Varicose veins appear as snarled, bluish-purple lines or bulges in your skin, usually on the legs and feet. They are quite common, afflicting more than 20 million people in the United States alone – up to 25% of women and 10-15% of men.
For many people, varicose veins and spider veins — a milder variation of the condition — are solely a cosmetic issue. For others, varicose veins can trigger more serious problems and complications, including itching, pain, swelling, leg fatigue and heaviness, inflammation of the veins, blood clots, bleeding, skin ulcers or other circulatory system disorders.
Boulder Community Health’s board-certified interventional radiologists form Boulder County’s most experienced team of leg vein specialists. Our doctors have been specially trained to treat vascular diseases, and can evaluate all potential causes of varicose veins, including pelvic congestion syndrome, May-Thurner Syndrome, perforator veins, and deep venous incompetence. They offer the latest options for treating varicose veins.
Ultrasound guidance is sometimes needed for both diagnosis and treatment of varicose veins and our interventional radiology suite is equipped with a state-of-the-art fluoroscopic unit – a device that lets us obtain real-time moving images of your vein networks. Once your problem has been properly diagnosed, even veins with the most challenging anatomy can be treated with our comprehensive array of therapies.
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Comprehensive Range of Treatments
Self-care — such as exercise, losing weight, elevating your legs, avoiding tight clothing or long periods of standing or sitting, or wearing compression stockings — can help you ease the pain of varicose veins and may prevent them from getting worse. However, if self-care measures are unable to keep your condition from getting worse, effective medical treatments are available.
At BCH, we start with a personalized ultrasound of the legs, followed by a consultation. Both are done personally by your physician. The initial ultrasound is the key in identifying the source of the varicose veins, which subsequently determines the treatments needed. A detailed examination is crucial in order for all possible causes to be identified and that all necessary procedures can be offered. This approach assures comprehensive treatment and long term patient satisfaction.
Endovenous Thermal Ablation
Endovenous thermal ablation is a recent technical advance that allows physicians to direct laser or radiofrequency energy through a long thin tube called a catheter to seal shut the varicose vein. The procedure closes targeted veins but leaves them in place, reducing bleeding and bruising. This means less pain and a faster return to normal activity. The treatment is done on an outpatient basis. The incision can be covered with a Band-Aid and any post-procedural pain is usually relieved with ibuprofen or acetaminophen.
After administering a local anesthetic, your surgeon uses ultrasound imaging to guide a catheter into the varicose vein. The doctor injects a solution of salt water and more anesthetic agent along the length of the enlarged vein, which makes the subsequent treatment painless. Then the doctor slowly withdraws the catheter while applying heat (via laser or radiofrequency waves) through the tip of the catheter. This heat causes the refluxing vein to close. Because the catheter is totally contained within the vein, it poses minimal risks to surrounding structures. As the catheter is withdrawn, the vein seals shut along its entire length. Your body automatically reroutes blood from the legs through healthier veins (with functioning valves) back to the heart. This thermal ablation procedure not only treats the large varicose veins, but also eliminates many of the smaller unsightly branching veins.
A typical thermal ablation procedure takes just 45 minutes, and no sutures are needed once the catheter is removed. You can walk immediately afterwards. A graduated compression stocking must be worn for at least two weeks, and walking is strongly encouraged as part of the recovery regimen. A small minority of patients may have residual varicose veins that require additional treatment with ambulatory phlebectomy or sclerotherapy.
Benefits of endovenous thermal ablation include:
- Minimally invasive, nonsurgical
- Local, rather than general, anesthetic
- Quick recovery, minimal discomfort
- No scars
- Minimal risk of infection
- High success rate and low recurrence rate
- Excellent long-term effectiveness
- Reduced risk of complications
In this procedure, your doctor injects a chemical solution into small- or medium-sized varicose veins. The solution shrinks those veins until they close. Your leg is then compressed with either stockings or bandages that must be worn for one week after treatment. In a few weeks, the treated veins dissolve and disappear as the body naturally absorbs them.
