Varicose Vein FAQs
Is surgery the only option for bulging varicose veins?
In the past, only surgery (stripping) could adequately expose the source of abnormal venous blood flow under the skin that causes varicose veins. In 1987 ultrasound guided sclerotherapy was introduced as an alternative to surgery, and in the hands of an experienced and skilled phlebologist this method is very effective, particularly when combined with foam sclerosant. Ultrasound guided heat catheter treatments, including radiofrequency (ClosureFast®) and laser (EVLT®), were introduced between 1995 and 2000 and are extremely effective at closing even the largest abnormal veins.
Are the results of treatment with endovenous laser, radiofrequency or sclerotherapy just temporary?
While it is possible for someone with a hereditary predisposition to develop new varicose veins after either surgical or non-surgical treatment, modern non-surgical treatment is extremely effective in permanently closing off existing varicose and spider veins.
Should you wait until after you’re done having children before having your veins treated?
While pregnancy can cause new dilated veins due to hormonal changes, treatment between pregnancies makes later pregnancies much more comfortable, improves self-image, decreases the chances of superficial phlebitis and slows the progression of new varicose veins. The recommendation made in the past that women wait to have treatment until after having all their children was based on the fact that surgery was the only treatment available.
Wouldn’t closing varicose veins just redirect flow into normal veins and make them become varicose?
Because varicose veins have abnormal blood flow, surrounding veins are already being burdened by having to compensate. Treatment of abnormal veins actually removes this burden from the surrounding veins, thereby improving circulation. This is why symptoms improve after treatment.
Doesn’t your body need all of its veins?
Your body hasn’t used these veins effectively since they became abnormal. There is no reason to keep them.
What kind of specialist should you see for this kind of treatment?
As managed care has had a greater and greater impact on American medicine many doctors have turned to cosmetic procedures to enhance their revenues. Consumers face the challenge of choosing qualified specialists from amongst the many physicians who advertise their services. Here are some questions that may help you choose a doctor for your vein treatment needs:
“What is your specialty?” In the past, patients needing vein treatment were referred to vascular surgeons because surgery was the only effective method for treating varicose veins. As non-surgical methods have become more effective, doctors from many backgrounds have turned to treating veins. In 2006 the AMA recognized Phlebology as a self-designated specialty for physicians who have devoted their practices to vein treatment. It’s a good sign if your doctor identifies himself/herself as specializing in Phlebology. A doctor with a different specialty may be treating veins as a minor part of a much larger practice.
“Are you a member of either the American College of Phlebology or the American Venous Forum?” These are the two American specialty societies for doctors who treat vein problems. The American College of Phlebology is open to doctors from all backgrounds while the American Venous Forum is open primarily to surgeons. It’s an even better sign if the doctor has served as faculty at the meetings of one of these societies.
“How many of these procedures have you done?” If you are contemplating ultrasound guided sclerotherapy, endovenous laser, radiofrequency heat catheter treatment or another invasive procedure, it is important to know that your doctor is very experienced in this procedure.
“Where did you receive your training?” Very few American medical schools and residency programs teach vein treatment. Doctors must make an effort to find adequate training before they start treating patients, no matter what their specialty background. Make sure your doctor has had more than a simple, brief workshop or seminar for training.
“Are you a Fellow?” The American College pf Phlebology awards Fellowship status to those doctors who have made outstanding contributions to the specialty of Phlebology. This is evidence of the highest status of expertise currently available.
Do you need to save your saphenous vein in case you need bypass surgery?
Patients who have multiple risk factors for heart disease (such as male gender, smoking, high blood lipids, hypertension, a sedentary lifestyle or a strong family history of the disease) may need to preserve one of the saphenous veins, assuming that it is not already too abnormal. By combining ligation (tying the vein at the source of abnormal flow) and sclerotherapy, varicose veins can be removed while the saphenous vein is preserved.
If you don’t want full stripping can you just have the vein tied?
Tying (ligating) the vein temporarily solves the problem, but studies have shown that the rate of recurrence is high.
Does sclerotherapy cause stains on the skin?
Temporary brownish discoloration is common. It is caused by a pigment called hemosiderin that is released in the skin from veins that are in the process of disintegrating. These stains can take from several weeks to several months to fade, depending on the size of the veins, the type of skin and the individual’s healing ability.
