Veins bring blood back to the heart. While the arterial system has a heart to pump blood around, the vein makes its way back to the heart via a series of valves that stair step the blood back toward the heart.
Valves in the veins can become dysfunctional. They can allow blood to go back, in reverse direction, and cause the veins to engorge beyond that valve.
Patients at risk of having these valves become dysfunctional are those who have had lots of pregnancies, patients that have had previous blood clots, patients with a family history of varicosities and patients in a profession that puts them at risk, such as nursing or a waitress. Anyone who’s on their feet for a prolonged period of time can develop varicose veins.
A varicose vein is something you can actually see. It often protrudes. The skin sticks out and you can see it. It’s unsightly. Spider veins are in the dermis or in the skin of the patient. They often just look kind of ugly. They are just like they sound, like a spider with little tentacles of vein that spread through the skin, but it’s just in the skin.
The main thing we’re worried about with patients with long-standing varicose veins is changes at the ankle. The skin can become brown and discolored from long-standing high blood pressure, high venous blood pressure in that location. Eventually, you can end up with an ulcer that can be very difficult to heal. That’s the main thing we’re concerned about.
There’s not really a risk necessarily of pulmonary embolism or a clot going to your lung. Varicose veins can be a sign of some compressive effect of the veins in the pelvis. We’d want to check that out when you’re evaluated to make sure there’s nothing more sinister going on. But for most cases, it’s mostly a cosmetic issue, or it’s an ache, or itch that patients present with for evaluation.
Some patients present with just itching. The itching can be pretty intense. It can get worse throughout the day. Most symptoms do worsen throughout the day. You can have swelling. You can have pain. Pain is probably the more common complaint. Patients come in with all sorts of tingling pain, burning pain, achy pain, pain at night. They really just want some relief from those symptoms.
A compression hose or hosiery is the main way to do it. It’s tough here in San Diego because it gets so warm, but a compression hose will definitely prevent progression. That is our mainstay of treatment. There are other ways to treat veins besides just wearing compression hose.
High heels, not so much, but definitely elevating your legs will help as well as avoiding situations that put your legs in sort of a gravity-dependent state. That often is hard to do if you’re working. At night, if you elevate your legs, that will certainly help alleviate some of those symptoms.
We start off with an ultrasound. That helps us identify what the underlying problem might be. If we see that it’s in a major vein, then we can treat that with a catheter-based system. A catheter is inserted through an IV in your lower leg, and we can treat the vein in 30 minutes. You’re back to normal activity within a day or two.
The other ways we can treat it are with laser, or radiofrequency ablation, which are heat-based, or VenaSeal, which is glue-based.
Other methods of treatment are surgery. We can go in and remove the veins if they’re large and unsightly through a series of small incisions. The last way we do this, and probably the most common method is with sclerotherapy. We use ultrasound to help us guide the needle, or we can just use a vein lamp and treat the vein directly.
Most office-based procedures, with the exception of the phlebectomy, can be done within 30 minutes. You’re back to normal activity within a day or two.
The phlebectomy takes a little bit more recovery because it is surgery. But usually within a couple days, you’re back to doing what you normally do.
You could have a varicose vein checked out for any reason. The most common complaint patients have is pain. If you have pain, or you have swelling, or itching, or something that’s bothering you, you should just get it checked out to make sure it’s not something more serious.
If they’re untreated, first it’s a quality of life issue. People suffer with pain, itching, swelling. The worst case scenario is that they end up with a skin breakdown, an ulcer, and that requires months of wound care.
If you have varicose veins, you don’t need to suffer. We have treatment and we’re happy to assist you here, anytime.
Watch the San Diego Health video with host Susan Taylor and Dr. Weiss discussing causes and treatments for varicose veins.