Veins, Vein Disease, and Vein Treatment - FAQs

Below you will find the answers to common questions that people like you have about the treatment of venous disease, varicose veins, spider veins and the technologies intended for their treatment. For answers to frequently asked questions specifically related to spider veins, sclerotherapy, and laser vein therapy, please click spider vein removal - FAQ. Click varicose veins overview to learn about the nature of varicose and spider veins, go to varicose veins treatment to read about endovenous ablation methods, or go to vein treatment to learn about the treatment options available at the center. If you have any more queries or concerns that you don't see answered here, please don't hesitate to contact us to arrange a free consultation with Dr. R. Dishakjian, the vein specialist at the Center.

What are the symptoms of venous insufficiency?

Venous insufficiency symptoms may develop very slowly and individuals may go years before being diagnosed with the disease. Symptoms of the disease vary, and people will experience different combination of the following symptoms:

• Varicose and other unsightly surface veins
• Dull aching, heaviness, or cramping in legs
• Restless legs
• Leg pain that gets worse when standing
• Leg pain that gets better when legs are raised
• Swelling of the legs
• Bleeding from superficial veins
• Redness of the legs and ankles
• Skin color changes around the ankles (bluing and browning of the skin)
• Ulcers on the legs and ankles
• Thickening and hardening of the skin on the legs and ankles

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 a menstrual period, at the end of the day, or while on birth-control pills or hormone-replacement therapy. An itchy rash (venous 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 can handle.

What is superfecial venous reflux?

Venous reflux disease develops when the valves that keep blood flowing out of the legs and back to the heart become damaged and the blood refluxes down the leg. The pooling of blood in legs puts excess pressure on vein walls and leads to the expansion of veins and symptoms, such as varicose veins, pain, leg heaviness, fatigue, and swollen limbs.

How do VNUS closure or EVLT work to treat superfecial venous reflux?

Since damaged vein valves can't be repaired, the only alternative varicose veins treatment method is to re-route blood flow through healthy veins. The VNUS Closure procedure or EVLT treat venous reflux by sealing the incompetent saphenous vein or perforator vein from inside by means of either electrical heating generated by a catheter (VNUS radiofrequency closure), or alternatively, by light energy generated by a laser fiber (EVLT). Once the diseased vein is sealed, other healthy veins take over and carry blood from your legs.

Why does my doctor insist on treating my saphenous vein instead of my bulging lower leg veins?

If venous reflux is the root cause of your bulging varicose veins, as determined by a duplex venous scan, treating the varicose veins before shutting down the sources of reflux would not work. Such treatment would be ineffective, short lived and plagued with high recurrence rates. The saphenous vein, being the most common source of venous reflux, is probably the root cause of your varicosities. In fact, shutting down the saphenous vein will often lead to dramatic improvement in the appaearance and symptoms of the varicose veins within a few weeks. Additional improvement may be achieved then, with sclerotherapy and/or foam sclerotherapy, as needed.

I have bulging veins in my legs. Can they be removed without treating the saphenous vein?

Moderately bulging varicose veins can sometimes occur without any underlying venous reflux. In such cases, these veins can be treated alone by any of the effective treatment methods, like sclerotherapy, foam sclerotherapy or microphlebectomy.

Does exercising help my varicose veins?

Venous reflux is often the root cause of visible bulging varicosities. Although there is no guaranteed way of preventing the occurrence of venous reflux, adoption of a healthy lifestyle like engaging in regular exercise, keeping your weight in check and wearing adequately supportive stockings, when indicated, may minimize your chances. Your genetic predisposition, however, is the single most important contributing factor. In fact, many patients seeking treatment for bulging varicose veins are in great physical shape and lead athletic lives. Once venous reflux is established, exercising does not necessarily improve the circulation in the varicose veins, since the venous reflux will channel the increased venous pressure in the deep veins (generated by the exercising leg muscles) back into the superficial varicose veins in a reverse flow pattern. The only way to temporarily prevent the bulging and engorgement of these superficial veins and help ease the symptoms of venous congestion is to wear high compression stocking (20-30mm Hg pressure).

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 the varicose saphenous or perforator veins misdirects the deep vein blood flow backwards and downwards towards the lower leg, instead of the heart. This "loop" circulation causes venous congestion, resulting in swelling and capillary leakage of fluid and blood components. Often, shutting down the source of venous reflux will dramatically reduce swelling of the leg, visibly reduce its circumference and re-establish a healthy circulatory pattern. It is this improvement in blood circulation that causes improvement of symptoms, like tiredness and heaviness in the legs.

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 obesity, sedentary lifestyle, female gender, pregnancy, age and localized trauma are contributing or precipitating factors. Family history, however, is probably the most important one. More than 70% of patients have a first degree relative who has varicose veins. Women get them 3-4 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, wearing tight clothing, 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.

