Varicose Vein Information
Our understanding of venous disease has improved tremendously and as a result we now have more effective and minimally invasive treatment options available.
We now know that venous disease is more common than we once appreciated. In fact it is the most prevalent vascular disorder world wide. As many as 40 million Americans, more commonly women, have varicose veins. It was once believed that varicose veins rarely caused any symptoms and therefore any treatment was purely cosmetic. The reality is that most patients have lifestyle limiting symptoms and not all patients present similarly. Furthermore, many patients seek medical attention with great reluctance because they have learned that short of major surgery, or life long compression therapy, little can be done.
How do varicose veins occur?
Most people have three groups of veins in their legs; the superficial veins (which lie closest to your skin); the deep veins (which lie in groups of muscles); and perforating veins (which connect the superficial to the deep veins). The deep veins lead to the vena cava, your body's largest vein, which runs directly to your heart. Varicose veins occur in the superficial veins in your legs.
When you are standing or sitting, the blood in your leg veins must work against gravity to return to your heart. To accomplish this, your leg calf and foot muscles squeeze the deep veins of your legs and feet. One-way flaps, called valves, located within your veins keep blood flowing against gravity and eventually reaches the heart. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing in reverse, back down the legs. The entire process of sending blood back to the heart is called the venous or calf pump.
The calf pump is very efficient when a person walks. Within a few steps the leg has been emptied approximately 80% demonstrating how well the venous pump works. However, when you sit or stand, especially for a long time, the blood in your leg veins tends to pool and the pressure in your veins increase significantly. Deep veins and perforating veins are usually able to withstand short periods of increased pressures. In certain individuals, the veins are repeatedly overstretched which weakens the walls of your veins and ultimately damages the valves. Damage to these valves then cause reflux of blood back into the legs, further increasing venous pressure, further increasing valve damage. It is the high pressure in the leg that leads to various degrees of symptoms and varicose veins. Spider veins are mild varicose veins which look like a nest of red or blue lines just under your skin. Spider veins are not a serious medical problem, but they can be a cosmetic concern for some people. A very advanced form of venous reflux present with markedly dilated ropy veins which can spontaneously bleed and lead to the development of (venous) ulcers.
What are the symptoms?
Chronic pain from increase venous pressure in the limb and swelling of varicose veins
Recurrent cellulitis (infections of the skin)
Stasis dermatitis a chronic skin condition resulting in redness, itching and pain
Heavy, tired, restless achy legs which worsen with prolonged sitting or standing
Restless leg syndrome or night cramps
Localized or generalized burning
Achiness and heaviness
Patches of skin darkening known as hyperpigmentation
People with severe varicose veins have slightly increased risk of developing deep vein thrombosis (DVT) – clot in the deep veins. DVT may cause sudden, severe leg swelling and redness. DVT is a serious condition that requires immediate medical attention.
Who is more likely to develope varicose veins?
Factors that can increase your risk for varicose veins include having a family history of varicose veins, being overweight, not exercising enough, smoking, standing or sitting for long periods of time, or having a history of DVT. Women are more likely than men to develop varicose veins for reason incompletely understood but likely do to estrogen effects on vein function. Varicose veins usually affect people between the ages of 30 and 70.
Pregnant women have an increased risk of developing varicose veins, but the veins often return to normal within 1 year after childbirth. Women who have multiple pregnancies may develop permanent varicose veins. We generally recommend that women postpone any vein procedure for at least 3 months following child birth.
How are patients evaluated?
Generally this begins with seeing your health care provider who will obtain information about the individual’s general health, medical history, and symptoms. In addition, a physical exam is performed to make the diagnosis. Once the diagnosis has been made usually a referral is made to a vascular specialist who treats varicose veins.
To confirm a diagnosis of varicose veins, your physician or the vascular specialist may order a duplex ultrasound test. Duplex ultrasound is a painless test used to visualize the veins in the leg and determine how effective blood moves through them. This is best way to determine whether leaky valves resulting in reflux is present. The examination takes approximately 20 minutes for each leg. Besides showing varicose veins, duplex ultrasound can show if the varicose veins may be related to some other condition beside leaky valves such as a DVT or a developmental (congenital) problem (May-Thurner Syndrome).
How are varicose veins treated?
Unfortunately, varicose veins often worsen without treatment. Most patients are first offer non-surgical methods in an attempt relieve symptoms. Patients with mild to moderate varicose veins are instructed to elevate their legs as much and whenever possible to help reduce leg swelling and relieve pain. When people need to sit or stand for a long period of time, they should flex their ankles up and down or perform toe raises to activate the venous pump and increase blood moving towards the heart which reduces pressure, swelling and pain. Walking regularly is also very helpful in this regard.
Other treatment options include:
• Compression stockings
• Injection or foam Sclerotherapy
• Radiofrequency Ablation (RFA)
• Endovenous Laser Ablation/Therapy (EVLT)
• Microphlebectomy (Ambulatory Phlebectomy)
• Surface laser therapy
• Vein stripping and high ligation
Venous disease, when left untreated, may lead to long term complications which can be irreversible or extremely difficult to treat. These include
• Ankle hypo or hyperpigmentation ( appearance or white or black spots in the skin )
• Lipodermatosclerosis (hard, raised skin areas generally along the ankle)
• Stasis dermatitis (recurrent inflammation or infection of the skin)
• Venous ulcerations (very painful and difficult to treat ulcers most commonly along the ankle.)
• Bleeding from varices
• Thrombophlebitis (inflammation and blood clots along the superficial veins)
• Deep venous thrombosis
Why chose the Oregon Vein Center (OVC)?
OVC has a long standing reputation for exceptional care and expertise. The clinic has been present for decades, founded by two vascular experts who adopted and brought the most advance treatment options to Lane County. They were the first to offer EVLT, microphlebectomy and foam sclerotherapy to the region as an alternative to traditional stripping. Soon after it was established, it became a referral center for patients outside the area including multiple communities along the coast, Deschutes, Linn, Douglas, Coos, Benton and Lincoln Counties. Dr. Viramontes has continued the mission and legacy of its predecessors. Anyone or any group can claim to be the best but very few can substantiate it. We believe that one way to determine this is to ask to speak with former or current patients. Ask them whether they felt the vein specialist was knowledgeable, clearly explained their condition and how it can be treated both medically and surgically. In addition, ask your health care provider who they would go, or refer a family member to if they had a similar problem. We treat all patients of varying backgrounds, educational and professional levels equally regardless if they need a procedure or not. We enjoy educating and empowering individuals with knowledge regarding their condition. We welcome and advocate for second opinions if you're ever in doubt.