Varicose veins are most often swollen, gnarled veins that most frequently occur in the legs, ankles and feet. They are produced by a condition known as venous insufficiency or venous reflux, in which blood circulating through the lower limbs does not properly return to the heart but instead pools up in the distended veins.
Know your options for treating varicose veins
If you have painful, unattractive varicose veins, you are not alone: More than 30 million Americans, men and women alike, are affected by the condition called venous insufficiency, which includes varicose veins, spider veins, and telangiectasias. While rarely serious to your health, varicose and spider veins can affect your psychological and physical sense of well-being—from their unsightly appearance to the feelings of pain, cramping, heaviness and fatigue that failing veins can produce. In some cases, changes in the skin, and even leg ulcers, may develop.
“Venous insufficiency occurs when the vein’s valves become damaged and cannot transport blood back to the heart efficiently,” says Misaki M. Kiguchi, MD, a vascular surgeon at MedStar Heart & Vascular Institute and a specialist in the management of vein disorders. “Family history, multiple pregnancies, occupations requiring long periods of standing, obesity and age are all contributing factors.”
Fighting against gravity, healthy veins rely upon valves to open and close tightly, keeping the blood flowing in one direction: back to the heart and lungs. When the valves cease to function as they should, some blood leaks backward and pools in the legs, straining blood vessel walls.
The result is visually swollen veins close to the skin’s surface. Unfortunately, varicose veins will not resolve by themselves and, left untreated, may worsen over time.
Approaches to the common condition range from conservative therapy to surgical intervention.
“Compression hose, which no one likes to wear, actually work
by providing extra support and pressure,” Dr. Kiguchi says. “But it’s like wearing prescription eye glasses: You’re not really fixing the problem—only treating the symptoms.”
Today’s improved, minimally invasive techniques cannot only relieve pain, but address the root cause of the problem and improve appearance, safely and effectively.
Radiofrequency ablation (RFA), for instance, uses a needle, a small catheter and heat to collapse varicose veins. Similarly, sclerotherapy involves using a chemical injection to close off either spider or varicose veins. For the appropriate patients, these approaches produce results that are as effective as more invasive approaches, with less pain and recovery time.
“RFA and sclerotherapy are both well tolerated,” Dr. Kiguchi concludes. “Most patients are surprised by how quick and easy the treatments are.”
And what happens to those now-destroyed blood vessels? The body eventually reabsorbs them, as other veins take over their important job: keeping blood moving back to the heart and lungs.
Sclerotherapy for Varicose Veins
Treatment Overview
Sclerotherapy uses an injection of a special chemical (sclerosant) into avaricose vein to damage and scar the inside lining of the vein. This causes the vein to close.
During this procedure, the affected leg is elevated to drain blood, and the sclerosant is injected into the varicose vein. The procedure is done in a doctor's office or clinic and takes 5 to 30 minutes, depending on how many varicose veins are treated and how big they are.
After the injection of sclerosant is given, pressure is applied over the veins to prevent blood return when you stand up. You may need to wearcompression stockings for several days or weeks to maintain the pressure.
The sclerotherapy injection may be painful, and the chemical (sclerosant) that is injected can cause a feeling of burning or cramping for a few minutes in the area where the shot was given. You may need repeated sessions and many injections each session, depending on the extent of the varicose veins and type of sclerosant used.
A newer, minimally invasive technique allows your doctor to inject sclerosant with a catheter. The catheter and sclerosant are guided to the affected vein with the help of duplex ultrasound. This process allows sclerotherapy treatment to be used on larger varicose veins that previously could only be treated surgically with ligation and stripping, in which larger varicose veins are tied off and removed.
What To Expect After Treatment
Sclerotherapy generally does not require any recovery period. You will likely be able to walk immediately after the treatment, but you should take it easy for a day or two. Bed rest is not recommended, but you may need to avoid strenuous exercise for a few days after sclerotherapy. Avoid exposing your legs to the sun for the first 2 weeks after the procedure.
Why It Is Done
Sclerotherapy is used to treat:
- Spider veins and small veins that are not causing more serious problems.
- Smaller varicose veins that come back after vein-stripping surgery.
