Varicose Veins

Approximately 15% of men and 20-50% of women have some

degree of venous disease. The venous system in the legs is composed

of the deep and superficial systems connected by the perforator

or communicating veins. With the aid of one-way valves,

these systems allow blood to flow from superficial to deep and

from distal to proximal but not back down the leg.

With primary venous disease, these valves fail allowing blood to

flow from deep to superficial and/or from proximal to distally.

This leads to distended or varicose veins. The superficial system

consists primarily of the greater and lesser saphenous veins in the

front and back of the legs, respectively. These veins have multiple

branches which often connunicate one with the other.

Venous disease ranges from very small spider veins barely visible

to large, finger-sized veins, which protrude beneath the skin and

are unsightly. The symptoms from varicose veins may involve

aching leg pain, leg fatique, night cramps, burning pain, heaviness

and leg swelling.

The etiology of varicose veins is multi-factorial and may include

heredity, female sex, obesity, pregnancy and female hormones,

progesterone in particular. Prolonged standing may lead to

chronic venous distention and may be associated with an

increased tendency towards varicose veins. Varicose veins

increase in frequency with aging.

Spider veins are best treated with sclerotherapy. In an office setting

and using a very small needle, chemicals are injected into

the spider veins. Relatively painless, with no recovery period, it

provides good cosmetic results. It is usually regarded as a cosmetic

procedure, not covered by many insurance plans.

Several surgical options are available for true varicose veins. The

goal associated with its removal (stripping) in the thigh remains

one method of treatment. It’s an outpatient surgical procedure

of small incisions with some activity restrictions post-operatively.

A newer option utilizes catheter-based radio frequency heating

to obliterate the saphenous vein (VNUS Closure System). This is

an office-based procedure involving insertion of a specially

designed catheter into the saphenous vein in the lower leg with a

needle puncture of a small incision.

The catheter is then directed under ultrasound guidance to the

groin, and on its slow withdrawal, energy is applied to the leads at

the end of the catheter heating the wall of the vein and leading

to its obliteration. Patients have minimal pain and rapidly resume

normal activities.

The branch varicosities of the greater and lesser saphenous systems

require attention because they are often what the patient

most notices. After surgical removal of the saphenous vein in the

thigh or following the Closure treatment, they may decrease in

size, but may still require intervention. Surgical removal may be

performed with small incisions. This procedure is called mini

phlebectomy and is usually office-based.

All of these procedures are ambulatory or outpatient with a

short recovery times.

Dr.Knott is a fellowship-trained vascular surgeon with Coastal

Surgery Specialists.