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What
Are Varicose Veins? Varicose
veins are dilated or tortuous veins located close to the skin surface. There are several
types of veins that are often referred to as ``varicosities." These include
telangiectasias (``spider veins"), reticular veins (``blue veins") and the
prominent, bulging varicose veins. What
Causes Varicose Veins? While
a myriad of factors have been ascribed to the development of varicose veins, there is
little scientific evidence to suggest anything, other than genetics, is responsible for
the development of varicose veins. The overwhelming majority of people with vein problems
have a relative (mother, grandmother, or aunt) with similar problems. Certainly a
lifestyle in which standing in one position for a prolonged period of time occurs (e.g.,
teacher, nurse, hairstylist, etc.) would increase the chances of developing varicose
veins--especially in those genetically predisposed. The
effect that hormones have on the leg veins cannot be overlooked. Since these hormones rise
and fall on a regular basis (the menstrual cycle) it is not surprising that many women
experience discomfort that varies consistently with their menstrual cycle. What
Can I Do to Prevent Varicose Veins From Developing? Unfortunately,
in those with a strong genetic predisposition to the development of vein problems, little
can be done to prevent the development of varicose veins. The use of appropriately fitted
surgical support stockings, leg elevation when possible, avoidance of standing in one
place for a prolonged period of time and not crossing the legs may delay the onset of
venous problems. What
Are the Signs & Symptoms of Venous Disease? The
signs and symptoms of venous disease run the gamut from being completely asymptomatic
(unknown to the patient) to having large ulcers on the legs that are severely painful and
debilitating. Many patients find telangiectasias and varicose veins to be unsightly and
embarrassing. These patients have become so disturbed by the appearance of their legs that
wearing bathing suits or shorts is unthinkable. Other patients describe a feeling of
heaviness or pain that is usually present at the end of the day. Women
may notice a cyclical appearance of symptoms that coincides with their menstrual cycles.
This is readily understood by appreciating the effect that hormones have on the venous
system. What
Can I Do About My Varicose Veins? There
are many treatment modalities available for the treatment of varicose veins.
Unfortunately, there are very few centers that are experienced in all of the different
therapeutic options. This results in each center attempting to utilize the one or two
treatment therapies with which they are most familiar on all patients. It is our
experience that different veins respond differently to each of the treatment options.
Therefore, appropriate therapy for one individual may involve all of the three major
therapeutic options applied at different points in the leg. Injection
sclerotherapy involves the injection, using a fine needle, of a solution caustic to the
inner lining of the vein wall. The subsequent inflammatory response results in
obliteration of the vein. Laser treatments rely, essentially, on the same principle with
the exception of the use of light or thermal energy to damage the inner lining of the vein
wall rather than chemical solutions. Surgical therapy (Ambulatory Phlebectomy, Vein
Stripping and Subfascial Endoscopic Perforator Ligation) is reserved for the larger veins
and ulceration that cannot be safely treated, in our opinion, with injection sclerotherapy
or lasers. The
most important aspect to the treatment of varicose veins is the application of the
appropriate treatment for the specific vein(s) present. How
Long Am I immobilized After Treatment? We
encourage our patients to be up and moving about on the day of treatment. This is true for
all types of therapies: injection, laser and
surgery. There are no real activity restrictions with the exception of the avoidance of
heavy aerobic exercise for 4-7 days for those treated with surgery. There is no overnight
stay required for any of the therapies and the vast majority of our patients are back to
work within 72 hours of the surgical procedure. Those patients treated with injection or
laser can resume their full level of activity immediately following therapy. Will
the Varicose Veins Return? It
is unlikely that the treated veins will recur. However, since most veins are present as a
result of a genetic predisposition, other veins will likely appear over the course of
time. These are generally fewer in number and, thus, easier to treat. What
Do the Surgical Support Stockings Do? Essentially,
these stockings improve the ability of the calf muscle to expel blood effectively from the
leg. By offering compression to the calf area, the calf muscle pump becomes more efficient
at its function. In our opinion, these is little gained by the use of thigh-high level
stocking since there is little added in compression at this level due to the large muscle
mass of the thigh. Additionally, it is difficult for most people to keep the stockings
pulled up to the level of the thigh with the use of a garter belt. Support
stockings are extremely effective in minimizing edema (swelling) and leg fatigue in
patients with venous disease. It is unlikely that they offer much assistance in the
prevention of the formation of telangiectasias or other varicosities in those patients
genetically susceptible to their development. What
Are The Results of Therapy for Venous Disease? The
results of therapy for venous disease are excellent. Most patients have complete relief of
their symptoms with recurrence of symptomatic varicosities being the extreme exception,
rather than the rule. The aesthetic results of treatment are also excellent with most
patients feeling significantly less inhibited about the appearance of their legs than
prior to treatment. The need for bulky, surgical compression stockings is eliminated and
chronic pain and fatigue no longer restrict activities. It
is imperative to understand that NO therapy will restore the appearance of the legs to
that of a teenager. The results of sclerotherapy are quite satisfactory. Many of the
obvious varicosities will be obliterated; however, small blemishes inevitably remain. Most
women are able to wear sheer stockings without having their varicosities visible. Reappearance of varicosities is not uncommon as
the underlying condition that causes the spider veins has not been altered by
sclerotherapy or laser treatments. The sclerotherapy process is a tedious one that
requires patience and communication between the patient and physician. Most patients are
rewarded for their patience with outstanding clinical results.
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