Our specialists use state-of-the-art treatments such as endovenous thermal ablation and echosclerotherapy (ultrasound guided injections to close veins) to treat varicose veins and improve cosmetic results with minimal downtime and discomfort. These advances have replaced traditional surgical therapies in most patients.
There are a number of options available for treating varicose veins. Treatment recommendations may include compression stockings, sclerotherapy (injections into surface veins to close them), endovenous thermal ablation or surgery.
What are Varicose Veins?
Varicose veins are veins that have become dilated or bulging because of valve failure. Valves are thin membranes inside veins that keep blood flowing from the feet towards the heart. When the valves fail, blood can pool in the veins, causing increased pressure and dilation.
Varicose veins usually occur in superficial veins between the skin and the muscle, but could be a sign of a deep vein problem. In contrast to spider veins (in the skin) that are easily identified by their vivid purple, red or blue color, varicose veins typically appear as a bulge under the skin which may have a faint blue color.
What causes Varicose Veins?
Varicose veins tend to run in families, are more common in women, but also occur in men. Up to 30% of Americans will have varicose veins at some point during their life . They are influenced by hormones and often appear during pregnancy. Although not a sole cause of varicose veins, prolonged standing and obesity or weight gain can worsen pre-existing varicose veins.
Severe varicose veins occur equally between men and women. Treatment options are the same for both genders.
Previously recognized or unrecognized deep vein clots can damage valves and cause varicosities.
What are the Symptoms?
The symptoms can vary. In some cases, varicose veins don’t have any symptoms (asymptomatic). In those cases, however, they may be unsightly and a cosmetic concern. Many patients avoid wearing shorts or skirts because of embarrassment about the appearance of their legs. Varicose veins, however, are often symptomatic. They may be tender to the touch, or may cause aching, throbbing, itching or swelling.
In the most severe cases, the varicose veins may cause skin changes or ulcers. Sometimes the blood flow in the varicose veins may slow until a blood clot forms (this is called phlebitis). Blood clots in superficial veins are not as dangerous as deep vein blood clots (deep venous thrombosis or DVT), but they can be very painful. Superficial vein clots do need evaluation by a medical professional.
On rare occasions, varicose veins can bleed after minor trauma or sometimes even spontaneously (usually around the ankle). Should bleeding occur, immediate treatment should include elevation of the leg above the heart and gentle to moderate direct pressure over the area of bleeding. Control of the bleeding is almost assured. Patients with bleeding veins should always have a medical evaluation, even if the bleeding has stopped.
Your clinic evaluation will determine whether your vein problems are a health issue, a cosmetic issue, or both.
Veins differ from arteries in their basic anatomy. Veins in the arms and legs need valves to keep the blood from pooling with gravity, whereas arteries do not have or need valves since the blood is being pushed directly by the heart’s pumping action.
When the arterial blood is pushed through the small capillaries and enters the smallest veins, the pressure in the veins is very low. In order for the blood in the veins to rise up to the heart again against gravity, veins need valves. These one-way valves are incredibly thin, as thin as plastic wrap, yet are normally able to hold against the pressure of gravity pulling on the blood above the valve. Vascular surgeons have been specially trained to diagnose and repair your complex circulatory system.
The veins in our upper and lower extremities are in three distinct layers:
The deep veins lie within the muscle compartments surrounded by fascia, a canvas-like white material that separates the subcutaneous fat from the muscles. Each time you walk, your calf muscles contract and squeeze the deep veins, forcing the blood upward from valve to valve.
The superficial veins lie outside the fascia but under the skin. The great saphenous vein is an important superficial vein which runs from the inside of the ankle up the leg and thigh to dive deep in the groin to join the femoral vein (a deep vein). Varicose veins caused by branches of this vein are often very visually prominent. In our lower legs, the small saphenous vein is a superficial vein which runs from the outside of the ankle up towards the back of the knee where it usually dives deep to join the popliteal vein (a deep vein), but sometimes continues up the back of the thigh.
Communicating veins connect the superficial veins to the deep veins. These communicating veins have to cross through small holes (perforations) in the fascia in order to reach the deep veins. That is why they are also known as perforator veins. Each communicating (perforator) vein has a valve which lets the blood go from the surface into the deep system, but not the reverse. When your calf muscles squeeze as you walk, the venous blood in the deep veins should only go upwards towards the heart, not outwards to the superficial veins in the subcutaneous space.
When valves do not work, then blood that should be rising towards the heart falls downward. If the non-functioning (incompetent) valves are in the deep veins, then we call that “deep venous insufficiency.” The patient will often have leg or ankle swelling, may have brown discoloration above the inside ankle bone, and may or may not have varicose veins as well. The main treatment for deep venous insufficiency is prescription grade compression hose. There are no clinically proven surgical or medical solutions to replace or fix the valves (except in experimental or most severe cases). In legs with chronic swelling due to venous obstruction (such as occurs after a blood clot), however, there are minimally invasive techniques such as venous stenting that may offer relief in certain patients.
When the valves do not work in the superficial veins, then those veins tend to gradually dilate, and lead to varicose veins. The most common cause (80% of cases) of medically significant varicose veins is failure of the valves in the great saphenous vein. Valve failure of the small saphenous vein or the anterolateral saphenous vein can also cause clinically significant varicose veins. In some cases, two, or even three of the main saphenous vein trunks may not be functioning properly. Often the varicose veins that are visible are side branches coming off of an incompetent greater or lesser saphenous vein. Other sources for varicose veins include incompetent communicating veins (perforators), and veins from the pelvis in some women. Varicose veins from a pelvic source most frequently occur after pregnancy. These patients often have prominent varicose veins in the upper inner thigh/groin area, and can have a heavy, full, aching sensation in their pelvis.
Our highly skilled vascular technologists use duplex ultrasound machines to painlessly evaluate your leg veins to determine the source of your vein problems: deep veins, superficial veins, communicating veins, pelvic veins, or no major underlying vein problem.