Varicose Veins - Frequently Asked Questions

Although we at the Nu Vela Vein Center are more than happy to answer any questions you may have on varicose vein treatment, we have noticed many people have similar questions. For your convenience, we have compiled a list of frequently asked questions.

The following questions tackle most topics not covered in depth in other pages of our website. Click Varicose Veins Overview to learn about the nature of varicose and spider veins, or go to Varicose Veins - Vein Treatment Options to learn about the treatment options available at the center. If you have additional queries or concerns, please don't hesitate to contact our office and arrange a free consultation with Dr. R. Dishakjian, the vein specialist at the Center.

What are the symptoms associated with varicose veins?

Varicose veins are initially painless, but with time can cause aching or discomfort in your legs. Symptoms of varicose veins may vary from person to person and are often worse just before your period, at the end of the day, or while you're on birth-control pills or hormone-replacement therapy. An itchy rash (varicose eczema), leg restless, swelling of ankles, lumps and blue or purple coloring under your skin, cramping, fatigue, and ulcers are other symptoms associated with these veins. Occasionally, these symptoms may be caused by problems other than varicose veins. You should ask for your doctor's advice.

It should be pointed out that large varicose veins don't always cause more discomfort than smaller varicose veins, and some people don't have any symptoms at all.

Why do varicose veins and spider veins usually appear in the legs?

Compared with other veins in the body, leg veins have the toughest job since they have to carry blood from the bottom of the body up to the heart against the force of gravity and the pressure of body weight. Hence, leg veins endure the most pressure. This pressure can be stronger than the veins' one-way valves.

Do the deep leg veins form varicose veins?

The formation of varicose veins in the 'deep' veins is extremely rare because these deep veins are supported and surrounded by muscles. Superficial veins on the other hand, have less muscle support; accordingly, congestion in these veins is much more likely to result in bulgy, dilated and twisted varicosities than in the deep veins.

Do varicose and spider veins serve any useful purpose?

In the vast majority of cases, spider and varicose veins do not serve any useful function; only in extremely rare cases, when the deep veins of legs are blocked, varicose veins of legs may carry useful circulation. In fact, the backward flow of blood in varicose veins and saphenous veins interferes with the normal venous return of blood to the heart. Removal of these abnormal veins actually improves circulation of blood in the treated leg. It is this improvement in blood circulation that causes improvement of symptoms of tiredness and heaviness in the leg.

What are the factors that contribute to the formation of varicose veins?

There are many factors that lead to the formation of varicose veins. It is established that trauma, age, obesity are important contributors. Family history; however, is probably the most important. 70% of patients have a first degree relative who has varicose veins. Women get them 4 times more frequently than men due to hormonal differences and pregnancy. There are also 'lifestyle' factors which can affect the veins. Standing for prolonged periods, lack of exercise, lack of antioxidants in the diet, wearing tight clothing, high heels, smoking, birth-control pills, hormone-replacement therapy, or carrying excess weight, all contribute to the worsening of your varicose your veins. Exposure to the sun can also cause spider veins, particularly on the cheeks or nose of fair-skinned persons.

How can varicose vein be prevented?

Although there are no scientifically proven ways to prevent varicose veins, the elimination of factors contributing to their formation reduces the risk for their formation or getting worse. The following suggestions may significantly slow down their progression: wear properly fitted compression stockings, periodically elevate your legs, avoid prolonged standing, avoid wearing tight clothing, exercise regularly, control weight, don't smoke, don't cross your legs when sitting, wear sunscreen to protect your skin from the sun and to limit spider veins on the face, and finally eat a low-salt food rich in fiber.

Will varicose veins associated with pregnancy disappear after delivery?

The appearance of varicose veins during pregnancy is caused by the pressure put on leg veins by the increased blood volume and the weight of the growing fetus. Moreover, a surge in the hormone progesterone makes vessel walls more elastic. The majority of women get some varicose veins during pregnancy. Fortunately, however, the swollen veins usually go back to normal within 3 months after delivery. A growing number of abnormal veins usually appear with each additional pregnancy. Pregnant women are advised to exercise regularly to ensure proper blood flow through the body. Wearing support hose can help keep circulation flowing in the legs, especially if they swell during the final months of pregnancy.

Why do doctors recommend compression stockings?

