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Disease Information : Varicose Veins : FAQ's

Varicose Veins : FAQ’s

Q. What causes varicose veins?

A. Many factors or influences have been discovered that lead to the development of varicose veins, but the four main causes are:

Q. My legs often ache or throb if I am on them too long. Is this related to my varicose veins?

A. Since there may be other conditions related to your leg discomfort, it is recommended that anyone experiencing leg pain have an evaluation by a medical provider.

However, if you have varicose veins, leg aching is a common complaint. The longer you stand still, the more blood will pool in the veins and cause the usual symptoms of ache, swelling, and over time, even ulcer formation. People who work in standing positions, such as hairdressers, bank tellers, assembly line workers, or cashiers may be particularly bothered by these symptoms. If possible, taking breaks to raise the legs or walk can help relieve the discomfort from venous pooling, as can use of compression support stockings.

Q. My varicose veins seem to be increasing in size and I am getting more and more of them. What can I do to stop them from spreading?  

A. This is often a frustrating problem for patients with varicose veins, as the causes are often beyond personal control – heredity and hormone influences account for a large part of the development and progression of varicosities. These measures are recommended to control the progression of the disease:

Q. I have heard that insurance companies won’t cover surgery for varicose veins because it is considered “cosmetic.” Is this true and, if so, is there anything to be done to get approval?  

A. If you are considering surgery for removal of varicose veins, contact your insurance company to discuss requirements for prior approval. Your insurance company may require proof of necessity for surgery – this includes documentation of symptoms, a thorough physical exam, and possibly non-invasive ultrasound tests on the venous system.  

Q. I have heard of stripping procedures for removal of varicose veins, but I also have heard that the veins will come back after surgery. Is this true? If so, then how do I know if I should have the surgery?

A. Yes, varicose veins can grow back after a stripping procedure, although this is not true for all patients. Sometimes this occurs within a few years; other times, not for many years. You need to have a thorough discussion with your vascular surgeon so that you understand both the risks and benefits of varicose vein surgery. Generally, if patients are having significant symptoms or ulcers related to varicosities, the benefits outweigh the risks.  

After surgery, following the recommendations listed in question 3 will aid healing and may help to slow or possibly prevent the return of varicosities.

Q. Are there any new procedures for treatment of varicose veins?

A. The previous method of removing veins by making a long incision down the leg has been replaced by stab phlebectomy, which is the removal of short segments of the varicosed vein through very small incisions that usually do not need stitches. The procedure is typically done in the operating room but does not require overnight hospital stay. Compression bandages are applied for a few days and the patient is back to usual activities very quickly.

Laser has also been used for removal of small spider veins. Laser is a high-intensity light beam that is aimed at the vein and burns the vessel closed without damaging surrounding tissue.

The SEPS procedure is a relatively new technique of removing a perforator vein that connects the deep veins to the superficial veins. The surgery is performed with the use of a small fiberoptic scope inserted under the skin through a small incision.

Sclerotherapy is an office procedure useful for treatment of spider veins (telangiectasia). A small needle is inserted under the skin and a solution of a sclerosing agent or chemical is injected into the vein to permanently close it. Multiple injections are usually needed to completely close a cluster of these varicosities.

A new technique known as the VNUS Closure® procedure has recently been developed to close varicose veins with the use of a radiofrequency catheter inserted into the vein. The heat produced by the radiofrequency energy causes the vein to collapse and seal shut. This is also a same day operating room procedure, with expected return to normal activities in 1-2 days.

Q.I have major varicose vein problems. Is bruising on the skin of my legs and arms an expected problem that goes with this disease?

A.Long-standing varicose veins can be associated with discoloration of the skin, over the veins or in the ankle area, often associated with ankle swelling, but discoloration of the skin on the arms suggests that something else is causing this. If you take anticoagulation medicine (such as Coumadin) or steroid medications (such as prednisone or cortisone), bruising or little hemorrhages under the skin are common. Aspirin or anti-platelet drugs can also cause this easy bruising or capillary fragility. Your doctor should investigate this further to identify the underlying cause beyond the varicose veins.

Q. Should I be worried about varicose veins? How are these related to peripheral arterial disease?

A. Varicose veins are caused by abnormalities in the veins themselves, a different part of the circulatory system, that returns blood from the body to the heart. Varicose veins are a form of vascular disease, but the causes and consequences of varicose veins are very different from PAD, and there is no relation between these two conditions.

Varicose veins can be caused either by a blockage of blood flow in the vein from prior phlebitis, or more frequently is caused by an incorrect functioning of venous valves that are attempting to return blood to the heart. When one or more of these valves fails to function correctly, some blood is able to flow back down these veins—in the wrong direction—and tends to overfill and distend branches of superficial veins under the skin. Over a period of time, this additional pressure of blood causes the veins to stretch, bulge and become visible. At the same time, tiny capillary branches of the veins may also be stretched with blood, and may produce multiple spider veins and purple discoloration of the skin. Although varicose veins and PAD are not caused by the same factors, individuals may experience both PAD and varicose veins.

Q. I was told my veins are refluxing (opening and closing improperly) causing a burning pain in the back of my thighs. I feel this burning mostly when I menstruate and occasionally when I do a lot of walking. I was told surgery might help. Could this be PAD and if so what should I do?

A. This is not PAD. Your veins return blood from your legs to your heart. Vein reflux means the valves, which help return blood, are not working correctly and leak. This is a relatively common problem in the superficial system of the veins in the legs and is associated with varicose veins. The deep veins may also reflux, which is more serious and may occur after deep venous thromboses (blood clots in the leg veins). The association with the menstrual cycle may indicate a condition called pelvic congestion syndrome, which can be associated with refluxing veins in the pelvic veins and can be associated with varicose veins.

Pain in the back of the thighs is an unusual location for pain due to venous problems. It would be important to be absolutely sure that your symptoms are related to the pain in the back of the thighs before having surgery. It would be important to see a certified vascular surgeon in your area, particularly one who is a member of a major national society such as the American Venous Forum or the Society for Vascular Surgery, these are found on our links page.

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