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. Most, but not all, swollen veins spotaneously improve 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 laser vein treatment. 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 Venefit, Targeted Endovenous Therapy (formerly known Vnus Closure) and EVLT procedures?

Venefit 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 Venefit Targeted Endovenous Therapy, radiofrequency causes the heating and destruction (thermal ablation) of the vein.

Is the Venefit Targeted Endovenous Therapy better than EVLT for the sealing of the great saphenous vein?

Both technologies, Venefit (formerly known as VNUS Closure) 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. More about VNUS closure and EVLT.

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 for Spider Vein Removal?

After several spider vein removal sclerotherapy sessions, 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?

In the hands of experienced vein doctors, the discomfort of a spider vein treatment by means of sclerotherapy should be minimal or at least easily tolerable for the vast majority of patients. An occasional spot may be more sensitive than others, but generally the procedure should be well tolerated for most patients; even the needle phobic ones. In fact, most patients are pleasantly surprised at how little discomfort occurs during the procedure. Of course, pain perception is somewhat subjective, but several factors may affect the level of discomfort during injections. These include:

• the skill of your doctor
• the patients overall pain sensitivity
• the nature of the sclerotherapy solution (some solutions are more painful than others)
• the inclusion of numbing medicine in the solution
• the sensitivity of the area injected (ankle, foot, shin area and the back of the knee)
• the use of topical numbing cream, specially for sensitive areas of the leg.

In addition, veins that usually ache before sclerotherapy tend to be generally more sensitive to injections than the ones that do not.

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.

How do I prepare for vein treatment?

In the week before your treatment, avoid taking NSAID medications, such as ibuprofen (Advil, Motrin).

I have seen some videos showing veins magically disappearing when injected. Is that realistic or even possible?

The precise injection of any clear liquid in a vein will make a vein temporarily disappear from view. Patients should not be misguided however into thinking that that's all there is to it. Since sclerotherapy involves injection of a solution that is intended to chemically damage and shut down the targeted veins, one should expect a certain degree of inflammation to follow, including redness, swelling and tenderness. Also right after treatment, a certain amount of blood often returns to these injected veins leaking out of the vein into the skin tissues causing bruising and dark blue discoloration of the treated vessels. Even under the care of the most skillful and experienced vein doctors, it may take several weeks of healing for real clearance of these spider veins to occur.

I have friends who say they have had sclerotherapy done, but it did not work. Why would that be the case?

Success in sclerotharapy is very technique and skill dependent. First of all, choose your doctor well. Needless to say, an experienced vein doctor (Phlebologist) would probably give you the best results. In good hands, most patients should get a remarkable clearance in the order of 80-90%. Success in spider vein removal by means of splerotherapy is dependent on many factors, like:

• the injection skill and technique of your doctor
• the type and strength of the solution used
• the use of a trans-illuminating device to identify and treat the underlying feeder veins that supply spider vein clusters
• completing the required number of treatment sessions for a particular area (most leg veins have to be treated more than once for optimal results)
• identifying and treating of any underlying venous reflux disease (venous reflux refers to the backward and outward flow from the deep to the superficial veins in reverse flow pattern). Suffice it to say that unidentified and untreated venous reflux is one of the more common reasons for poor sclerotherapy outcomes.

I've heard a lot about lasers. Aren't these modern way of treating leg spider veins more effective and less painful?

Not really. Even compared with the best lasers, sclerotherapy is still the "gold standard" for the removal of leg spider veins. In fact,

• laser treatment ends up being a lot more painful than a comparable sclerotherapy treatment (lasers damage the vessels by heating the blood in the veins)
• when it comes to leg spider veins, laser treatments are generally significantly less effective in getting predictable, reliable outcome.

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

A significantly dilated, incompetent and varicose saphenous vein cannot be used for coronary artery bypass surgery, and permanently shutting it would not present future problems. Fortunately, the lower part of the saphenous vein is sometimes mostly unaffected, whereby venous insuficiency from the groin is chanelled into varicose side branches, sparing the lower saphenous vein (above the ankle) from forced dilation. This part of the vein is often left untreated and can be used for future vascular bypass procedures. There are also other alternatives to the saphenous veins for coronary bypass surgery, like arm vains or internal mammary arteries, which, incidentally, 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. Currently there are no FDA approved medications that effectively treat varicose or spider veins or prevent their appearance. However, a certain class of medications, commonly used in the European market, known as bioflavinoids, provide some symptomatic relief. These medications act by decreasing capillary leakage of fluid that results in leg swelling, rather than addresssing the mechanical plumbing issue that is the root cause of chronic venous insufficiency. Paroven, Venoruton and Daflon are such examples. Homeopathic remedies claim to help relieve some symptoms of varicose veins or 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 symptoms similar to that 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 and your constitution. Individuals with serious cases may benefit from a constitutional remedy prescribed by an experienced homeopath.