Varicose Vein Disease

By James M. Gracy, PA-C

For many people, the often large, ropey-looking veins bulging from their legs are enough to keep them from wearing shorts or skirts.  Most people consider them just plain unsightly but the truth is they may be indications of something more serious going on that should be evaluated and treated.  The underlying condition, lower extremity venous reflux disease or "varicose vein disease", is a common medical condition that affects up to 50% of the adult population.  Women are affected one and a half times more frequently than men.  Once you have varicose veins, they often worsen as you become older.  If either of your parents had varicose veins, you are more likely to have them yourself.

Symptoms include leg aches, fatigue, discomfort, swelling, itching, burning and cramps.  You may see small spider veins and/or the more dramatically enlarged and bulging varicose veins.  Many people have symptoms without anything visible.  No matter what your symptoms are, your quality of life is probably affected.  You don't participate in the activities you love; you don't wear the clothes you like; you may have two sets of shoes so you have one pair for morning and another pair for the afternoon when your feet are swollen.  You probably can't stand on your feet all day like you used to.  Aching in your legs may interrupt your sleep, making you feel tired and sluggish throughout the day.

Understanding Our Anatomy

Circulation is the process by which blood flows away from the heart to the rest of the body and then back to the heart again.  We have two types of blood vessels: arteries that carry blood away from the heart and veins which return blood to the heart.  Superficial veins lie just below the skin and deep veins lie within the muscles of our legs.  Veins and arteries vary greatly.  Arteries are under pressure, (blood pressure of 120 mmHg is normal arterial pressure, while blood pressure of a vein in the same location might vary from 6-15 mmHg).  Because veins have such little assistance from the heart, they compensate by having one-way valves that help the blood constantly move in one direction.  The veins also rely a great deal on the movement of our leg muscles squeezing the veins and thus pushing the blood along.  In a damaged vein, the valves no longer work and the vein walls become weak and dilated. This allows the blood to leak backwards through the valve.  Over time, blood pools in the veins and varicose veins may result.  What starts as merely unsightly can turn dangerous if swelling and blood clots form where the blood moves too slowly.

Treatment

If you are diagnosed with venous reflux disease, treatment begins with conservative measures such as increased walking every day, elevating your feet, taking over the counter medications like ibuprofen or Tylenol for pain and most importantly, wearing compression hose prescribed by your health care provider.  Almost all insurance companies will require these "conservative measures” for a period up to 3 months before they will pay for any surgical treatment.  Today, there are several different treatment options that can be performed with little discomfort right in our office; Laser ablation, Radiofrequency ablation, Verithena, sclerotherapy and phlebectomy.  The goal of surgical treatment is to obliterate the weak, nonfunctioning superficial vein.  Following your procedure, you walk out of the office with minimal discomfort.  Follow-up occurs periodically over the next few months to ensure the vein stays closed and your symptoms improve.