Where did these varicose veins come from?
Those bulging, tortuous veins on your legs that seem to appear from nowhere are actually quite common. At least 50% of people will develop varicose veins. They appear on the legs as twisted raised knots and result from damaged valves in the veins. While the veins serve to return blood flow from the legs back to the heart, pressure on the nonfunctioning valves can force the blood to back down into the legs. Gravity’s pull while standing further exacerbates the problems. The result is swelling and distortion of the veins closest to the skin. These veins enlarge, and then become unsightly varicose veins. The condition of valve dysfunction is known as venous insufficiency. The result is varicose veins.
Why do my legs look like a road map?
Smaller veins, known as spider veins, appear on the legs as a bluish hue in lines that emanate from a center and look like a spider. They can be found on the legs or face. They can be a single vein, or several large patches. Larger varicose veins may be purple or blue, and the skin surrounding the veins or along the ankle may darken. This is due to the chronic deposition of blood into the tissues around the vein and is known as hemosiderosis. Once the skin changes occur, it may be difficult to hide or reverse the brown discoloration.
Am I doing something wrong to get these veins?
Well, a component of the cause is heredity, so you can blame your parents. But other factors are involved, including age and other medical problems. Sitting or standing for prolonged periods of time are definite risk factors, and we see a lot of patients with varicose veins whose careers keep them on their feet or sitting behind a desk all day. Hormones play a role, especially those darn estrogens and progesterone. Previous pregnancies cause veins to over distend and this may result in varicose veins as well. Most patients have more than one risk factor. In some cases, the veins may be caused by a serious underlying medical problem. But no, there is little you are doing to cause the varicose veins.
Doctor, I can handle the veins, but are they serious??
Nobody ever dropped dead from a varicose vein but they can cause problems in addition to being ugly. The most common problem is pain, heaviness, and burning. Oddly enough, the size of the veins doesn’t always correlate with the degree of pain. You may also have a throbbing sensation in the leg, itching, swelling, bruising, and skin discoloration. The most serious cases can result in sores (ulcerations), bleeding, or clots in the superficial veins. The symptoms you are having often determine how the veins are treated.
Ok, I stopped wearing shorts. Now what?
You can run, but you can’t hide those legs in Florida’s sunny weather. A visit to a vascular specialist for an examination and discussion about the veins is in order. Be sure your physician is trained and board certified in the treatment of vascular diseases. Though many physicians treat varicose veins, few physicians are actually recognized as vascular specialists, and fewer are board certified in the treatment of vascular diseases. Be sure to ask your physician if his or her practice is dedicated to the treatment of vascular disease to avoid any misunderstandings. The presence of spider or varicose veins may require specialized ultrasonography to visualize the veins and the valves of the leg. This study and a physical exam are usually enough to confirm the diagnosis and explore treatment options.
I don’t care where they go, I just want’em gone.
There are several options available, and only a vascular specialist can offer you every option. The purpose of treatment is to alleviate pain, prevent complications and improve the appearance of the leg. The most common noninvasive treatments lifestyle changes that will alleviate the symptoms. Elevating tired legs and wearing compression stockings go a long way to improve symptoms. Exercise, hydration, and weight control contribute to good circulation in the legs. Many of our patients only require a structured, conservative approach to the management of their vein issues. These conservative treatments also serve to prevent the varicose veins as well.
For patients who do not respond well to conservative management, or for those who are looking for a more definitive treatment for their veins, there are procedural options. Most of these treatments are minimally invasive and require little or no downtime. They can result not only in resolution of venous symptoms, but improvement in cosmetic appearance as well.
For larger veins the most common procedure is radiofrequency or laser ablation. This procedure requires no incisions and symptomatic improvement can be immediate. Over the course of several months after the procedure the visible varicose veins on the legs have a tendency to become much smaller or even completely disappear. Another option for larger veins is “phlebectomy”. This involves making a few small “paper cut” style incisions through which the veins are removed. Phlebectomy can result in immediate improvement in both symptoms and cosmetic appearance. Ablative procedures and phlebectomy can be performed in our outpatient Vein Center.
Some patients who have extensive venous disease will require the traditional “vein stripping” procedure. This procedure involves physically removing a main (though nonessential) superficial vein. Vein strippings are performed in the hospital; however patients are discharged home the same day with minimal restrictions. This procedure as well as the laser/radiofrequency ablation and phlebectomy have the potential to be covered by insurance. If spider veins are the concern, sclerotherapy is the primary treatment. This involves injecting solution into the veins through a very fine needle. This solution can cause the veins to collapse and become invisible on the legs. Several sessions can be required to treat all of the visible spider veins. Sometimes people are concerned about the repeated injections, but the needles are so small it is almost painless! Patients may be candidates for more than one therapy, and therefore expert consultation is warranted. No therapy is guaranteed 100% success, but most patients can find relief of symptoms and a satisfactory cosmetic result.
What’s this, they can come back?
Yes, like a boomerang. Most appropriate therapies are pretty good at eliminating the veins completely. However, incompletely or inappropriately treated veins can come back. Also, an inappropriate therapy may treat the cosmetic result of varicose veins but ignore the treatment of the actual cause of the varicose veins. And repeat trips for treatment can become costly, especially if the underlying problem is never addressed.
There are many clinics treating veins, why are you different?
Glad you asked! It’s an important question, given the rising number of clinics providing “vein care” in addition to a variety of other disease treatments. Many of these clinics are run by physicians trained in specialties other than vascular surgery and don’t hold privileges to treat varicose veins and their complications in area hospitals. Would you let an electrician fix your plumbing? Why let anyone but a vascular specialist treat your veins?
Vascular Specialists of Central Florida, Inc. is the largest single specialty group of vascular physicians in the area. All of our physicians and staff are trained in the only specialty recognized as delivering comprehensive and complete vascular and vein care. Our board certified and board eligible phycourse sicians have met the highest level of training for the treatment of venous diseases. Our clinics are dedicated exclusively to the vascular patient. Not only do we perform procedures and see patients at our outpatient vein center in Downtown Orlando, but Vascular Surgeons are the only specialty recognized by area hospitals for the treatment of venous diseases. We hold privileges at several area hospitals where we consult for some of the most difficult vein and vascular cases in the state. Our clinic is therefore unique in that we can offer each patient the complete breath of treatment options from board certified and board eligible physicians in vascular diseases. After all, our patients deserve the best.