- Larger varicose veins, when minimally invasive techniques are used.
Sclerotherapy may be done alone or as a follow-up to surgery.
Watch Spider Veins Disappear as They're Injected During a Sclerotherapy Session
About 55 percent of women have some sort of vein problem--whether it's spider veins or varicose veins. While there are a variety of treatments available, the most effective option is sclerotherapy, which involves injecting the vein with a solution to clear it out.
Sclerotherapy ‘I don’t like these ugly veins’
“Darling, the legs aren’t so beautiful. I just know what to do with them.”
We have all heard the saying: “I have a circulation problem.” All “circulation” problems are not the same, and clearly, a medical professional is needed to evaluate what is required.
Varicose veins, which are more superficial, can be treated with sclerotherapy and or laser therapy. For the purpose of this article, we will discuss sclerotherapy.
Varicose veins are caused by the inability of blood to return from the legs, back up to the heart because the valves are not functioning. As a result, the blood collects and the bulging, or distension of the veins, causes a back pressure and all the veins that are connected in turn get bigger. They can be painful, but even worse, they are not so cute.
Sclerotherapy involves injecting a solution directly into the culprit vein. The solution irritates the lining of the vein, causing it to swell and stick together. Over time, the vessel will scar, and fade.
Who asks for sclerotherapy?
• “I hate these legs. I am always trying to hide them.”
• “My legs are aching, burning, throbbing, itchy, feel heavy, and full.”
• “Symptoms improve only when I lie down.”
• “The veins are worse when pregnant, or prior to the menstrual period.”
Who cannot have this procedure?
You are not eligible if you have the following issues:
• Pregnancy;
• Possibility of heart bypass surgery (they may require those veins for your heart);
• Recent diagnosis of blood clots;
• On Coumadin;
• Inability to walk;
• Infection or rash to the legs;
• Prior failures with sclerotherapy;
• Unable to afford a series of treatments.
Preparation for treatment
Avoid anti-inflammatories like aspirin and herbal medications. No lotion should be put on the legs the morning of the treatment. Compression stockings will need to be bought before the procedure, to be worn on the way home.
After treatment
Showers are permitted, but the water should be cooler than usual. A mild soap can be used to wash the injection sites. The compression stockings should be worn all day and all night, otherwise the physician will advise for how long.
For 48 hours, there should be no:
• Hot baths;
• Hot compresses;
• Whirlpools or saunas;
• Direct exposure to sunlight;
Will it last?
Veins that respond to treatment will not reappear. Fifty to 80 per cent of injected veins will respond to each session of sclerotherapy. Less than 10 per cent of the people who have sclerotherapy do not respond to the injections at all. In essence, most people respond, but as life is, in everything there are no guarantees for success.
So, remember, beauty is in the eye of the beholder, and that beholder is you!
Scheduling Treatment: What to Expect with Sclerotherapy for Varicose Veins
What Exactly is Sclerotherapy Again?
Sclerotherapy is an injection of the chemical sclerosant directly into a varicose vein in order to damage the inside lining of the vein. The subsequent scarring causes the vein to close. The procedure is done in the doctor’s office and takes about thirty minutes, sometimes as little as five, depending on the size and number of the varicose veins to be treated.
After the injection, pressure is applied over the veins in order to prevent the blood from returning once you stand up. Compression stockings are recommended for several days or weeks post-procedure to maintain pressure and maximize effectiveness.
Repeated sessions are sometimes necessary, depending on the extent of the varicose veins.
How Long Will I Take to Recover?
There is no actual recovery period from the procedure itself, and patients can walk out of the office immediately after completion. Every body has its own recovery pace (think about people who are more susceptible to drowsiness-causing medications, or the stories of people who wake up during surgeries), so there is no one answer.
Generally, you want to take it easy for a couple of days following treatment, and do avoid strenuous exercise for the following few days. Bed rest, however, is not recommended.
When is the Best Time to Get Sclerotherapy?