Compression stockings can temporarily reverse the effects of vein disease and relieve the swelling and aching of your legs but they won't prevent more varicose veins from developing. These thick elastic leggings provide support for surface leg veins and help the blood in your veins flow up towards your heart. Some people won't need any other treatment. Many insurance companies require a trial of stocking use before approving definitive therapy. Take the advice of your doctor to find out which type of compression is the right one for you.

What are the perforator veins?

Perforator veins are blood vessels that connect the superficial venous system to the deep vein network. These veins allow blood to drain from the skin into the deep veins. The number of perforator veins in each leg is around 150, and their concentration is the highest in the lower part of the leg. When valves inside the perforator veins malfunction, blood is pushed back into the superficial veins causing varicose veins, thread veins, brown stains, and possibly leg ulcers.

What is Duplex Ultrasound diagnosis?

The only way to determine whether you suffer dysfunction of the major veins as a cause of visible varicosities is with the use of the Duplex Ultrasound diagnosis. This technology uses ultrasound vibration with a computerized system attached to a monitor. A Duplex Ultrasound diagnosis shows a detailed picture of the anatomy and function of the venous network of the legs and helps your doctor detect the presence of truncal/saphenous insufficiency, perforator incompetence, and determine the type of treatment that suits bests to your condition.

Which lasers are used for varicose vein removal?

All lasers are not created equal when it comes to treatment of veins. Make sure your doctor has the expertise and the knowledge to use a state-of-the-art laser system that is safe for all skin types and has the flexibility and the power to treat veins of different size, depth, color and location. It is of utmost importance to use adequate cooling of the top skin layer with a cooling gel, chilled air or other cooling methods to reduce discomfort and lower the risk of injuring the skin. Sometimes the laser treatment is complemented by non-laser light devices, such as the intense pulse light (IPL) treatments, which target superficial smaller vessels.

What can happen to varicose vein disease if left untreated?

Having varicose veins doesn't necessarily mean that you will get complications. If left untreated, smaller abnormal veins may increase in number and symptoms associated with varicose veins are worsened. Check with your doctor if you notice a tender, reddened area on the surface of a vein, experience leg pain, your legs are significantly swollen, or if there are sores on the veins that won't heal. These symptoms indicate a more serious circulation problem. Phlebitis, thrombosis (blood clots), spontaneous bleeding and skin ulcers are also complications of varicose vein disease.

What is the difference between the Vnus Closure and EVLT procedures?

Vnus and EVLT procedures are almost identical, both sharing the Endovenous approach, the tumescent anesthesia technique, and relying on heat energy to destroy the veins. The only difference between the two is the way in which heat is generated. In the case of EVLT, heat comes in the form of a laser beam, whereas in the VNUS closure procedure, radiofrequency causes the heating and destruction (thermal ablation) of the vein.

Is the Vnus procedure better than EVLT for the sealing of the great saphenous vein?

Both technologies, Vnus and EVLT, work very well and are equally efficient for the ablation of great saphenous vein. Overall, the long-term data are also essentially equal. However, according to a recent study published in the prestigious monthly publication of the Society of Interventional Radiology, the Vnus system for radiofrequency (RF) is statistically "significantly superior" to endovenous laser (EVL) in providing fast and comfortable recovery, and for treating venous reflux, the underlying cause of varicose veins. In addition, according to a study published by Vnus Medical Technologies, minor complications were five times less prevalent in patients who had undergone the Vnus Closure compared to those who had chosen the endovenous laser approach.

What are venous leg ulcers?

Venous leg ulcers are a common, recurring and disabling condition. Early signs that a venous ulcer may develop include a darkening of the skin in the area of the ankle. These ulcers are usually located in the lower third of the leg and are characterized by a cyclical pattern of healing and recurrence. The wound, often surrounded by discolored skin, is shallow, leathery or waxy in appearance, leaks lots of fluid and isn't very painful. An Arterial ulcer on the other hand, which usually occurs lower in the leg back and the foot, is painful and deep, with unhealthy tissue at its base. These wounds can deteriorate rapidly with possible infection and may need surgery in severe cases.

Compression stockings, using bandages can help heal most of these ulcers and might be able to prevent their returning. There is some evidence that people wearing high rather than moderate compression are less likely to get a new ulcer. Reflux in the perforator veins, caused by damage to the valves, is the primary cause for the formation of venous ulcers. Dr Dishakjian, the phlebologist at the Vein Treatment Center has the technology and equipment to diagnose and treat the incompetent perforator veins. Without treatment, the skin may eventually breakdown and bleeding may occur.