Patients sometimes need two or more treatment sessions -- separated by several weeks -- to significantly improve the appearance of their leg veins. While the same vein may need to be injected more than once, sclerotherapy is generally quite effective and doesn't require anesthesia.
Sclerotherapy is preferred over laser or radiofrequency therapy for eliminating larger spider veins, smaller varicose leg veins, and veins that are too twisted for insertion of a thermal ablation catheter. Unlike ablation, the chemical solution used in this approach also closes the "feeder veins" under the skin that are causing the spider veins to form, thereby making a recurrence of spider veins in the treated area less likely.
Ambulatory phlebectomy is a micro-extraction procedure that removes large varicose veins near the skin’s surface through tiny skin punctures that require no stitches. Removal of these veins is often necessary to prevent the varicose veins from reoccurring. Unlike traditional vein stripping, the incisions are small, and bruising is minimal.
During the procedure, micro-incisions as small as 2-3 mm in diameter are made in your leg. The physician then uses a special instrument to extract the varicose vein through the incision. Veins are very collapsible, so even large veins may be removed through the tiny incisions used in this technique. Scarring is generally minimal, and you can walk immediately following the procedure. Intravenous sedation (fentanyl and versed) is used during this procedure. Patients return the following day for a dressing change, and a compression stocking is applied for the following week.
Frequently Asked Questions
What Causes Varicose Veins?
Arteries carry freshly oxygenated (red) blood from your heart to the rest of your tissues. Then the veins recirculate that deoxygenated (bluish) blood back to your heart.
Your veins must work against gravity in order to return the deoxygenated blood from your legs. Muscle contractions in your lower legs act as pumps to help push the blood upward.
Tiny valves in your veins open as the blood flows toward your heart, then close to stop the blood from flowing backward or "refluxing." All the veins in your legs have these valves. They are designed to ensure that the blood flows in only one direction – toward the heart.
Sometimes a vein weakens and its one-way valves fail. These failed or "incompetent" veins lose their ability to help push deoxygenated blood back up to the heart. Instead, the incompetent vein expands or "dilates" in response to increased pressure. Gravity then causes a backflow or reflux of blood. The veins appear blue because they contain deoxygenated blood that hasn’t yet recirculated through the lungs.
Causes of varicose veins can include:
Age. As you get older, your veins often stretch and lose elasticity. The valves in your veins may weaken, allowing blood that should be moving toward your heart to flow backward.
Defective perforator veins. The veins closer to your skin are called superficial veins, and the veins closer to your nerves, bone and organs are called deep veins. Perforator veins connect these two networks, draining blood from the superficial veins into the deep veins as part of the process of returning oxygen-depleted blood to the heart and lungs.
Like all veins in your leg, perforator veins have one-way valves that should prevent the backflow of blood. When those valves no longer function properly and reflux occurs, the buildup of blood and pressure can cause both the superficial and perforator veins to become incompetent. Perforator veins in the lower leg and ankle are particularly vulnerable, and these circulatory problems create an increased likelihood of pain, swelling, hyperpigmentation (skin discoloration), dermatitis (skin rashes)and skin ulcers in the immediate area.
Pregnancy. Although pregnancy increases the volume of blood in your body, it also decreases the flow of blood from your legs to your pelvis. This circulatory change supports the growing fetus, but it can also produce enlarged veins in your legs. Varicose veins may surface for the first time or may worsen during late pregnancy, when your uterus exerts greater pressure on the veins in your legs. Hormone changes during pregnancy also may play a role. Varicose veins that develop during pregnancy generally improve without medical treatment within three months after delivery.
What Are the Major Symptoms?
Varicose veins usually don't cause pain and they’re typically easy to spot. Although any vein may become varicose, the ones most commonly affected are those in the legs and feet, particularly those associated with the longest vein of the body, the great saphenous vein (GSV). Varicose veins are often branches of the GSV.
Painful symptoms of varicose veins can include:
Spider veins are similar to varicose veins, but smaller. They are found closer to the skin's surface and can be red or blue. Spider veins generally occur on the legs, but can also be found on the face. They vary in size and often look like a spider's web.