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East Tennessee Vein Clinic
1344 Dowell Springs Blvd.
Knoxville, TN 37909
Phone: (865) 686-0507
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East Tennessee Vein Clinic is a specialty center for the treatment of varicose veins based in Knoxville, Tennessee.  Andrew M. Douglass, MD opened the first clinic in Tennessee dedicated solely to the treatment of varicose vein disease in 2001 and in 2008 was among the first 200 physicians in the United States to be made a diplomate of the American Board of Venous and Lymphatic Medicine.  At East Tennessee Vein Clinic we only treat varicose veins, every day all day. 

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  Varicose Veins Diagnosis and Treatment

Consultation and Diagnosis   
Only a fraction of varicose vein disease is visible on the surface of the legs.  Just as only  a small portion of an iceberg is visible above the water, so most varicose veins lie deeper and out of view.  All evaluation and treatment of varicose veins depends on ultrasound.  Ultrasound allows us to see the hidden “roots” of visible varicosities so that a proper diagnosis may be made and ultimately, appropriate treatment carried out.  Treating varicose veins simply on the basis of the appearance of the legs is both inadequate and inappropriate.

Consultation with Dr. Douglass:    At your first visit Dr. Douglass will perform a brief screening ultrasound of both legs with ultrasound to assess the underlying origin of the visible varicosities.  A treatment plan with alternatives will be described along the pros and cons of all available treatments.  A report describing your diagnosis will be provided as a courtesy to your physicians.  Your insurance will also be contacted.  You should leave the office much better informed about the state of your legs and your options.

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Why are varicose veins even treated? 

Varicose veins are treated for three primary reasons:

  1. To make the legs feel better.
  2. To make the legs look better.
  3. To keep varicose vein disease from simply progressing or causing complications.

First and foremost, veins are treated to make the legs feel better.  We know varicose veins cause pain because when the veins are treated, the legs feel better.  Even those patients with relatively mild symptoms of leg pain or swelling are frequently pleased by how much better their legs feel after treatment.  This is because varicose vein disease begins and is fully in motion in the legs years before visible veins appear.   Then once visible, varicose and spider veins continue to gradually progress.  This gradual deterioration of vein function proceeds so very slowly over the course of decades that we often equate leg symptoms as being those of aging and yet are pleased to find improvement in how the legs feel after treatment.
We also treat the legs to make them look better.  This should not be overlooked and is a valid reason to treat the legs.  The disfigurement of large varicose veins and extensive spider vein disease is such that many patients will forego activities simply because wish to avoid the embarrassment of their legs being seen and being questioned about their legs.  They may not put on shorts or a bathing suit or sandals and this avoidance of being seen may cause them to miss out on activities they would otherwise enjoy.  Or they may wear long pants in hot weather when they would prefer to wear something cooler.  This avoidance of being seen is in these patients greatly affecting their lifestyle.
 Finally, we treat varicose veins to prevent them from getting worse or causing complications i.e. I don’t want to let my legs get like my mom’s legs.”  The nature of vein disease is that left untreated, it is slowly progressing.  In most patients this progression if untreated will slowly lead to more symptomatic legs with more and larger varicose veins.  In about 10% of patients with varicose veins this progression will lead to complications of persistent swelling, leg discoloration, clotting (phlebitis), heavy bleeding or venous leg ulcers.  CLICK HERE TO READ ABOUT COMPLICATIONS OF UNTREATED VARICOSE VEINS.

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How are varicose veins treated? 

We treat varicose veins by getting rid of them.  While this may sound obvious, yet what is meant by this is that we do not try to repair these veins.  We simply get rid of them.   Some may object saying, “If these veins are so large, they must be important for something.”  The answer to that is actually no, they are not important.  Why is that?  There are three reasons we treat veins by getting rid of them rather than repairing them:

  1. In most patients with varicose veins the veins that have failed represent a very small portion of the total venous return moving blood back to the heart, usually less than 5%.  Over 95% of the veins are working just fine.  In most patients, the large deep muscular veins of the leg are intact and working well, carrying over 90% of the flow of the legs.  These veins are large because they carry over 90% of the venous flow back up the leg and they are located deep within the muscles of the leg where they are protected.  These large deep muscular veins are like the “interstates” of your legs carrying venous blood up to the heart.    The varicose veins that have failed working in the legs are in the skin and not in the muscle and are much smaller, more like “country roads” than interstates. 
  2. We have far more veins and venous return available to us within the legs than we are using at one time.  A helpful analogy of this is our kidneys.  We have two kidneys yet a healthy adult may donate one kidney for a transplant to their child.  We know of course that our kidneys are vital to life and that we must have functional kidneys or otherwise be on dialysis or die.  If this is true, then why do we have two kidneys when we can do quite well with just one?  The answer is I believe, we were designed (by God, in my opinion) with a backup.  Just as my truck has not four tires, but rather five (a spare being in the trunk) so we are designed in numerous aspects with a “principle of reserve”.  We are designed with “backup”, and this is true also of our veins.  So when we treat varicose veins in the legs, we find where they are with ultrasound, treat the varicose veins by eliminating them, leave the normal veins behind and there are plenty of normal veins functioning well. 
  3. Our body is no longer using these veins to circulate blood, only store it.  Our body is bypassing these veins because of the backward flow of blood down these veins with gravity anytime we are sitting upright or on our feet.   The backward flow down varicose veins with gravity is because of a genetic trait inherited causing failed venous valves.   Because blood is backing down these veins with gravity anytime we are upright there is a “back pressure” of blood, a sort of “traffic jam” where blood can’t move forward.  Our body then perceives this higher pressure because of the “traffic jam” of blood which can’t move up the legs and then begins sending blood through other routes that are not “congested”.  So while there is still blood in varicose veins, the blood is not being circulated but is rather sitting relatively still like cars in a traffic jam.   (These illustrations are of course oversimplifications but helpful in our understanding of what is going on in varicose veins.)

And so we treat varicose veins by first locating all failed veins with ultrasound including many that are not visible on the surface.  We treat the varicose veins by getting rid of them and leaving the normal veins behind and there are plenty of good veins to carry us through a lifetime!

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Normal flow in veins. The calf muscle contacts forcing the blood past one way valves that only allow the blood to move heartward.
 
Why do varicose veins form?

The cause lies primarily in heredity. It is believed a genetic defect leads to the valve failure and vein swelling.

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