Vein Therapy 101

When summer hits North Texas, many of us switch to shorts, dresses or skirts as a means of staying cool. But if you struggle with spider or varicose veins and are self-conscious about them, showing off your legs may be the last thing you want to do.

Whether your swollen, visible veins are painful or just something you’d rather live without, there is hope, as vein therapy is progressing, and several options are available to fit patients’ medical needs and personal preferences.

The National Heart, Lung, and Blood Institute (NHLBI) explains how varicose veins form, resulting when the valves that control the blood flow in our veins malfunction and the blood gets backed up, causing them to swell. Varicose veins may be unsightly but are usually harmless. However, some people experience pain, blood clots or skin ulcers due to their swollen veins and require medical intervention.

There are several factors that increase a person’s likelihood of getting varicose veins, including the following:

  • Family history — around 50 percent of people with the condition have relatives with varicose veins as well
  • Older age
  • Gender — women are more likely to get varicose veins, often due to hormonal changes
  • Pregnancy — pregnancy-related varicose veins usually resolve within three months to a year after delivery
  • Being overweight or obese
  • A sedentary lifestyle
  • Leg trauma — including blood clots or injuries

Jerry Light, M.D., a vascular surgeon and physician on the medical staff at Texas Health Harris Methodist Hospital HEB and CVT Surgical Associates of Bedford, a Texas Health Physicians Group practice, says that while some people are more predisposed to varicose veins, especially women, everyone should be aware of their risk factors.

“Whether one will develop varicose veins is often the luck of the draw, and generally not preventable,” he explains. “When veins do start to develop, wearing graduated compression stockings can prevent the veins from getting worse.”

Light says exercise and an active lifestyle are also beneficial to preventing varicose veins. And contrary to popular belief, crossing your legs too often will not lead to the development of varicose veins.

According to an article published in the American Heart Association journal Circulation, a patient’s physician may recommend several options before recommending surgery, depending on the severity of his or her varicose veins. The first step will likely be lifestyle changes, including weight loss (if the patient is overweight), regular exercise, smoking cessation, and the avoidance of long periods of standing or sitting. Physicians may also prescribe compression stockings, which help to decrease valve leakiness and pressure in the veins, and which should be worn consistently and used correctly. If these methods do not produce the desired effects, patients may need to consider nonsurgical or surgical treatments.

Light explains that there are several options for treatment, and that the best course for each patient must be determined by his or her physician, while potentially also considering his or her insurance coverage.

“For spider veins and small reticular varices, sclerotherapy is safe and effective, and we do this procedure in our office,” he says. “Laser treatments are also an option, but my office does not offer this. The treatment of these veins is almost always considered cosmetic, and not covered by standard insurance policies. The best treatment for larger varicose veins is more complicated. Treatment options depend on the etiology of the venous disease and are often directed at the underlying cause of the varicosities, rather than the visible veins, which may shrink in size if the underlying cause can be eliminated.

“Proper evaluation with an ultrasound, done in the office of a vein specialist, is critical to determining the best treatment options. Criteria for deciding on the best option for a particular patient are too specific to be able to give a generalized statement, as this can only be determined with evaluation of the patient. Options include endovenous ablation with radiofrequency, with laser, or with foam sclerotherapy. In most cases, these procedures will be covered by insurance in the presence of appropriate symptoms, although treatment criteria vary from company to company.”

The NHLBI explains the most commonly available treatments, ranging from nonsurgical to surgical. Usually used to treat spider or small varicose veins, sclerotherapy and microsclerotherapy involve injecting a chemical into the vein that creates scarring, causing the treated vein to close and eventually fade. Laser surgery is completely non-invasive and uses a medical laser to cause the vein to fade.

Endovenous ablation therapy isn’t completely non-invasive, but it can be done in a physician’s office with local anesthesia. During the procedure, a catheter is inserted into the vein via a small incision before laser or radio wave heat causes the vein to close off.

For patients with more severe varicose veins requiring surgical treatment, there are three main options, including ambulatory phlebectomy, endoscopic vein surgery, and vein stripping and ligation. During an ambulatory phlebectomy, local anesthesia is used before the physician makes small incisions to remove varicose veins close to the skin’s surface.

In the case of more severe vein issues which result in longer post-procedure recovery time, patients may require endoscopic vein surgery, which involves a small camera and surgical tools being inserted through a tube via small incisions, allowing the physician to close the offending veins. Vein stripping and ligation is usually reserved for the most serious vein issues, as a patient’s veins are tied shut and removed during the procedure.

Light recommends that patients see a vascular surgeon for the best evaluation and treatment plan for their varicose veins.

“The most important thing for people to know about varicose veins and vein therapy is that they will get the best evaluation of their problems from a specialist who is trained in the treatment of varicose veins and other venous conditions,” he says. “A board-certified vascular surgeon receives specific training for the treatment of these during their residency and/or fellowship. Other ‘vein specialists’ may not have any real formal training in the treatment of these conditions, other than short training symposiums and classes, and often do not understand or recognize the underlying pathophysiology of a particular patient’s venous disease.”

If you are concerned about the health or aesthetics of your veins, a vascular specialist can help. To find a vascular physician near you, visit TexasHealth.org/provider or call 1-877-THR-WELL (1-877-847-9355).

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