There are several ways that varicose and spider vein disease can be classified in the lower extremity. These include spider veins, varicose veins, deep vein thrombus, superficial vein thrombosis, chronic venous insufficiency, pelvic congestion syndrome, phlebitis, venous stasis among others. Each has its own set of symptoms, manifestations and ramifications to the venous circulatory system.
For the great majority of patients, a simple visual examination by an experienced physician may be all that is necessary to establish the presence and, therefore, the conservative management of varicose and spider veins.
Although, in some situations, a detailed examination using a sophisticated Duplex Doppler ultrasound test is done to evaluate the venous blood flow, and characterize the vessels.
Common vein conditions include Spider Veins, Varicose Veins, Deep Vein Thrombosis, Chronic Venous Insufficiency, Lymphedema, Restless Leg Syndrome, and the following.
Varicose veins around the ovaries and in the pelvic cavity often are related to pelvic pain. These varicose veins are due to the result of valves that do not work correctly. The blood then increases in pressure and causes the veins to bulge much like in the legs. These veins cause pelvic insufficiency often referred to as pelvic congestion syndrome.
Some studies show that 30% of patients with chronic pelvic pain have pelvic venous insufficiency. Risk factors for developing pelvic insufficiency include multiple pregnancies, polycystic ovarian disease, fullness of the leg veins, and hormonal dysfunction.
Women with PVI usually complain of a dull aching and heaviness in the pelvis that increases when standing, during pregnancy, and during menstruation. Sometimes this pain may be experienced in the lower back. There may be visible varicose veins in the groin area, buttocks, or upper thigh and pressure behind the knee during menstruation.
Phlebitis is a common term for inflammation of a vein or varicose veins. Often times the inflammation of the vein is due to the formation of a clot or thrombus. When there is a clot the condition is known as thrombophlebitis or venous thrombus. When the thrombus is in the superficial veins it is generally called superficial thrombophlebitis. While superficial thrombophlebitis can be very painful it is generally not life threatening. Thrombophlebitis in the deep veins is a serious condition and is usually called deep vein thrombus or DVT.
Superficial phlebitis is more likely to develop in people with varicose veins or those who have had trauma to the vessel wall such as with an IV stick or blood draw. There may be obvious inflammation with a red streak along the path of the vein. There may also be localized tenderness and heat associated with the inflammation and thrombus in the varicosities.
Vulvar varicosities, or varicose veins in the vulva, are poorly understood. They tend to occur most often during pregnancy when the risk of varicose veins is greater due to the increase in blood volume and decrease in how quickly your blood flows from your lower body. This puts pressure on your veins. Vulvar varicosities can occur alone or along with varicose veins of the legs.
If you have vulvar varicosities, the only way you’ll know is because your health care provider tells you. The symptoms include a feeling of fullness or pressure in the vulva area, vulvar swelling and discomfort. Long periods of standing, exercise and sex can aggravate the condition.
Venous stasis is the chronic disease in which the valves of the legs are damaged, letting blood flow backwards toward the feet. The increased blood in the venous system increases the pressure in the veins and causes the other veins to dilate. The blood can stagnate in the veins of the lower legs and causing chronic inflammation in the veins, skin and can lead to ulcers.
Vein Treatment Options
Endovenous thermal ablation is a minimally invasive treatment of varicose vein and venous insufficiency that involves the insertion of a small thin, flexible tube called a catheter into a diseased vein to seal it shut using either a laser or radiofrequency to generate heat. Blood that would normally return to toward the heart through these veins will then travel through other veins instead. Over time the treated veins shrinks and is absorbed by the body. The treatment is effective as the treated vein is the source of the venous insufficiency. Compared with surgical options like ligation and vein stripping, endovenous ablation results in less pain and quicker recovery time.
Targeted Endovenous Therapy, formerly known as the VNUS Closure™ procedure. New name, same proven results.
The Venefit™ procedure uses radiofrequency energy to precisely and effectively treat patients suffering from Chronic Venous Insufficiency (CVI). With less pain and bruising than alternative treatments, physicians can feel confident that a better patient experience is part of every Venefit procedure.
More than 30 million people are undiagnosed with varicose veins or CVI*,3. Physicians can now help patients understand their condition and their treatment options.
Dr. Craddock and Southern Vein Care are one of only a few dedicated vein centers in the Atlanta and Southern United States to offer both technologies in regard to endovenous ablation. This enables treatment decisions based on which therapy is better for that individual. Both are 98% effective, however depending on the patient’s anatomy one system may be better suited for that treatment.
Endovenous Laser Treatment for the elimination of varicose veins is quickly becoming the gold-standard in the treatment of varicose veins. Endovenous Laser Treatment uses laser energy, which is simply a highly concentrated beam of light. Medical lasers work by delivering this light energy to the targeted tissue with extreme precision, so as not to affect the surrounding tissue. Lasers have proven their safety and effectiveness through years of use in all types of medical procedures, from eye surgery to dermatology. In the hands of a skilled physician, lasers offer far less risk for complications than conventional surgery.
In endovenous laser treatment, a thin fiber is inserted into the damaged vein through a very small entry point in the skin. A laser light is emitted through the fiber, as the fiber is pulled back through the vein, it delivers just the right amount of energy. The targeted tissue reacts with the light energy, causing the vein to close and seal shut. The veins that are closed are superficial veins that handle less than five percent of the body’s blood flow. The blood is automatically routed to other, healthy veins.