There is no right or wrong time to get sclerotherapy or laser treatment. But there are a few situations you may want to consider:
- Since you also will be wearing compression stockings, decide how affected you are by weather. If you are susceptible to heat and like to wear skirts or shorts that expose the legs, you may schedule treatment for more pants-friendly weather. But this is not a rule, and many patients are not bothered by their end-of-summer sclerotherapy treatments.
- Also, some patients experience initial side effects such as itching, bruising, pain, or blistering in the area of treatment. If this is something that might concern you, I recommend that you wait for the cooler weather so you can keep covered more comfortably.
- Unlike laser treatment, which treats the small red veins called telangiectasias and requires patients to stay out of the sun for two weeks following the procedure, sclerotherapy has no such requirement. However, if you are worried about the temporary appearance of blotches or bruising, you may want to avoid scheduling treatment the week prior to your big beach vacation.
- If you are pregnant, now is not the time for sclerotherapy.
What Are the Benefits of Sclerotherapy?
Sclerotherapy has over an 80% effectiveness rate among patients. Among its many benefits, sclerotherapy costs much less than surgery or EVLT/RFA (endovenous laser therapy or radiofrequency ablation) and requires no hospital stay.
And sclerotherapy is convenient: You can immediately return to work and most of your normal activities.
In a short amount of time, varicose veins can be either greatly reduced or completely neutralized, giving you back your healthy-looking skin.
Home Lifestyle Health Vein treatment improves runner’s circulation, energy
Tracy Jed, 44, of New Baltimore, isn’t a typical soccer mom.
While she’s a big supporter of her two soccer-playing sons, 8 and 15, Jed also plays soccer herself and runs, participating in 5K and 10K races with her oldest son and good friends.
About 12 months ago, pain and intense fatigue in her right leg started putting Jed on the bench and sofa.
“My right leg just felt really, really heavy, I could barely cross the finish line anymore,” Jed recalls.
Jed’s primary care physician, Parag Patel, M.D., provided her with a referral to board-certified interventional radiologist, Michael Bischoff, M.D., founder and director of the Beaumont Vein Center in Sterling Heights.
“Tracy’s case wasn’t typical,” says Bischoff, who has more than 20 years of experience performing and interpreting ultrasounds and ultrasound-guided procedures. “Though she was experiencing significant insufficiency in her great, small and intersaphenous veins, she did not have visible varicose veins to indicate this.”
A lower extremity ultrasound revealed Jed’s veins were unable to properly deliver blood from the ankle, lower leg and thigh up toward the heart, due to incompetence of the valves of her saphenous veins, which runs down the leg. Failing vein valves let blood flow backward and pool in her leg, causing poor circulation, pain and fatigue.
Bischoff successfully addressed the problem in May with an endovenous laser ablation. This minimally invasive procedure destroys the damaged vein, causing it to shrink, collapse and disappear. Afterward, the patient wears a support stocking for one week to minimize pain and promote healing.
To eliminate unsightly spider veins — a cosmetic issue, but potentially a sign of underlying venous insufficiency — Jed received sclerotherapy. In this outpatient procedure, a medicine is injected into the vein, causing it to collapse and fade.
“I feel so much better, more energetic, and I can run again,” says Jed, who ran her first 5K in a year on June 24. She also looked forward to returning to the soccer field this summer. “I’m glad I had this procedure done and would recommend it to anyone who wants to continue to enjoy an active lifestyle.”
Vein Center patients such as Tracy usually are able to return to work immediately following their procedure, Bischoff says.
“We make people look a lot better and feel a lot better, with minimal discomfort and the ability to return to their busy lifestyles right away,” he explains.
Treatment plans are developed in a one-on-one physician consultation, based on ultrasound scans, which assess damage. In addition to saphenous ablation, the Beaumont Vein Center, located across the street from Beaumont Hospital in Troy, offers perforating vein ablation, microphlebectomy and ultrasound-guided foam sclerotherapy.
Endovenous laser vein ablation and most other procedures can be completed in less than an hour and are covered by most insurances. In addition to the Beaumont Vein Center in Sterling Heights, Grosse Pointe Farms and West Bloomfield, Beaumont offers vein treatment in Berkley, Farmington Hills, Royal Oak and Westland.
