SIGNS AND SYMPTOMS
Vein disease may range from cosmetic spider veins to severe chronic venous insufficiency associated with skin discoloration and ulcers (spontaneous, non-healing wounds) of the legs.
SPIDER VEINS: These small surface veins, less than 3 mm in size, are primarily a cosmetic issue. Spider veins are usually asymptomatic, though some patients report itching or discomfort with prolonged standing.
VARICOSE VEINS: These bulging veins are a sign of a deeper circulation issue. Patients may experience vein disease symptoms like cramping, heaviness, fullness, pain, Restless Legs or swelling. Patients with varicose veins – even if they don’t have symptoms – are at risk of progressing to venous stasis and venous ulcers.
VENOUS STASIS, VENOUS ULCERS: Left untreated, varicose veins and venous insufficiency can lead to discoloration of the legs, called venous stasis, and venous ulcers. About half of patients who do not have visible varicose veins develop venous stasis, making diagnosis more difficult. Many patients with venous ulcers, including weeping blisters of the legs, can go years without an appropriate diagnosis.
WHO GETS IT AND CAUSES
While vein disease is possible at any age, it becomes more common with increasing age. Almost everyone over 30 will have a few spider veins. 20% of people over the age of 70 have serious vein disease which has advanced to the point of venous stasis, a discoloration of the lower legs which puts them at risk for a venous ulcer. Vein disease is primarily hereditary. Patients with multiple pregnancies and those who stand for long periods of time (nurses, hairdressers, flight attendants, teachers, retail employees) are at higher risk.
DIAGNOSIS, TREATMENT AND OUTCOME
Diagnosis of vein disease is obtained by a combination of physical examination and ultrasound. For patients with superficial spider veins, an ultrasound examination may not be necessary. For patients with varicose veins, swelling, leg pain or discoloration and ulcers, an ultrasound examination will allow the doctor to pinpoint the source of the circulatory problem and develop a treatment plan. The ultrasound should be performed by someone experienced in vein disease with the patient in the standing position, in order to demonstrate vein function.
Treatment for vein disease has evolved dramatically in the last ten years; vein stripping is a thing of the past. Most vein disease can be treated in the office, using local anesthesia, with no downtime. A combination of EndoVenous Laser Ablation (EVLA), microphlebectomy and sclerotherapy can address even the most complex vein disease. Treatment is customized based on your personal ultrasound results. Treatment typically takes less than an hour and typically provide years of, if not permanent, relief.
Treatment for patients with serious vein disease is covered by Medicare and most major commercial insurance.
TIPS FOR MANAGING
Patients who undergo definitive treatment are usually able to return to normal activity immediately. While patients are awaiting treatment, it is helpful to:
Wear compression stocking or socks. Calf high socks with a 20-30 mmHg strength are usually sufficient. These are readily available in medical supply stores in a number of styles and sizes
Elevate legs at rest, allowing blood to return to the heart
Avoid prolonged standing or sitting. Walking or moving every 20-30 minutes improves circulation in the legs
Manage weight. Keeping off excess weight reduces the burden on your circulation
Walk or do exercise. Moving the legs briskly improves circulation
Sclerotherapy is a medical term for injecting medication into a vein to collapse the vein. This can be performed for both cosmetic spider veins and serious medical vein disease such as venous ulcers. While some offices still use hypertonic saline or saltwater injections, we are pleased to offer treatment with Asclera (polidocanol), the only brand name medication for sclerotherapy approved by FDA. Unlike salt water injections, Asclera does not burn and also produces more consistent results.
Dr. Malvehy offers the latest techniques in sclerotherapy including ultrasound guided and foam sclerotherapy. Treatments typically last 20-30 minutes and do not have associated downtime afterwards. Patients can resume normal activities immediately but are advised to avoid heavy sun exposure for several days afterwards. Dr. Malvehy performs over 500 sclerotherapy treatments a year.
Microphlebectomy is a minimally invasive vein removal technique used primarily for bulging varicose veins. Using local anesthesia, pinhole incisions are made in the skin and the bulging varicose veins are removed. Steri-strips, small tape strips, are used to close the skin. The bulging associated with varicose veins is gone immediately. There may be minimal bruising after the procedure, which usually resolves in 1-2 weeks. Patients can return to normal activity immediately, including driving home afterwards. Dr. Malvehy performs 100-200 microphlebectomy procedures a year.
ENDOVENOUS LASER ABLATION (EVLA)
EVLA is a revolutionary treatment which has replaced vein stripping. The treatment is used to close the root vein at the source of most vein disease. Using local anesthesia, a small IV catheter is threaded into the problem vein and then a thin fiber optic laser (about ½ a millimeter in size) is inserted into the vein and used to close the vein from the inside out. Patients do not feel anything during the procedure and are able to return to normal activity immediately, including driving home afterwards. Dr. Malvehy is an expert in EVLA, performing 300-500 of these procedures a year.
Treatment for medical vein disease (varicose veins, venous stasis, ulcers and leg swelling) is covered by Medicare and most commercial insurance. Spider vein injections are never covered by any insurance.