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SPOTLIGHT ON: VARICOSE VEINS

By: Dr. Jacques Doueck



What are varicose veins?

Varicose veins, also known as varicose or varicosities, are swollen, bulging superficial veins, usually in the legs, which appear as purplish-bluish “bumps” protruding from under the skin. Spider veins (a “cousin” of varicose veins) are bulging tiny veins underneath the skin which are frequently arranged in the form of a spider web.

Who is prone to develop venous varicosities?

Up to 75% of women and up to 50% of men will develop venous varicosities during their lives. Pregnant women are particularly prone to develop varicosities as a result of increased blood flow during pregnancy, as well as due to compression of the pelvic veins by the fetus. Varicosities tend to worsen with each pregnancy, but improve three to twelve months following delivery. Age is also an important risk factor. As you age, veins lose their elasticity, causing the valves to stretch and leak. If immediate family members have varicose veins there is a greater chance that you will too. Being overweight puts added pressure on your veins, and makes one more likely to develop of venous varicosities and
leg swelling. Weight lifting and heavy manual labor also increase the risk of developing varicosities.

What symptoms are associated with venous varicosities?

Varicose veins, although unsightly, may have no symptoms at all. However, many patients complain of heaviness, tiredness, throbbing, and aching pain within the legs, related to the varicosities. They also commonly describe severe itching and swelling at the site of the abnormal veins. Symptoms are typically worse at the end of the day, after standing for long periods of time, and after exercising.

What are current treatments for symptomatic venous varicosities?

Lifestyle modification is the initial treatment for symptoms related to varicose veins. Exercising, eating a high fiber, low salt diet, weight loss, not wearing tight clothing, elevating your legs with two pillows, and avoiding long periods of standing or sitting can ease pain and prevent worsening symptoms.

A number of alternative therapies claim to be helpful for chronic venous insufficiency, a condition associated with varicose veins. These include taking butcher’s broom (a plant whose root is used to treat varicose veins and circulatory problems), eating grapes (leaves, sap, seed, and fruit), and taking horse chestnut, and sweet clover (these are dietary supplements, generally available in health food stores). Talk with your physician before trying any dietary supplement to make sure these products are safe and will not interfere with any other medications.

Wearing graduated compression stockings is often the preferred initial treatment for symptomatic venous varicosities before pursuing more invasive treatment. Compression stockings steadily squeeze your legs, helping veins and leg muscles to move blood more efficiently. You can buy compression stockings at most pharmacies and surgical supply stores. Prescription strength stocking are also available. It is a good idea to buy more than one pair at a time, as they tend to require frequent laundering.

Less than 20 years ago surgery was the standard invasive treatment for varicose veins. This required anesthesia and a hospital stay. Newer treatments have been developed which are minimally invasive, and are performed in vascular physicians’ offices. These include:

Sclerotherapy –the doctor injects small and medium sized varicosities with a solution (generally a salt solution) that scars and closes the veins. Larger veins are treated with a special foam solution. In a few weeks, the treated varicosities should fade. Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly.

Photolaser – pulses of laser light are used to treat spider and small varicose veins.

Endovenous Ablation procedures – a catheter (thin tube) is inserted into the enlarged vein and the tip is heated, using radiofrequency or laser energy. As the catheter is slowly withdrawn, the heat destroys the vein, collapsing and sealing it.

Ambulatory Phlebectomy –tiny skin punctures are made and the veins are removed through these tiny incisions. Scarring is generally minimal.

Adequate treatment for extensive venous varicosities frequently requires a combination of the therapies described above. These procedures are very safe, with very low risk of complications, and minimal post procedure discomfort. If you are considering treatment for venous varicosities, look for a physician who has extensive experience with the full complement of venous treatments.

Dr. Joseph Shams

Dr. Joseph Shams is a board certified endovascular surgeon.
He is anAssistant Clinical Professor at the Mt. Sinai School of Medicine and Director of Advanced Vascular Care, a dedicated vascular practice in Manhattan and Brooklyn. He has been named
a Castle Connolly Top Doctor from 2012-2016 and was listed as one of New York City's "Best Doctors" by New York Magazine in 2016.