Swollen, achy legs could be vein disease
The swelling and aching in her legs started long before Lynn retired from her career in business development 11 years ago. Aside from gardening, Lynn’s hobbies, including reading and staying active with crafts, kept her sitting for long periods and she noticed her legs were always exhausted by the end of the day.
“I felt like I was carting around concrete blocks because my legs and my ankles would swell,” Lynn recalled. She also experienced cramping, fatigue and trouble sleeping at night.
She reported that she did not have any visible varicose veins, so it did not occur to her that it might be a venous thing. She had other health issues so she kept thinking her symptoms were related to some of her other health issues.
After doing some research on the various causes of her symptoms, Lynn scheduled an appointment to have her venous system evaluated. She underwent venous insufficiency ultrasound examination, and then sat down with her vein specialist to discuss the ultrasound findings and treatment options.
After 15 years, Lynn finally learned that a very real and potentially serious vein disease was the cause of her swollen and achy legs. More importantly, she learned that she didn’t have to live with it.
Veins are blood vessels that are specially designed to pump blood back toward the heart, against the force of gravity. Inside the veins are a series of one-way valves that open and close with the rhythm of muscle contractions. Healthy valves close tightly, keeping blood moving upward toward the heart.
With vein disease or venous insufficiency, the valves do not close properly. This allows blood to flow backward down the legs and pool in the veins. The pooled blood can lead to bothersome symptoms such as swollen, achy legs or leg cramping, and other signs of progressive venous disease such as varicose veins, and skin changes that can lead to bleeding veins and leg ulcers. These complications are signals that vein disease is present.
Symptoms and signs of venous disease are numerous. Varicose and spider veins are the most common indicator of vein disease. They are the easiest to diagnose. But in the absence of spider or varicose veins and in the presence of other symptoms such as heaviness, achiness, nighttime leg cramps and nighttime urination, a physician should consider the possibility of underlying venous disease. If you have varicose veins, you most likely have venous insufficiency, but someone can have venous insufficiency without presenting varicose veins.
The investigation of venous disease with ultrasound is accurate and noninvasive that it makes sense to be proactive rather than waiting for the disease to progress or for the complications of the disease to develop.
Patients are simply unaware that a disease process is causing their symptoms and, further, that the disease can be treated. More often, patients tend to accept the way their legs feel and attribute the achiness, cramps, swelling, etc. to the normal result of aging, heredity or being on their feet all day.
For Lynn, the turning point was learning that the feelings she was experiencing were not normal and came from a treatable disease. She encourages others to examine their own situations and seek help if they recognize themselves in the symptoms.
“Do not overlook the fact that your ankles are swelling or your legs are swollen and you have dull, aching pain or cramping at night or interrupted sleep,” she suggests. “Do not push that off and say, 'It’s always been like that' or 'I’ve always had that uncomfortable feeling.'”
What Varicose Veins Say About Your Blood Pressure
Varicose veins are caused by high blood pressure within a vein. The unsightly or bulging veins in the legs or pelvis occur when valves in the veins break.
Although the veins become enlarged or twisted, varicose veins aren’t usually a serious medical condition, Johns Hopkins reports. Other symptoms of varicose veins include sores on the legs, rashes, skin color changes, and a heavy or aching feeling in the legs.
"To what extent can varicose veins affect blood pressure and cardiovascular health remains somewhat of a medical mystery," says Vein Specialists of the South. "However, doctors do know that it contributes to blood pressure conditions like venous hypertension and other illnesses that could put a person’s life at risk."
Varicose veins result from venous hypertension, increasing blood pressure in the veins, according to the Illinois Vein Specialists. Valves in the veins normally transport blood from the feet to the heart as the veins are flattened when standing or walking.
However, the valves can break over time in about 25 percent of people. Blood pressure increases in other valves as each valve breaks. Problems result when high blood pressure occurs in most or all of the valves from venous hypertension.
The pressure builds in the branch veins, also affecting larger veins in the leg. The veins can bulge through the skin, causing unsightly varicose veins.
The elevated blood pressure in particular veins damages valves and weakens the walls around the veins, Johns Hopkins notes.
