Risk factors for venous disease

Question: My father has bad veins. Am I going to get that as well?

Answer: A recent article in The Journal of Venous Disease discussed this very topic. Venous disease ranges in severity from minor cosmetic concerns to the very severe blood flow changes that result in ulceration or blood clots. In part the article reads:

“The cause of the disease is probably multifactorial. Genetic predisposition, older age, female sex, obesity, number of pregnancies, oral contraceptive use, hormonal replacement therapy, prolonged sitting or standing, low level of physical activity, smoking, prior episodes of blood clots, leg trauma, flat feet, hernia surgery, history of cardiovascular disease, diet, and bowel habits have all been investigated.”

These investigations, however, can be confusing. In our experience with thousands of patients, it is evident that these factors can be present in any combination or not.

And the real question may be, is there anyone on the planet that does not have one or more of these risk factors?

We have no control over our genetics, but certainly we can modify our risks by taking action. The proper action is to seek evaluation as soon as possible. We are currently offering free screening for leg discomfort problems. “Captain Obvious” says that free is better than not free; and that now is better than later.

Recurrence of varicose veins

Question: I had vein-stripping many years ago. Why do I my veins look worse than ever?

Answer: In the past, vein-stripping was the universally accepted treatment procedure for varicose veins. This required general anesthesia, a groin incision, and multiple large incisions. Research has demonstrated that the groin incision and dissection actually stimulates the growth of additional abnormal veins (neovascularization). This practically ensures recurrence in the years to follow.

Additionally, most surgeons are not providing adequate follow-up exams and treatment. Post-op ultrasound scan often demonstrates additional abnormal veins that contribute to recurrences. These veins are often not evident until several months after the initial procedure.

Once they are identified, they can easily be treated with special sclerotherapy procedures. At our clinic, we use endovenous laser techniques instead of vein-stripping. We have seen about a 1% recurrence rate (compared to 85% with stripping). In each case, we follow up our procedures with ultrasound scanning to identify and treat any residual veins that may be present.

The final step is to treat spider veins with compression sclerotherapy. We encourage yearly scans, to detect any changes that could lead to future problems. Depending on the individual situation, some patients may need touch-up sclerotherapy to maintain an excellent cosmetic result.

The many misconceptions of vein disease

Question: I have very severe bulging veins in both of my legs. My doctor told me to just wear support stockings because there is no treatment, and no reason to try treating this condition. Is this correct?

Answer: There are many misconceptions about vein disease, and unfortunately many of these bad ideas are coming from physicians. Many think varicose vein disease is a normal aspect of aging. Or that varicose vein disease is only of cosmetic concern.

I think that aching, heaviness, tiredness, itching, burning swelling, skin disruption and ulcers – that is, all the symptoms that accompany varicose veins – are not cosmetic. These are dangerous signs that constitute a medical condition that should be corrected.

Others will advise the use of support stockings. This is also incorrect. Support stockings and TED anti-embolic stockings are useless in the care of varicose vein disease. The stockings must be properly fit to order, and be gradient compression. This requires a written prescription.

Some doctors think that because vein disease is “cosmetic,” insurance will not cover treatment. Treatments are medically necessary and are covered by most plans. Another misconception passed on by some doctors is that no treatment really works. We have performed more than 4,000 in-office procedures with excellent results that have withstood the test of time.

Some good advice about vein problems

Question: Why should I get my varicose veins treated?

Answer: This is a question that even your primary care doctor may not be able to answer. Many of our patients tell me that their doctor advises “if they don’t bother you, don’t bother them.” The fact is that even the appearance of your legs is not always a reliable guide to the extent of venous disease.

Swelling (edema) is one sign that has many causes, but if this problem persists after treating other causes, chances are high that the venous or the lymphatic system is not functioning properly. The diagnosis can only be determined by having an ultrasound of the superficial and deep veins of the legs.

Also, the size of your varicose veins is not a reliable indicator of the extent of venous disease. Research has shown that even the common symptoms of leg pain, leg cramps, restless legs, and itching occur years after venous insufficiency is demonstrated on ultrasound testing.

Venous disease is progressive and will never improve without treatment. The slow progress of venous disease and the aging process increases the risk of blood clots and significant skin changes leading to ulceration. The eventual outcome without treatment is stasis ulceration (an open sore on the ankle).

So why get your varicose veins treated? Because you will look and feel better as you reduce chances of future complications.

The many misconceptions of vein disease

Question: I have very severe bulging veins in both of my legs. My doctor told me to just wear support stockings because there is no treatment, and no reason to try treating this condition. Is this correct?

Answer: There are many misconceptions about vein disease, and unfortunately many of these bad ideas are coming from physicians. Many think varicose vein disease is a normal aspect of aging. Or that varicose vein disease is only of cosmetic concern.

I think that aching, heaviness, tiredness, itching, burning swelling, skin disruption and ulcers – that is, all the symptoms that accompany varicose veins – are not cosmetic. These are dangerous signs that constitute a medical condition that should be corrected.

Others will advise the use of support stockings. This is also incorrect. Support stockings and TED anti-embolic stockings are useless in the care of varicose vein disease. The stockings must be properly fit to order, and be gradient compression. This requires a written prescription.

Some doctors think that because vein disease is “cosmetic,” insurance will not cover treatment. Treatments are medically necessary and are covered by most plans. Another misconception passed on by some doctors is that no treatment really works. We have performed more than 4,000 in-office procedures with excellent results that have withstood the test of time.

How vein treatment feels depends on severity

Question: How will I feel after vein treatment?

Answer: Venous disease presents in many different forms and many degrees of severity. No two patients are exactly alike. In the case of cosmetic spider veins, you may experience some bruising for several days after treatment. Over about a month, you will notice the gradual disappearance of the spider veins. Your legs will also feel better. We use cosmetic sclerotherapy for these veins. Laser technology is not indicated for spider veins. 

