Varicose Veins

Leg Veins
The veins of the lower extremity are subdivided, into two sets, superficial and deep; the superficial veins are placed underneath the skin; the deep veins within the muscle fascia. Both sets of veins are provided with valves.
The superficial veins of the lower extremity are the great (or long) and small (or short) saphenous veins and their tributaries.
The great saphenous vein is
the longest vein in the body, begins in the medial marginal vein of the dorsum of the foot and ends in the femoral vein about 3 cm. below the inguinal ligament. 
The small saphenous vein  begins behind the lateral malleolus and ends in the popliteal vein,
 behind the knee.
Veins serve to return de-oxygenated blood from organs to the heart; for this purpose, they have one-way flaps called venous valves that prevent blood from flowing back and pooling in the legs due to gravity.

 
Venous Insufficiency
When valves become floppy, they are unable to keep the blood from returning back down into the leg and allow downward, reverses flow. Venous insufficiency can be caused by progressive valvular incompetence in the superficial or deep venous system or both, or be the consequence of an episode of venous thrombosis (clot in the leg vein). In these instances  venous blood refluxes backward down the veins causing increase in leg vein pressure. 
Untreated venous insufficiency in the deep or superficial system causes  progressive symptoms involving varicose veins, pain, swelling, skin changes, and eventual tissue breakdown.



Varicose Veins
Prominent, large, tortuous (Varicose) leg veins are an expression of venous infufficiency. In the United States, most studies demonstrate varicose reflux in about 40% of the population, most commonly women (72% of women aged 60-69 years).
Varicose veins are not just an esthetic problem, they are often associated with symptoms such as
  • Heaviness
  • Restless legs
  • Leg fatigue
  • Burning
  • Swelling
  • Throbbing
  • Cramping
  • Aching
  • Itching
  • Skin discoloration
  • Eczema
  • Ulcers

Possible complications of chronic venous insufficiency include: chronic nonhealing leg ulceration, superficial thrombophlebitis, deep venous thrombosis (blood clots) and pulmonary embolism, bleeding varices.
Besides, a number of patients with complicated varicose veinshave a significant impairment of their quality of life, sometimes with loss of working days due to hospitalizations for the complications of their advanced chronic venous disease. Risk factors for the development and progression of varicose veins include:

- Genetic predisposition
- Female gender
- Older age
- Obesity
- Pregnancies
- Prolonged standing
- Previous episode of venous thrombosis
- Hormonal intake

      

Diagnosis
A precise diagnosis is very important before any vein treatment.
Vascular Ultrasound provides the most accurate initial diagnosis and is the basis for targeted treatment for varicose veins.
A vascular technologist usually performs the procedure in an out-patient setting or to assist with procedures such as radiofrequency vein ablation. 
A clear gel is applied to the area of the body being studied to help visualization of the veins. The sonographer then presses the transducer firmly against the skin and sweeps it back and forth over the area o interest. Superficial and deep leg veins are visualized and tested for disease such as valvular incompetence and blood clots.
The results are instant and reported by the vascular technologist to the physician, who supervises the technologist and is responsible for the final report.    
  • Vascular ultrasound scanning is non-invasive (no needles or injections) and is painless.
  • Ultrasound imaging uses no ionizing radiation.  
  • Ultrasound causes no health problems and may be repeated as often as is necessary.
  • There are no known harmful effects on humans.
                                                        

 
Treatment

A Vascular Surgeon is the only medical specialist trained to address vein disease in its entirety, which means being able to perform way more that just sclerotherapy or treating the superficial veins.
A Vascular Surgeon formal training includes more experience in vein treatment than any other specialty. It spans from the diagnosis and treatment of superficial as well as deep venous incompetence, which may need anything from an office-based procedure to an hospital admission for complicated cases (i.e. leg ulcer with cellulitis, complicated deep venous thrombosis) or surgery (venous reconstructions, stripping, bypasses, stents, caval filters). Moreover, sometimes a patient with a venous condition has a concomitant arterial condition, such as peripheral arterial occlusive disease, which needs to be addressed first, and which will not be able to treated along with the venous condition by any other medical specilaty.

                                    Office-based treatments for Varicose and Spider Veins performed at SCOVAS include:

- SCLEROTHERAPY

This procedure is performed to treat spider veins, varicose veins, perforating veins, venous branches and, occasionally, the saphenous veins. Liquid or foam sclerotherapy can be injected depending on the case, with or without the aid of Ultrasound. No anesthesia is needed and return to normal activities is immediate.

VEIN RADIOFREQUENCY ABLATION (VNUSR Closure Procedure)
This minimally-invasive technique is utilized to eliminate the saphenous veins as well at perforating veins and larger venous branches. Only local anesthesia is required, and just a tiny incision is performed at the knee level. After the vein has been treated by heating it with radiofrequency energy, the patients can walk immediately and resume their normal activities.

-
AMBULATORY PHLEBECTOMY
This technique is sometimes used to eliminate larger varicosities which are not amenable to sclerotherapy. Tiny skin incisions are performed over the vein, which is then pulled out. Local anesthesia only is generally sufficient. Some bruising and pain may result, which usually resolve in a matter of days.