Varicose veins affect 30-40% of the population and occur when the one-way valves that are meant to pump blood from the legs and feet toward the heart weaken. These valves pump blood towards the heart when the leg muscles contract, but when the valves weaken blood is allowed to pool in the veins. Over time the pooled blood builds pressure and distends the veins, which may create symptoms such as leg swelling, aching, heaviness, burning, throbbing, or pain.
Causes and Symptoms of Varicose Veins
Varicose veins are largely heredity (though up to 15% of patients will have no known family history of varicose veins) and affect both men and women, although women are at a higher risk of developing them due to hormones and pregnancy. Obesity and occupations that require you to either be on your feet or sit for long periods of time can also increase the risk of developing varicose veins. While not life-threatening, varicose veins cause people to avoid activities they once enjoyed either because of leg pain or embarrassment about the appearance of their legs.
Cosmetically, varicose veins may appear as ropey, bulging veins, but only a fraction of varicose vein disease is visible on the surface of the legs. Much like the tip of the iceberg, most varicose veins lie deeper and out of view. Over time, symptoms may include leg pain, swelling, throbbing, heaviness, burning, or itching. If untreated over a long period of time, varicose veins may cause pain, dermatitis or a redness and darkening of the skin over the veins, leg ulcers, heavy bleeding or blood clots.
Treatment Overview and Options
Why do we treat varicose veins?
First and foremost, veins are treated to make 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. Patients with more severe symptoms are relieved to be able to return to their daily activities without the limitations their varicose vein symptoms had been creating.
We also treat the legs to make them look better. Oftentimes the disfigurement of large varicose veins is such that patients forego activities to avoid embarrassment, which negatively affects their lifestyle.
Finally, we treat varicose veins to prevent them from getting worse. Varicose vein disease is both chronic and progressive. If untreated, over time it may lead to more symptomatic legs and, for a minority of patients possible complications of persistent swelling, leg discoloration, clotting (phlebitis), heavy bleeding, or venous leg ulcers.
All evaluation and treatment of varicose veins depend on ultrasound. A physical examination alone is insufficient, as only ultrasound allows us to see the hidden “roots” of visible varicosities so that a proper diagnosis may be made. Once the ultrasound technology maps the entire network of a patient’s vein disease, we can determine the best treatment options.
How do we treat varicose veins?
In general, it’s first important to realize varicose veins are not repaired but rather eliminated. We eliminate the veins because the veins represent a very small portion of total venous return and also because blood within varicose veins is sitting relatively still or moving backward and so is not participating in the normal venous circulation blood moving up through veins towards the heart.
Varicose Vein Treatment Options Include:
EVLT: Endovenous laser treatment is a no-surgery, no-scarring way to treat varicose veins. The in-office procedure places a laser catheter inside the varicose vein, and then targeted laser energy seals the diseased vein(s) shut. EVLT procedures typically last less than an hour and require only a local anesthetic and no incision. Relief of symptoms is frequently immediate and patients can return to normal activity immediately with little or no pain.
Learn more about EVLT
Ambulatory Phlebectomy: Ambulatory Phlebectomy (Microphlebectomy) is performed when there are large visibly bulging varicose veins that persist after endovenous laser ablation. The vein is anesthetized locally, and then a small needle puncture over the vein is made to allow a "knitting hook" type instrument to extract the vein. The procedure typically takes 45 minutes, and the patient only feels pressure. No scalpel is used and no stitches are needed.
Learn more about Ambulatory Phlebectomy
Ultrasound Guided Foam Sclerotherapy: Ultrasound Guided Foam Sclerotherapy (or Endovenous Chemical Ablation/UGFS) is a highly-specialized technique pioneered in Europe and now used worldwide in the treatment of varicose vein disease. The procedure involves an ultrasound map of the entire diseased venous network and then, under direct ultrasound visualization, a foamed sclerosant is injected into the diseased veins which causes the diseased veins to close down gradually. Over time, the veins narrow to a fibrous thread which is invisible since it’s beneath the skin.
Learn more about UGFS
Cosmetic Sclerotherapy: Typically used to eliminate spider veins, sclerotherapy may be used to “clean up” any remaining vein disease. Sclerotherapy consists of an injection that closes the diseased veins, which are then absorbed by the body. Like the treatments mentioned above, sclerotherapy is performed in-office and typically requires less than an hour.
Learn more about Cosmetic Sclerotherapy
About East Tennessee Vein Clinic
East Tennessee Vein Clinic was the first dedicated vein clinic in Tennessee and since then Dr. Andrew Douglass has helped thousands have healthy legs that look and feel better.