Treatment of Varicose Veins & Lymphedema

In the United States approximately 80 million adults have varicose veins and spider veins of the legs. These veins can cause pain and discomfort, in addition to cosmetic concerns, and they may have serious health consequences. Varicose veins are abnormally large veins visible beneath the skin of the legs. Some people develop varicose veins after an episode of phlebitis (venous blood clot) when the superficial veins enlarge to accomplish more of the work of draining blood from the leg. However, most people with varicose veins simply have inherited the tendency from their parents, and under conditions of increased internal pressure within the veins, the vein walls stretch somewhat like a wet sweater, never to return completely back to normal. The veins of the leg have internal valves which promote flow uphill against gravity back to the heart when we are standing up. When these valves do not function well, the pressure within the veins below the valves will increase, causing the problem to worsen further downstream. Any increase in pressure can promote the stretching process in susceptible people. Varicose veins develop as a result of increased internal pressure within the veins, accompanied by a weakness in the wall of the veins. Varicose veins are most common in people with a positive family history, and a job requiring lots of standing, lifting or straining, and of course, during and after pregnancy.

Mild varicose veins may cause no symptoms at all and need no treatment other than support hose to diminish the tendency of the veins to stretch further. Patients with advanced cases complain of leg fatigue, swelling and congestion, particularly as the day wears on. This leads to edema and swelling of the leg, and thinning and discoloration of the overlying skin. After years, complications such as painful blood clots in the vein (superficial phlebitis), bleeding from eroded veins near the skin surface, and nonhealing ankle sores (venous stasis ulcers) may develop. Also, many people find varicose veins unsightly.

Because of the potential serious and long-term complications of varicose veins, proper treatment is important, and the best results are obtained before complications have already developed.

TREATMENT OPTIONS:

1. Sclerotherapy

2. Endovenous ablation

Endovenous ablation uses ultrasound guidance to accurately place a catheter probe varicose venous channel (saphenous vein). Our practice utilizes the radiofrequency powered VNUS Closure system by Covidien. The probe is passed into the vein using only a needle puncture. The internal heat energy developed by the probe causes the vein to scar completely, eliminating the channel without surgically stripping out the vein. Most patients are delighted to avoid the anxiety, pain and recovery time involved with a standard surgical procedure. Complications are extremely unlikely, but include failure to completely close the vein, burning of the skin, deep vein blood clots, nerve injury, as well as other rare events. The procedure is covered by most insurance plans. We will work with your insurance to obtain coverage.

3. Ligation and stripping

The classic definitive treatment for varicose veins remains ligation and stripping (removal) of the offending source vein (the greater and/or lesser saphenous vein). This is performed in the operating room under regional (epidural or spinal) or general anesthetic, as an outpatient procedure. We take pride in performing this procedure with great attention to an ideal cosmetic result and minimal postoperative discomfort. Unlikely complications can occur such as blood clots, bleeding, infection, and skin numbness, as well as other rare events. The vast majority of patients have superb results and are back to full activity within one week.

Spider veins

Spider veins are tiny red and blue veins that only rarely cause discomfort but are commonly noted as a sign of aging. As such, many people find them cosmetically displeasing. Like many vein problems they are commonly passed down as a genetic trait from parents to children. Their development can be promoted by the presence of underlying varicose veins (with higher than normal venous pressure in the legs), as well as by minor local injuries. They are particularly promoted by estrogen, which is why they occur much more frequently in women than in men, especially after pregnancy.

Spider veins can frequently be eliminated or improved by sclerotherapy, a safe and simple office procedure. This involves the injection of a sclerosing agent directly into the vein using a tiny needle. The solution irritates the lining of the vein leading to vein wall swelling, causing the vein walls to stick together and permanently scar closed. Thus, the vein does not carry blood. There is no useful function to these veins and therefore eliminating them will have no effect on leg circulation. Sclerotherapy may be used for abnormal veins of all sizes. It is ideally suited for isolated varicose veins that are not too close to the skin surface and for cosmetically displeasing spider veins. Multiple treatment sessions may be needed depending on the size and number of veins to be treated. As with all surgical procedures, unlikely complications can occur such as failure of the injection to obliterate the vein, allergic reactions, skin injuries, blood clots, pigmentation changes and other rare events. It is important to note that most insurance companies do not cover this procedure because it is considered a cosmetic treatment.

Lymphedema

Many patients with swollen legs believe their problem is due to varicose veins. However, there are many other causes of leg swelling, including inflammation, heart failure, kidney failure and insufficiency of the less well known lymphatic drainage system. The consequences and treatments of these conditions differ greatly and the expertise provided by a vascular surgeon's consultation can be invaluable. Often a simple examination by an expert can eliminate the need for costly tests frequently ordered by physicians with less experience managing patients with swollen legs.

Lymphedema is a condition, unrelated to venous diseases, that is an insufficiency of the lymphatic drainage system in an extremity. The lymphatic system is made up of small channels that carry a clear fluid called lymph, a protein rich fluid, back into the bloodstream in the upper part of the body. Any breakdown or mechanical obstruction of the lymphatic channels leading from an extremity can lead to swelling. This may eventually lead to infection or skin breakdown and ulceration.

Treatment is multifaceted and involves leg elevation and the use of external compressive devices, usually in the form of a fitted external support garment. The use of sequential compression devices can at times be useful, as can massage therapy. Attention to excellent hygiene and the avoidance of skin breakdown, injury or infection in limbs affected with lymphedema are extremely important.