Questions on Varicose Veins

Dear Dr. Spence,
Can you explain what treatments are available for varicose veins? How can they be prevented? Signed,
Imma Changin

Dear Imma,
Everyone hates varicose veins, those unsightly, uncomfortable blue bulging ropes underneath the skin. Affecting nearly 40 million Americans, varicose veins are a consequence of valves that become less elastic and fail, allowing for poor blood return to the heart. In essence, that decreased flow results in pooling of fluid in the legs resulting in swelling, achiness and heaviness. Furthermore, the veins may enlarge and swell to over four times their normal width and cause a cosmetic nightmare. There are several typical causes of varicose veins, some of which are relatively obvious. Age is the single biggest factor as normal wear and tear and a lifetime of being on your feet can take a toll on the veins and the valves. Secondly, if mom had them, there is a good chance you will be equally blessed, as nearly 50% of cases are genetic. Seventy percent of women in their 60’s have varicosity as opposed to only 40% of men, thus gender differences appear to play a role. Pregnancy and obesity may contribute simply due to compression of veins in the lower pelvis that restrict blood flow. Treatment revolves around maintaining normal weight, getting regular exercise and ensuring you do not sit or stand for long periods of time without moving. Leg elevation and the use of support hose may also help. When all else fails, a trip to the doctor may be in order. First line therapy may include use of prescription compression stockings that squeeze the veins and improve flow back to the heart. Sclerotherapy is a procedure whereby the physician injects smaller veins with a chemical (usually 3% normal saline) that causes them to collapse and disappear. Vein excision via a series of skin punctures is a second option for smaller vessels. Larger varicosities may require catheter ablation – a thin flexible tube is inserted into the vein and heat constricts the vessels and closes them off. This is effective in 40% of cases – sclerotherapy and excision can be used to treat any remaining vessels. Finally, vein stripping can be performed under general anesthesia and can help tie off and remove larger veins. Spider veins are similar in that they can be unsightly, but they are generally of minimal consequence. They involve only the smallest blood vessels and appear as those reddish or blue lines at the surface of the skin. They have no potential to become varicose veins, but many are still turned off by their appearance. They can be cosmetically closed through sclerotherapy or laser. Sclerotherapy of spider veins is relatively straightforward and is widely offered, even in our own office.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.