bronzing of the skin which is most likely at the most dependent partsof the lower extremities, farthest away from the heart - the lower legs and ankles.
image of vein systems in the leg, image taken from westsussexveins.co.uk on July 25, 2010
When varicose veins become prominent, they can be seen through the skin and may develop a purple-blue hue. If the skin over the varicose vein ulcerates, occasionally bleeding occurs from the thin walled vein. This can be quite dramatic and potentially dangerous, placing the patient at risk for hemorrhage.
More commonly, however, once the diameter reaches 5 mm, varicose veins cause itching in the overlying skin, burning or an ache in the affected leg. This is especially notable when the individual is upright for several hours during the day.
image taken from gvg.org.uk on July 25, 2010
If the condition is left untreated, the skin overlying the vein hardens (gets indurated) and hyperpigmentation of the skin sets in. This is followed by swelling of the lower extremity. The final step in the pathophysiology of varicose veins is ulceration of the skin.
image of thrombophlebitis of branches of great saphenous vein, taken from Adam.com on January 11, 2008
Watch video clip of phlebitis (superficial vein thrombophlebitis) after microphlebectomy:
Chronic venous reflux disease, both originating from the saphenofemoral junction, saphenopopliteal junction or along perforator veins can lead to the development of venous staisis ulceration (see video clips)
WATCH THIS VIDEO about Venous Stasis Ulcers by Dr. Karamanoukian. It discusses the natural history of untreated venous insufficiency:
Watch the most downloaded video about venous stasis ulcers on YouTube - by Dr. Karamanoukian
Even in these latter stages, there is significant benefit to be gained by radiofrequency ablation of the varicose vein or phlebectomy.
How Do You Diagnose And Evaluate Varicose Veins?
Following the history and physical examination, the next major diagnostic step is the Doppler ultrasound examination (Duplex scanning). The ultrasound examination gives us a real time and detailed view of your varicose vein system. The Doppler part of the examination determines if there is venous insufficiency (also known as venous reflux disease). Next, we prepare a comprehensive "venous flow map," which illustrates the path of the blood flowing through the abnormal veins and where the trouble begins. Special attention is paid to perforator veins that contribute to the development of varicose veins. We also measure reflux times at the saphenofemoral junction (at the level of the groin), at the saphenopopliteal junction (behind the knee).
Patients are often surprised to see how extensive the venous network is and how superficial they are beneath the skin. This vein map that we create depicts details not visible from surface examination of the skin, that is, details that make treatment more effective.
Since each patient and each patient leg (right and left) are uniquely different, the vein map helps us configure the optimal plan to treat symptomatic varicose veins.
How Do You Treat Varicose Veins?
There are several treatment options for varicose veins available.
- compression stockings
- VNUS Closure
- VenaCure EVLT Never Touch
- traditional sclerotherapy
- foam sclerotherapy
We also have the most advanced laser vein system for EVLT to accomplish the same goal as VNUS Closure, namely the EVLT VenaCure Never Touch system.
image of the EVLT laser procedure to treat venous insufficiency
What Can I Do To Prevent Varicose Veins?
Many of the things that seem to cause varicose veins are difficult to avoid such as a family history or a sedentary way of life.
Whenever possible, avoid standing for prolonged periods of time. Walking is much better for the veins and helps blood return to the heart more efficiently, preventing the pooling of blood in the legs.
In professions or occupations that require extended periods of standing, a few steps should be taken at regular short intervals to help the venous circulation. These include things like wearing support stockings. No supplements or drugs are effective in preventing the formation of varicose veins.
What About Elevating The Lower Extremities?
If you are sitting, leg elevation at or near the level of the heart can significantly alleviate symptoms of leg pain and swelling.
Other things that you can do include:
For more information about varicose veins, spider veins, venous reflux and treatment options such as the closure procedure or guided sclero, contact Dr. Karamanoukian at the Vein Treatment Center, a National Center of Excellence for Vein Disorders by email or by phone at (716) 839-3638.