Can you exercise after treatment?
Exercise is not only permitted, it is encouraged. We find that people who use their leg muscles every day after treatment have faster healing, fewer complications and less discomfort. The simplest and most effective form of exercise for good vein function is walking.
What about radiofrequency catheter treatment (ClosureFast®)?
The VNUS company has been a pioneer in developing an effective, catheter-based treatment for varicose veins. We used the early treatment method, Closure®, for several years in this office and found it to be safe and very effective for veins within certain diameter limits. Their newer method, VenefitTM (formerly ClosureFast), has proven to be even more effective, far easier to do, and applicable to a wider variety of patients.
Is Sotradecol® really what you use, even though I have heard it’s no longer available?
Sotradecol® (the brand name for sodium tetradecyl sulfate) used to be manufactured by Wyeth Pharmaceuticals, but it was discontinued in 2000. Another company, Bioniche, obtained the rights to this brand name and began making it commercially available in 2006. We use Sotradecol® except for situations in which we need to use a dilution that is not manufactured by Bioniche. In those instances we use a compounded generic equivalent made from FDA approved ingredients in a certified compounding pharmacy.
Can hand veins and veins on other parts of the body be treated?
Not all vein specialists treat hand veins, but in this office we have treated hand veins on hundreds of patients over the years with great success. Likewise we have treated visible and symptomatic veins on the breasts, abdomen, and vulvar area. Dr. Isaacs regularly receives referrals from OB/Gyn doctors whose patients have painful post-pregnancy varicose veins in the genital area.
Spider Veins and Broken Capillaries
Should you get spider veins treated by laser instead of going through a bunch of injections?
Current technology allows lasers to be very effective for treating very tiny broken capillaries like those that appear around the nose. Despite advertisements to the contrary, they are not very effective for the large spider veins that appear on the legs. In fact, laser treatment is more expensive, just as painful, and more likely to leave long-term pigmentation than sclerotherapy.
What about Photoderm?
Photoderm is an intense light energy source that is not really a laser. While the theory behind it is very interesting and it may turn out to be effective over time, currently I feel it is unproven and very expensive.
Are spider veins caused by crossing your legs, working on concrete floors or gaining weight?
There are many myths regarding spider veins. The most important causes are thought to be hereditary predisposition (the body characteristics you inherited) and hormonal effects such as those present during puberty and pregnancy. Other factors probably contribute very little.
Does exercise hurt your veins?
Anything that keeps the leg muscles in good shape is probably good for your veins in that the leg muscles are the pumps that keep vein circulation going. Only very extreme activity or direct trauma would cause harm.
After treatment with hypertonic saline, will most of your veins came back after a period of years?
There are two factors that could be at work here. One is that while hypertonic saline is effective for very small veins, it is much less effective on the larger, blue veins that feed into the spiders (and it is also quite painful). The second possible problem is that many doctors inject spider veins directly but fail to treat the feeder veins. Ongoing pressure from these larger veins will often cause recurrences. This is why we do not use hypertonic saline.
Surface Laser FAQ
Why can’t surface laser be used to treat varicose veins?
Why can’t surface laser be used to treat varicose veins? A: A laser that is applied from the surface of the skin can only penetrate a tiny distance before it loses its energy. External lasers can be used to eliminate small caliber “broken capillaries” on the surface such as those that commonly appear around the nose, but they rarely do as well on the legs. Even very small leg veins usually have larger feeder veins that must be injected before the smaller veins can be treated successfully.
However, endovenous laser involves threading a laser fiber into the vein and treating it from the inside rather than from the surface of the skin. This type of laser is extremely effective for large varicose veins.
Aren’t surface lasers less painful?
Unfortunately, surface laser often is more painful than injection treatment and usually quite a bit more expensive.
Are there different types of lasers?
This is a very important point. Laser is a special type of light which can be tuned to different frequencies in order to affect different targets. Vascular lasers target the pigment in blood, so that blood vessels can be destroyed without affecting surrounding skin. Pigmented lesion lasers hit brown pigment in order to get rid of skin spots without affecting blood vessels or unpigmented skin. Carbon dioxide and erbium lasers take off layers of skin in order to resurface the skin. It is extremely important that the right laser be used for the right purpose – and remember that newer is not always better.