Can I be cured of my varicose veins?

Varicose veins are a problem that can be successfully treated with many minimally invasive vein treatment options, but the disorder cannot be permanently cured. The major reason for this is that there is no cure for weak vein valves.

Could varicose veins reappear after being treated?

Current, minimally invasive treatments have very high success rates compared to traditional surgical treatments. Over a period of years; however, new abnormal veins tend to show up, and patients need to return for maintenance treatments after their initial treatment is completed.

Recent studies have clearly shown that there is a clear association between having incompetent perforating veins (veins that take blood from the superficial veins into the deep veins) and the recurrence of varicose veins. Accordingly, ablation of the large superficial saphenous veins alone will not correct the leg vein pump, and the incompetent perforating veins should also be treated as part of the therapy.

How successful is sclerotherapy?

After several sclerotherapy treatments, most patients notice a 70-90% improvement in the appearance and symptoms. The full effect and benefit of treatment usually takes several weeks. For this reason, many physicians recommend waiting 4-6 weeks in between sclerotherapy treatments. Compared to surgical removal of veins, sclerotherapy costs less, requires no hospital stay and anesthesia, and allows a quicker return to work and normal activities.

Is sclerotherapy painful?

With the use of the fine sclerotherapy needles, skin penetration causes minimal discomfort. Some sclerotherapy solutions, however may cause some cramping or aching sensation upon injection. This sensation lasts only a few minutes. No numbing creams or topical anesthetics are usually used.

Is sclerotherapy safe?

Sclerotherapy, when performed appropriately by a specialist, is a remarkably safe and effective technique. Common side effects are usually temporary and well tolerated. These include itching, tenderness, skin bruising and pigmentation, as well as growth of fine vessels in the treated area. Fortunately, serious complications like allergic reactions, skin ulcers, and blood clots are rare. You should always discuss the risks and treatment alternatives with your physician.

Is coronary bypass surgery possible after the removal of saphenous veins?

Yes, it is possible. Your surgeon can use your radial (arm) artery or other arteries, such as the internal mammary arteries, which have shown the best long-term results.

Are there any medicines or home remedies for varicose vein treatment?

Over the years many different medicines and creams have been tried for the treatment of varicose veins. However, apart from rutoside (eg Paroven), there is no evidence to suggest that any of these medicines can be used to effectively treat varicose veins. There is also no enough evidence to suggest that herbal creams, lotions are effective for the treatment of varicose veins.

Although there are no good studies to back up, there are some dietary supplements that you can take to help strengthen the vein walls and possibly improve the symptoms in your legs and slow the deterioration of the veins. These include rutins, bioflavonoids, horse chestnut, gingko, and witch hazel leaf.

Ayurveda prescribes Brahmi (indigenous Indian herb) as the drug of choice for the treatment of varicose veins and suggests a diet rich in protein, garlic, ginger, and onions. Another treatment suggested by Ayurveda is yoga. While lying on the floor raise your legs on a chair and breathe evenly. This helps drain the blood from the legs and improves blood circulation. There are some other simple stretching yoga exercises such as the Plow, Corpse, and Half Shoulder Stand that also help in treating varicose veins.

Homeopathic remedies often help relieve discomfort that comes with varicose veins, and may help prevent their worsening. Homeopathy is a form of alternative medicine that attempts to treat patients with extremely diluted preparations which are thought to cause effects similar to the symptoms presented. Homeopathic medicine suggests the uses of Arnica Montana, Calcarea Carbonica, Carbo Vegetabilis, Hamamelis, Lycopodium, Pulsatilla, Causticum, and Zincum Metallicum as remedies for varicose veins. The choice as to which of the preceding remedies is good for you, depends on the symptoms associated with your varicose veins. Individuals with serious cases may benefit from a constitutional remedy prescribed by an experienced homeopath.

Questions About Cost or a Treatment?

You may reach our Los Angeles medical spa and vein clinic by clicking the "Contact us" button at the top of the page, or by calling 818-832-4500. Our receptionist will be delighted to assist you with any enquiries regarding cost, additional information, or scheduling a free consultation session with Dr. Dishakjian, a cosmetic surgeon and phlebologist.