Dr. Craddock now uses a jacketed fiber, which prevents any contact between the fiber and the vein wall. This prevents much of the pain and bruising that is often associated with the more conventional method of ligation and stripping. Some patients may experience temporary soreness or some slight swelling, which can be treated effectively with over-the-counter, non-aspirin pain relievers and typically subsides within the first five days.
Sclerotherapy is the primary treatment for spider veins and small superficial varicose veins that usually appear on the legs. They less commonly appear on other parts of the body. Sclerotherapy involves the injection of a solution into a targeted spider vein or a reticular vein through a very fine needle (32 gauge). The chemical collapses the blood vessel within a few seconds and takes effect immediately. The natural healing process of the body then re-routes the blood flow to other veins and the spider vein can fade from view over a period of several weeks. The procedure is performed using the smallest needle possible to minimize the pain of injection. In fact, patients are pleasantly surprised when they experience how painless modern sclerotherapy is. Typically it takes 2-3 treatment sessions for gradual fading of the treated veins. Graduated compression stockings are recommended after treatment for up to a week.
Besides noticeable cosmetic benefits, sclerotherapy may but don’t always improve bothersome symptoms associated with spider veins, including itching, aching, burning and nighttime cramps. Unsuccessful sclerotherapy in the past could indicate that other larger veins may need to be treated first.
Foam sclerotherapy was first described in the late 1930″s. More recently, documented studies have demonstrated a good safety profile with satisfactory results with foam sclerotherapy. A couple of randomized trials have clearly shown the superiority of this technique versus liquid sclerotherapy in eliminating larger veins including the sites of reflux along the great saphenous vein and small saphenous vein systems. The long-term results of ultrasound-guided foam sclerotherapy have yet to be compared with traditional surgical treatment or endovenous ablation for varicose veins. These types of studies are needed and will help us provide physicians and patients with the information required to give a truly informed consent.
Patients who are only desiring some degree of pain control, this option may provide satisfactory relief. Conservative treatment includes elevation of legs, change in dietary habits and wearing of special prescription medical grade graduated compression stockings or hose. The graduated compression helps promote blood through the veins and may keep varicose veins compressed and collapsed. Conservative treatment is required by most insurance companies before more advanced treatments can be performed. Compression stockings also aid in the recovery after Closure, EVLT or sclerotherapy procedures. Conservative treatment also often includes leg elevation for extended periods of time to allow blood to drain from the veins of the leg. This is particularly important in patients who have skin changes, such as ulceration, in order for these areas to heal.
Conservative treatment will often not be practical for many patients, particularly due to work requirements, and progression of varicose veins may occur despite proper conservative treatment. Unfortunately, for some patients with severe deep venous insufficiency or post phlebitic syndrome, conservative treatment may be the only possible treatment option. This represents a small minority of patients with venous disease.
Ambulatory phlebotomy, or ambulatory microphlebectomy, is a surgical outpatient procedure to remove varicose veins by making tiny incisions. The tiny incisions in the skin are made and the vein is removed one segment at a time. Ambulatory phlebotomy can effectively remove varicose veins from the legs, thigh and feet, however similar to a stripping the procedure can have varying results. The procedure is quick, requires local anesthesia and produces some permanent effects. Ambulatory phlebotomy, however, is not 100 percent risk-free and has some known associated disadvantages.
Ambulatory phlebectomy can result in cutaneous complications, including paresthesia, hyperpigmentation, burning, numbness, tingling or pricking sensation. Darkening of the skin due to increased melanin, occurs in 5 to 7 percent of ambulatory phlebotomy patients. This discoloring or hyperpigmentation can fade within a few months without further treatment.
At Southern Vein Care we seldom perform ambulatory phlebectomy or microphlebectomy as increased effectiveness of ultrasound guided sclerotherapy and foam sclerotherapy offer better results with less pain and with cosmetically better results.
With the advent of endovenous ablation the practice of vein stripping is virtually non-existent in the vein community. The procedure which consists of making several incisions and the manipulation of a flexible tube between incisions and the vein being pulled out of the limb. There is increased bruising and much more down time before resuming exercise when compared to more modern treatments. The procedure is usually performed in the hospital under general anesthesia and due to this the cost is much higher.
Traditional surgery is recommended if treatment with heat, lasers or foam does not work. Different techniques can be used to remove the veins, depending on their site and severity. Many people can be treated as day cases. One to three weeks off work may be needed afterwards, depending on the demands of your job. At Southern Vein Care, while we can and have performed vein stripping, it is very rarely the best option for an individual.
The VenaSeal™ closure procedure is the first and only treatment approved for use in the U.S. that uses an advanced medical adhesive to safely and effectively close diseased vein segments. During the procedure, a trained clinician fills a syringe with the medical adhesive, which is inserted into a dispensing gun that is attached to a catheter. The catheter is advanced into the diseased vein under ultrasound guidance. The catheter is then placed in specific areas along the diseased vein and the clinician conducts a series of trigger pulls to deliver the medical adhesive.
The VenaSeal™ procedure improves blood flow by delivering a small amount of specially formulated medical adhesive to the diseased vein. The adhesive closes the vein and blood is rerouted through nearby healthy veins.
Unlike other heat-based treatments, the VenaSeal™ closure does not require multiple injections of a local anesthetic, enabling patients to rapidly return to normal activities following the procedure. The procedure also eliminates the risk of burning or nerve injury associated with thermal based procedures and may not require the use of compression stockings post procedure.
Varithena is a prescription foam medication that is used to treat varicose veins caused by problems with the great saphenous vein and other related veins in the legs.