Frequently Asked Questions
Why do I have varicose veins?
The universal cause of varicose vein is inheritance. If one parent has varicose veins there is a 50 % chance of getting varicose veins, if both parents 89%. As we get older varicose veins are more common and more serious. Just being a woman carries a 5 times chance of varicose veins. If you add pregnancy or weight gain, the chance increases. Very important is prolonged standing, such as at work and remember varicose veins are very common – up to 30% of the population will suffer from them but they are easily treated.
What is chronic venous insufficiency (CVI)?
The venous system is divided into superficial and deep veins. Superficial veins lie in the fatty tissue and are thin walled and unsupported and therefore become varicose when exposed to higher than normal pressure. Deep veins are veins under muscle supported by muscle and so can handle higher pressure. When abnormal valves allow the superficial veins to be exposed to the higher pressure in deep veins varicose veins and venous insufficiency develop. Blood then moves backwards down the legs, away from the heart. This is called reflux. This leads to an increase in venous pressure which damages the superficial veins – leading to varicosities – and the skin leading to inflammation, brown skin changes and ultimately ulceration—break in the skin. Fortunately, most cases of chronic venous insufficiency are caused by superficial disease which is easily treated.
What is the short-term treatment of varicose veins or CVI?
Exercise, compression hose, elevation and weight reduction.
What is the permanent treatment of varicose veins or CVI?
Since most venous disease involve primarily the superficial veins. These veins can be removed and the cause of reflux eliminated.
How is reflux diagnosed?
Complete history and physical and duplex ultrasound.
What is Duplex Ultrasound?
Invented by the military, ultrasound uses sound waves that are reflected through your tissues and then analyzed by a computer to delineate anatomy and direction of flow. It is painless and remarkably accurate.
What is vein stripping?
Surgery where the veins are surgically removed and is rarely done now.
What is sclerotherapy?
Injection of a chemical into the vein to destroy the lining and then allow the vein to be absorbed by the body. It is very good for smaller veins.
How do you treat larger veins?
We use laser and radio frequency.
What is laser?
Laser is focused light that is amplified by mirrors to target specific tissues whose color is absorbed by the wavelength of the specific laser. Tissues whose color does not absorb the laser are not damaged. Laser can generate temperatures of 1200 degrees in the body.
What is radio frequency?
Heat generated by electricity to destroy the lining of the vein.
What happen to the drainage in my leg when the varicose veins are destroyed?
Varicose vein do not transmit blood because of the defective valves and this causes increased venous pressure that damages normal veins that are overloaded. This is why veins get worse with time. Your legs do not depend upon varicose veins for drainage and studies actually show improvement in the other veins after endovenous treatment.
I had sclerotherapy before. Why didn't it work?
There are many reasons for varicose vein recurrence after sclerotherapy. If ultrasound was not used then proper diagnosis was not made. Deeper veins contribute to spider veins and if they are not eliminated, the spider veins will not go away.
Are some veins too large to treat with endovenous method?
We have not seen this except in patients with venous aneurysm, which are rare.
How long will treatment take?
It depends upon the findings on Ultrasound and this will be performed at the first visit and a treatment plan outlined for you. Most treatment sessions last less than one hour.
Do high heels or crossing one's leg cause varicose veins?
There is no scientific evidence of this.
Does insurance pay?
Most insurances pay for endovenous treatment, but most insurances do not pay for sclerotherapy.
Why should I go out of network?
Because of the recent innovations in vein treatment few doctors have committed the time and investment for modern vein treatment. A specific insurance plan may not have contracted with a dedicated varicose vein expert.
Is laser used for spider veins?
Only as a last resort because it does not treat the cause of spider veins and hurts more.
Why don’t my veins hurt?
People have been taught that varicose veins do not hurt as I was taught in medical school, but aching and fatigue especially at the and of the day is not normal.
Do you elevate your legs?
Elevating your legs while you rest can take pressure off of weakened and varicose veins.