Leg Vein Problems
Varicose veins are abnormally stretched or swollen veins that protrude from the surface of the skin. Generally found on the legs, varicose veins are the result of faulty vein valves or weak vein walls.
Spider veins, or broken capillaries, are medically referred to as telangiectasia. They are dilated capillary veins less than 2mm in diameter that exist just below the surface of the skin on the legs or face. Spider veins are blue, red, or purplish in color with a web-like or linear appearance.
Leg vein problems begin when the vein valves that prevent blood from flowing in the wrong direction (reflux) become weak or malfunction. This causes blood to pool in the veins, forcing them to protrude from the skin becoming tortuous or rope-like. This increased venous pressure can lead to further failure of other vein valves and to the development of varicose veins.
In addition to being unsightly and even embarrassing, varicose veins and spider veins can cause varying degrees of discomfort, including:
- leg cramps
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Varicose veins are a progressive disease that can eventually lead to ankle swelling, pigmentation, ulceration, bleeding, and advanced Chronic Venous Insufficiency (CVI). It is important to seek medical treatment early in order to stop the natural progression of this disease, and reduce symptoms to achieve the best possible results.
Spider veins often occur in conjunction with varicose veins due to increased venous pressure. They also develop on their own due to an increased number of shunts, or microscopic short-cuts, connecting the venous and arterial systems.
Pelvic Congestion Syndrome
In women, varicose veins can manifest in the genital area. This is known as pelvic congestion syndrome. Pelvic congestion syndrome is caused by poorly functioning veins in the ovaries and pelvic region, which can result in varicosities in the abdomen, buttocks, vulva, and legs. Women that suffer from a generalized achiness in their pelvic area, especially when standing, lifting, or after sexual intercourse, may suffer from this condition. With today’s advanced diagnostic tools, doctors can now easily identify pelvic congestion syndrome in women.
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While no one knows what causes varicose and spider veins, we do know that a number of factors can increase the likelihood of developing leg vein problems. We also know that the primary factor contributing to the development of varicose and spider veins is heredity, or the genetic predisposition to weak vein walls and vein valves resulting in leg vein problems.
There are also a number of lifestyle variables known to accelerate and aggravate the development of varicose or spider veins:
- birth control pills
- hormone replacement therapies
- lack of exercise
- prolonged sitting or standing
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The objective of the conservative approach in treating varicose veins is to help support the venous circulation of the legs in order to slow the development of new veins and to minimize symptoms. Conservative treatment methods will not cure or eliminate existing vein problems, however they will help slow the progression of the disease and alleviate symptoms such as swelling, aching, and cramping. As a result, they are viable alternatives to medical treatment for people who are sick, elderly, or pregnant.
Most conservative treatment plans use graduated compression stockings. Certain lifestyle changes can also help you manage some of the painful or uncomfortable symptoms associated with varicose veins.
The goal of medical treatment is to restore proper venous blood flow by eliminating varicose and spider veins from the venous circulation. The choice of medical treatment depends on the type, size, location, and depth of the vein problem as determined by invasive diagnostic tests, such as ultrasound. Through physical examination and diagnostic testing we choose one or more treatment methods to achieve the desired results.
Methods of treatment for varicose veins and spider veins include sclerotherapy, duplex-guided sclerotherapy, endovenous laser, and micro-phlebectomy. All are available at Community Vein Care.
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Endovenous Laser Treatment
Endovenous laser treatment is performed in the office as a minimally invasive method for treating large varicose veins. Under ultrasound guidance, a tiny laser fiber is inserted directly into the vein through a catheter (tiny tube). Pulses of laser energy are released along the course of the vein to seal it completely. Endovenous laser requires only a small nick in the skin and local anesthesia. The patient walks out of the office and may return to his or her normal daily routine within 24 hours. There is no hospital visit, stitches, or injection of chemical substances. This technique can be combined with micro-phlebectomy for the treatment of smaller branches, along with follow-up sclerotherapy to erase any remaining spider veins.
This endovenous laser treatment is a safe and effective treatment for large varicose veins, specifically approved by the FDA for treatment of greater saphenous vein reflux. There have been no serious complications reported in the thousands of cases. Endovenous laser has an overall success rate greater than 97%. These results are considered better than those of traditional surgery.
Micro-phlebectomy, also called ambulatory, mini, or stab avulsion phlebectomy, is an in-office surgical technique performed under local anesthesia. The procedure involves removing the faulty vein or perforator through minute incisions that require no stitches and leave no scars. A patient that opts for micro-phlebectomy can walk out of the office and may participate in normal daily activities within 24 hours. The micro-phlebectomy procedure bridges the gap between sclerotherapy and more invasive procedures.
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Sclerotherapy, or ‘injection therapy’, is the most common treatment for spider and varicose veins on the legs. During treatment, a mild chemical solution is injected into the incompetent vein or capillary. The sclerosing agent irritates the walls of the vessel, causing it to collapse. The body then absorbs the vein and blood is re-routed to a healthy vein, restoring proper venous circulation in the area.
A single sclerotherapy treatment session involves multiple injections. Patients describe the injections as feeling like a pinprick or mosquito bite. The number of treatment sessions needed will vary from patient to patient, depending on the number of veins treated.
At times, we may aid injection therapy by transilluminating the surrounding area to make deep problem veins more visible to the naked eye. By passing a special high intensity light through the skin’s surface we are able to locate and inject the deeper source of your varicose and spider veins.
Foam sclerotherapy is a new form of delivering the sclerosing agent. This method is used for large varicose veins. The foam solution has the consistency of shaving cream, which improves treatment in two distinct ways. First, the foam displaces blood within the vein, permitting the full strength of the sclerosing agent to be in direct contact with the vein wall for an extended period of time without any dilution effects. Second, the foam is visible via ultrasound imaging and can be easily tracked and guided to the source of the venous problem.
A glycerin-based sclerosing agent is used in the treatment of small spider veins and broken capillaries. Due to the fact that glycerin only irritates the inner lining of vein vessels, patients rarely develop redness or bruising in the treatment area.
Ultrasound-Guided Sclerotherapy Techniques
Using ultrasound, doctors can guide a needle to the exact location of the vein to be injected. This technique permits the injection of larger veins that once required more invasive treatments.
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Following all vein procedures, patients wear a compression stocking when you leave the office. We ask that you wear your stocking for the first 24 hours after your procedure and then each day when you are awake for two to four weeks. You may take it off to sleep and shower. You may also have an Ace bandage on over your stocking. Keep the Ace wrap on for 24hrs.
Normal daily activities can commence immediately after treatment, although patients are not allowed to exercise vigorously or get into a sauna or hot tub.
You may have some discomfort following your procedure. Some people find it helpful to take a few days off work, although we expect you to be able to resume all your pre-procedure activities quite rapidly. Take your prescribed medicine OR ibuprofen for the first few days. We would like you to continue to keep moving and maintain a normal level of activity. Walking twice daily for 20 minutes is encouraged and promotes speedy healing.