If you have a more advanced vein problem, the laser procedure may be indicated. This procedure is done in the office. The patient walks in has the procedure, walks out and in most cases, resumes normal activity the very next day. No longer is vein stripping required, thus there is no blood loss, and no bed rest required.

Our patients report a rapid decline in symptoms and problems related to their legs. In many the leg cramps, pain, tenderness, and heaviness is gone within the first week. If swelling is a problem, that usually takes longer to resolve. Follow-up treatment is a must. Although the problem is related to the long saphenous vein, many patients have branch veins that can contribute to recurrence. These veins are usually treated with sclerotherapy.

Ultrasound guided sclerotherapy as done for follow-up after laser treatment is very effective in clearing off residual veins. This in office procedure is essential to providing the comprehensive care of venous disease.

Many of our athletic patients report increase performance, stamina, and comfort as they compete in their respective sports.

Treatment options for varicose veins

Question: What are the treatment options in varicose veins?

Answer: Vein disease of the legs is a common disorder that looks bad, feels bad, and can result in dangerous medical conditions (stasis ulcers and blood clots). The appearance of your legs however is not a reliable guide to the extent of venous disease.

Swelling, for example, has many causes and a proper diagnosis must be established by Duplex Ultrasound mapping before any therapy is started. Also the size of the visible veins is not a reliable indicator of the severity of the condition. Symptoms are experienced and venous tests are abnormal long before any abnormal veins are visible. Some of the early symptoms that are associated with vein disease include night cramps, tired heavy legs, restless leg syndrome and skin changes (as in redness, burning and itching). The unsightly appearance of bulging veins is a late finding, and indicates that immediate evaluation is important. The sooner this process is reversed, the better. Never wait until there is an ulcer, phlebitis, or blood clots.

Recently, the treatment options for diseased veins has evolved from radical vein stripping (requiring hospital stay, general anesthesia and prolonged bed rest), to simple in office procedures that require essentially no down time, and have been remarkably effective.

At the Ashton Vein Center, you will meet the most experienced staff of professionals that are highly skilled in the diagnosis and comprehensive treatment of all vein conditions of the legs. Dr. Thomas Ashton, MD, FACPh, has performed more than 5,000 venous laser cases, and has taught these procedures to hundreds of physicians. Our team is dedicated to achieving superior results in today’s most advanced methods of effective treatments.

Vein treatment not a simple process

Question: Should my primary physician or dermatologist treat my veins?

Answer: In the last several years, the practice of vein treatment has become a special area of expertise. Many types of physicians treat spider veins and even larger varicose veins as an additional service to their existing practices. This often leads to incomplete or even disastrous results.

Medical science has evolved into many special areas that require additional training and advanced credentialing. Phlebology has recently been recognized as a board-certified specialty. No longer should physicians dabble in this field as a hobby or look to sclerotherapy simply as a source of additional income.

The staff at Ashton Vein Center is 100 percent dedicated to evaluating and treating venous disease. At the center, you will get expert advice about the latest techniques to improve circulation and reduce your risk of future venous problems. You will achieve a new awareness of what treatments best fit your specific situation, and you will become aware of some techniques that are not advised.

The risks of not treating venous disorders will be explained. You will receive a clear effective plan designed to solve your specific vein problem from minor treatments for spider veins, to more advanced laser treatments for venous insufficiency. Additionally, a complete analysis will be available for your Medicare and insurance coverages.

Recurrence of varicose veins

Question: I had vein-stripping many years ago. Why do I my veins look worse than ever?

Answer: In the past, vein-stripping was the universally accepted treatment procedure for varicose veins. This required general anesthesia, a groin incision, and multiple large incisions. Research has demonstrated that the groin incision and dissection actually stimulates the growth of additional abnormal veins (neovascularization). This practically ensures recurrence in the years to follow.

Additionally, most surgeons are not providing adequate follow-up exams and treatment. Post-op ultrasound scan often demonstrates additional abnormal veins that contribute to recurrences. These veins are often not evident until several months after the initial procedure.

Once they are identified, they can easily be treated with special sclerotherapy procedures. At our clinic, we use endovenous laser techniques instead of vein-stripping. We have seen about a 1% recurrence rate (compared to 85% with stripping). In each case, we follow up our procedures with ultrasound scanning to identify and treat any residual veins that may be present.

The final step is to treat spider veins with compression sclerotherapy. We encourage yearly scans, to detect any changes that could lead to future problems. Depending on the individual situation, some patients may need touch-up sclerotherapy to maintain an excellent cosmetic result.

Vein disease not always obvious

Question: At the health fair, a technician did a test on my legs and said I have a vein problem. I was shocked. How can this be true? 

Answer: Millions of people have varicose vein problems. Many of these cases remain undiagnosed or under diagnosed. 

It is true that the only method for detecting vein problems in some cases is with duplex ultrasound testing. The obvious cases will, of course, have bulging veins, swelling and lower-leg discoloration, but these findings are just surface manifestations of a more serious condition that is unseen. 

Sometimes the symptoms of vein problems are so subtle and insidious that the disease may go unnoticed for many years. In fact, the purple discoloration of the lower legs around the ankles is not seen unless the disease has been ongoing for 10 or more years. 

These external signs indicate the underlying vein problem known as venous insufficiency. Later, one may notice chronic pain and discomfort, leg heaviness, swelling and leg cramping. In addition to the comfort and cosmetic factors, venous insufficiency may also increase the risk factors that contribute to blood clots and ulcerations of the lower legs. This is especially true of patients with diabetes and/or who are overweight.