Some risk factors for varicose veins are the same risks involved in high blood pressure or heart disease. These factors include being overweight or obese, inactivity, smoking, or older age. Leg injuries, pregnancy, or being female also increase the risk for varicose veins.
Self-treatment often helps relieve blood pressure in the veins to reduce swelling or other symptoms. Elevating the legs whenever possible for about 15 minutes throughout the day helps improve blood circulation. Compression stockings squeeze the veins to prevent the pooling of blood.
Doctors can treat varicose veins in some patients by using sclerotherapy. A chemical solution is injected into the varicose veins so other veins take over the job of transporting blood to the heart. Laser treatment can destroy the varicose veins.
Surgery is another option for many patients, especially for cosmetic reasons. Vein stripping removes the varicose veins. Some veins benefit from small incision avulsion, accomplished through small cuts. The high blood pressure veins can also be removed through transilluminated powered phlebectomy, in which a bright light helps to remove veins.
The Dangers Of Leaving Varicose Veins Untreated
Varicose veins are typically seen as unsightly blemishes under the skin. But treating these dilated blood vessels is about more than just appearances. Leaving varicose veins untreated can lead to a variety of serious medical conditions. Most patients with varicose veins report symptoms of itchiness, fatigue, pain and discomfort in the legs, and swelling of the skin. In most cases, these symptoms will only get worse if the patient chooses not to see a medical professional. Individuals that suffer from the condition should take a moment to learn about who to see for varicose veins and the dangers of leaving the condition untreated.
Why It’s Important to Treat Varicose Veins
Every case of varicose veins is different. While some patients will see their symptoms worsen, others could be at risk of coming down with a range of more serious, potentially life-threatening conditions.
• Hyperpigmentation
If left untreated, varicose veins usually result in excess blood leaking into the tissues of the leg. The patient will experience painful swelling and inflammation as parts of their skin become dark and discolored. This condition is known ashyperpigmentation.
• Lipodermosclerosis
When the tissues of the leg are left inflamed for a long period of time, the tissues become firm and heavy. The patient might feel that their legs are becoming increasingly tender, making it more difficult to move or relax. Lipodermatosclerosisis the term used to define the stiffening or hardening of the leg tissues.
• Venous Leg Ulcer
Varicose veins usually result in a condition known as chronic venous insufficiency or CVI. Over time, CVI can result in what’s known as a venous leg ulcer. This is when an area of the skin breaks down to reveal the flesh underneath. Venous leg ulcers tend to get larger over time, leading to increasing discomfort and irritation in the legs.
• Spontaneous Bleeding
Varicose veins tend to break down the walls of the skin over time. This brings the varicose veins closer to the surface of the skin. In some cases, the slightest scratch or scrape can lead to excess blood loss. While the bleeding is usually painless, patients may experience significant blood loss if the condition goes untreated.
• Superficial Thrombophlebitis
Superficial thrombophlebitis is a condition that involves the inflammation of the veins just beneath the surface of the skin. This results from the weakening of the veins and decreased blood flow. The patient may experience redness of the skin, an increasing tenderness of the vein, as well as ongoing pain or swelling of the legs.
• Deep Vein Thrombosis
Deep Vein Thrombosis is the most serious condition related to varicose veins. DVT usually results in what’s known as a pulling sensation in the legs, stemming from a blood clot. The patient may feel as if their nerves are being pinched with increased redness and swelling in the legs. If the blood clot travels further up the body, the condition could be life-threatening.
While varicose veins can range from mild to severe, those that suffer from the condition should contact a board certified vascular surgeon. If neglected, varicose veins can have major implications for the patient’s health.
Who to See For Varicose Veins
Patients with varicose veins should seek a licensed specialist in their area for an initial evaluation. Only aboard certified vascular surgeon will be able to best determine the severity of the case in question and whether or not additional treatment methods are necessary.
How to Fix Varicose Veins
Treating varicose veins all depends on the severity of the condition. In most cases, the damaged vein is removed entirely using a range of different treatment methods such as endovenouslaser ablation, micro-phlebectomy, or sclerotherapy. Most forms of treatment are relatively painless and can be performed in just a few short appointments.