Varicose veins are abnormally enlarged veins that appear most commonly in the legs. They often appear blue, purple, or skin colored and look dilated, twisted, or bulging. Varicose veins are rope-like vessels that are caused by excess pressure due to improperly working valves. These valves operate to prevent backflow as blood returns to the heart. When these valves malfunction the blood may pool in the veins and lead to varicose veins. While the symptoms of varicose veins may sometimes be only cosmetic, they can often advance to a variety of painful symptoms. These symptoms include fatigue, restless legs, and heaviness in the leg. Varicose veins can also cause pain, aching, itching, throbbing, swelling, and a burning or cramping sensation.  In some cases, a varicose vein may appear as a rust-colored stain on the lower leg. However, not all symptomatic varicose veins have visually obvious surface veins or other physical findings.

Varicose Veins

Possible medical complications from varicose veins are phlebitis, thrombophlebitis, and venous ulceration. Phlebitis occurs when a varicose vein becomes irritated causing the skin overlying the site of the clot to become hot, red, and painful. This condition is sometimes mistaken for an infection of the skin of the inside calf. Thrombophlebitis occurs when a varicose vein develops blood clots that may cause the skin overlying the site of the clot to become hard painful lumps that also are hot and red.

Venous ulceration is where an open sore develops typically on the inside of the ankle or shin because of increased pressure in the veins. These ulcers will commonly occur near the ankle and are raw and painful wounds that are often difficult to treat. Often, antibiotics and salves are not enough to completely heal an ulcer. The best way to treat a venous ulcer so that it does not return is to treat the underlying cause. 70-90% of all leg ulcer cases are due to the improper functioning of the patient’s venous valves. These ulcers are often painful and can have a significant impact on your quality of life. If you believe you have venous ulcers, it is important to get them treated right away to avoid infection and further complications. The National Institute for Health and Care Excellence (NICE) recommends referral to a vascular service for anyone with a leg ulcer.

Spider veins and telangiectasias are small dilated blood vessels near the surface of the skin or mucous membranes, measuring between 0.5 and 2 millimeter in diameter. They are usually harmless but may be associated with several diseases. They are small blood vessels that lie close to the surface of the skin and occur either in lines or web-like patterns, earning them their name. They usually appear blue, purple or red in color. They are most often visible on the legs but sometimes can be seen around the nose and lips as well. Spider veins are commonly referred to as “broken veins.” These web-like veins are not generally accompanied by other symptoms but, occasionally, they may exhibit mild symptoms such as aching, burning, or itching. Spider veins are not harmful but they can look unpleasant.

Spider veins are caused by the engorgement or dilation of veins with improperly working valves. Veins are equipped with a series of one-way valves that help prevent backflow as they pump your blood back to your heart. When these valves weaken or stop working properly, it can lead blood to pool and increase pressure within your veins. This leads to conditions such as spider veins and varicose veins.

Who Gets Varicose Veins?

Varicose veins are a very common condition in adults. Women tend to develop them more frequently than men. Spider veins and varicose veins affect almost half of the adult population. There are a variety of risk factors that can increase your likelihood of getting varicose veins. One of the most common risk factors is aging. Other common risk factors include long periods of sitting or standing, pregnancy, obesity, hormone therapy and birth control pills. Family history, previous surgery, injury, and a history of blood clots can also increase the risk of developing varicose veins.

 

Office Treatment Options

Venous Ablation

As an office procedure, a catheter is inserted into the source vein under ultrasound guidance. The catheter heats up either directly or a laser fiber releasing energy causing the offending vein to shrivel up and shut down. The return blood flow is automatically redirected to the healthy veins. The radiofrequency ablation (the Closure™ Procedure) is an alternative treatment option to traditional vein stripping surgery, bringing state-of-the-art technology to an age-old disease. Laser thermal ablation typically causes more pain and bruising up front but has similar long-term outcomes as radiofrequency ablation.

Mechanical Chemical Ablation

A non-thermal technique to shut down the offending vein source. A small catheter is inserted under ultrasound guidance into the offending superficial vein. The tip of the catheter has a small ball at the tip of the catheter that spins around very fast irritating and damaging the vein. A small amount of sclerosant is concurrently injected into the area being treated while the catheter is spinning during pullback.

Ambulatory Micro or Stab Phlebectomy

Ambulatory phlebectomy is a method of surgical removal of surface veins.

Sclerotherapy

Sclerotherapy is a cosmetic medical procedure used to treat varicose veins and spider veins. A tiny needle is used to inject an FDA approved solution directly into the vein. This solution may be mixed with air or carbon dioxide rapidly to create a dish soap looking solution that chemically ablates (damages) the vein causing it to shut down.

Echosclerotherapy

Echosclerotherapy is an adjunctive medical procedure used typically venous ablation to treat the residual varicose veins. A tiny needle is used to inject the foam solution directly into the vein under ultrasound guidance.