BATTLING
GRAVITY
In
healthy leg veins, blood travels upward toward the heart with the aid
of resilient vein walls and one-way valves that combat gravity’s
downward pull. But in some cases, defective valves or a weakness in
the vein’s walls allow blood to flow backward and pool in the vessel,
causing it to bulge under the skin. No one really knows what causes
varicose veins but weak vein walls and flawed valves appear to be
hereditary and related to female hormones — which is why women are
more than three times as likely to suffer from the problem than men,
and pregnancy and birth control pills can further increase the risk.
“We believe it is a defect in the way the collagen is laid down in the
vein wall, almost like a radial tire with a defect in the radial
construction causing a blowout. Once the blowout occurs, the valve
leaflets no longer meet,” according to Dr. Robert Weiss, an assistant
professor of dermatology at Johns Hopkins University School of
Medicine.
Additionally, advancing age and added pressure due to obesity or
standing still for long periods of time can make veins more venerable.
Those twisted blue bulges are more than
just an issue of vanity— they cause some degree of pain or discomfort in
the majority of cases. And while women are more likely to develop the
condition, millions of men are also affected. “Everyone thinks varicose
veins are just cosmetic, but they cause symptoms,” said Dr. John Bergan, a
professor of vascular surgery at the University of California at San
Diego. “They bother people with achy pain and heaviness; therefore,
treatment is important.” Varicose veins can occur anywhere in the
body but they most often affect the legs. The most common symptoms are
tired, aching and heavy-feeling legs, and patients often experience
cramping at night. Varicose veins can occasionally cause serious
complications. “If you took 100 patients with varicose veins and did
nothing for them for two years, about half of the limbs would have leg
swelling; 25 percent would have phlebitis [inflammation and clotting],
which can be disabling and painful; and 5 percent would get an ulcer, a
non-healing sore,” estimates Bergan. Blood clots that occur in
varicose veins can, on rare occasion, dislodge and travel to the lungs, so
sudden pain, redness, swelling or warmth of the leg should be reported to
a doctor immediately. According to the American Society for
Dermatologic Surgery, approximately 6 million workdays are lost each year
due to complications from varicose veins and nearly 100,000 Americans are
seriously disabled by the condition.
Laser/light source therapy
A variety of laser and light source treatments are available to treat
small spider and varicose veins located close to the surface of the skin.
A laser or light beam is pulsed onto the vein in order to seal it and
cause it to dissolve. Several treatments may be necessary and it can take
several weeks for the vein to be reabsorbed by the body. The treatments
are usually done in a doctor’s office and patients can resume normal
activities immediately afterwards. Patients often complain of pain akin to
being snapped by a rubber band during the procedure. Recent advances in
laser technology have allowed lasers to be used on deeper veins and dark
skin. Dark-skinned patients were previously not candidates for laser
treatments because the skin’s pigment would absorb the laser and result in
burning or discoloration. Lasers are good for red blood vessels on the
face and for people for whom sclerotherapy is not an option because their
leg vessels are smaller than the sclerotherapy needle or for patients who
are needle-phobic. Possible side effects include burns and pigmentation
changes.
Sclerotherapy
Sclerotherapy, or injection therapy, can be used to treat moderate-sized
spider and varicose veins. A fine needle is used to inject the vein with a
chemical solution that irritates its lining, causing the vein walls to
collapse and turn into scar tissue that is absorbed by the body. Some
patients complain of a burning and cramping sensation with certain
solutions. Sclerotherapy usually requires several treatment sessions and
the treated veins usually disappear within six weeks. The procedure is
done in a doctor’s office and patients can usually resume normal
activities that day. Following each session, the patient may be advised to
wear bandages or compression stockings for up to several weeks. Patients
are often put on walking regimens after the procedure, which forces the
blood to flow into remaining veins and reduces the risk of blood clots.
Possible side effects include burns or pigmentation changes. Occasionally,
blood clots can result. People with allergies should be cautious as some
solutions can cause allergic reactions.
Ambulatory phlebectomy
Phlebectomy, a method of surgical removal used on moderate to large
varicose veins, is usually done in the doctor’s office under local
anesthesia. The damaged vein is marked using a special light source and is
extracted through tiny incisions in the skin with a hook. Patients often
feel tenderness in the treated area after the procedure, but can usually
resume normal activities the next day. Patients have to wear bandages or
compression hose for a short period after surgery. The procedure leaves
very small scars. Occasionally, blood clots can result.
Radiofrequency treatment
A procedure known as the Closure technique can be performed on large
varicose veins up to half an inch in diameter. Ultrasound is used to map
the greater saphenous vein, and a small tube called a catheter is inserted
into the bulging vein through a minor incision above the knee. The probe
delivers radiofrequency energy to the vein wall, causing it to heat,
collapse and seal shut. With the large varicose vein shut, its smaller
branches usually lose their source of blood and shrink as well. The
procedure is done under local anesthesia in a doctor’s office. Wearing a
bandage or compression hose, the patient can usually resume normal
activities later that day. Patients report less pain and less scarring
with this technique than with vein stripping. Rarely, blood clots can
result.
Vein stripping and ligation
Large varicose veins can be tied off and stripped out with a special
instrument through an incision in the groin. The technique can be used to
remove defective segments of veins or the entire greater saphenous vein,
which runs from groin to foot. The procedure can be performed under
general, regional or local anesthesia and is generally done by a vascular
surgeon in a hospital. Patients can usually go home the same day but a
recovery period of over a week may be required before patients can resume
normal activities. Besides the longer recovery time, patients are also
left with scars and often feel pain in the treated area in the weeks
following surgery. The advantages of performed on the largest varicose
veins, and because it has been used since the 1950s, there are years of
clinical data behind the technique. As with the other surgical techniques,
vein stripping involves a small risk of blood clots.
Compression stockings
People who don’t want surgery can opt for custom-made compression
stockings. Available by prescription, the stockings are tighter at the
ankles and looser at the thighs. They can ease minor discomfort and may
help prevent further stretching of the veins.
