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FREQUENTLY ASKED QUESTIONS (FAQS)
At Advanced Vein Therapies we like to keep our patients informed. Please browse this section to learn more about varicose and spider vein therapy.
What are varicose veins?
Varicose veins are abnormally enlarged, swollen veins at the surface of the skin. They may appear dark purple or blue and look twisted, ropey, and bulging. They develop when valves in the veins that are supposed to direct blood flow towards the heart stop working properly and, as a result, blood pools in the veins causing them to enlarge.
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What causes varicose veins?
There are many veins in the lower extremities which interconnect and include a deep and superficial system. Deep veins lie within the muscle compartments and carry most of the blood out of the leg while the superficial veins lie above the muscles and act as a reservoir to hold any remaining blood. Usually, abnormalities in the superficial system cause varicose veins. Normally, one-way valves in the veins of the lower extremities direct blood upwards toward the heart against gravity. When these valves become weak or damaged and don’t close properly, blood may flow backward, which is known as venous insufficiency or venous reflux. The most common vein in the superficial system to reflux is the Great Saphenous vein (although there are many other veins which may be affected). The Great Saphenous drains the veins that normally live just beneath the skin. When these veins cannot handle the excess blood and pressure transmitted from the refluxing saphenous, they engorge and become varicose veins.
Heredity, obesity, pregnancy, age, trauma and standing for long periods of time have potential to cause damage to the one-way valves and hence cause varicose veins.
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What are the symptoms of varicose veins?
Varicose veins are not just a cosmetic concern but are also a manifestation of the medical condition known as venous insufficiency. Most individuals affected with varicose veins have a variety of leg symptoms such as aching pain, fatigue/heaviness, swelling and pruritis (itchy legs). These symptoms usually get worse as the day progresses; individuals may get some relief from elevating their legs. Other symptoms include restless legs and night cramps.
While most people with varicose veins have symptoms, individuals without visible varicose veins can still be symptomatic because of pressure on nerves by dilated veins.
If left untreated, chronic venous insufficiency may cause skin color changes (known as stasis pigmentation or lipodermatosclerosis) around the ankles and lower legs. This denotes unhealthy skin, which may predispose individuals to open sores (ulcerations) and bleeding or bruising after a minor injury. Fortunately, this is relatively rare.
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What increases my risk of developing varicose veins?
Heredity, obesity, age, trauma and standing for long periods of time have all been thought to damage venous valves and therefore cause venous insufficiency and varicose veins. Women, especially if previously pregnant, are more likely to develop varicose veins.
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What are spider veins?
Spider veins are similar to varicose veins, but smaller. They are small, red, purple, or blue thread-like veins on the surface of the skin. Spider veins are considered cosmetic and most insurance carriers do not cover their treatment. Nevertheless, spider veins also may cause symptoms, including aching, throbbing, and itchy legs.
The body tends to continue producing spider veins despite successful treatment. For this reason, follow-up intermittent treatments are often necessary.
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What is the recommended treatment for spider veins?
 Sclerotherapy and/or laser techniques are the current treatments for spider veins. Typically, sclerotherapy is more effective and causes less pain than superficial lasers. At Advanced Vein Therapies, we utilize a special instrument known as a vein light that allows us to see the veins (known as reticular veins) that feed the spider veins. By injecting reticular veins we provide a better and more durable cosmetic result.
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What can I expect from a consultation at Advanced Vein Therapies?
Your initial consultation determines if you have any of the clinical signs or symptoms of venous insufficiency. If so, we perform a color duplex ultrasound exam. This allows us to assess the venous anatomy, vein valve function, and venous blood flow changes, and to firmly establish a diagnosis and create your treatment plan. Being cared for by an interventional radiologist with years of training and experience in the performance and interpretation of ultrasound is very advantageous. Having your ultrasound interpreted by anyone other than a Board Certified Radiologist would be a mistake. This ultrasound examination is thorough and includes assessment of both the deep and superficial venous systems.
Your diagnosis and treatment plan will be discussed with you and any questions or concerns will be fully addressed. When you leave Advanced Vein Therapies, you will realize you made the right choice for your vein care.
If you like, following your initial consultation, Advanced Vein Therapies will contact your insurance company and supply them with the necessary documentation to pre-certify you for treatment.
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What is venous reflux?
Normally, veins in the lower extremities carry blood to the heart against gravity. This is accomplished by one-way valves, which allow blood to flow upwards while your muscles contract. When your muscles relax, the valves snap shut preventing blood to flow in the wrong direction (towards your feet). (click for video)
When the valves in your veins become faulty, blood is allowed to flow in the wrong direction (towards your feet). This puts excess pressure on the vein walls, which causes them to expand. This expansion causes the valves to be even more ineffective. (click for video)
The most common veins to reflux are called saphenous veins. Visible varicose veins are typically branches coming off these veins.
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What is venous insufficiency?
Venous insufficiency is the medical condition in which the valves in the lower extremities do not function properly, causing a variety of symptoms (among them varicose veins). Venous insufficiency is synonymous with venous reflux.
Please see Venous Reflux for a detailed explanation of how venous insufficiency occurs.
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Can varicose veins cause significant medical problems?
Although rare, when left untreated chronic venous insufficiency may cause a variety of health concerns. Possible complications include:
- Stasis pigmentation: Leaking of blood products into the skin may occur, resulting in damaged and discolored skin, which usually occurs around the ankles and lower legs.
- Venous Eczema (also known as stasis dermatitis): The skin becomes dry and itchy. This may progress to blistering and a scaly appearance to the leg.
- Venous Stasis Ulcers: Unhealthy skin (as described above) is predisposed to open sores known as venous stasis ulcers, which are difficult to treat, painful, and can bleed. Fortunately this is relatively rare.
- Superficial Thrombophlebitis: Varicose veins may become inflamed and tender due to clotting.
- Bleeding: With minor trauma, varicose veins may bleed, sometimes profusely due to elevated pressure. As noted, venous stasis ulcers are predisposed to bleeding as well.
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When should I consult a doctor?
With safe, effective treatments readily available, you no longer need to suffer with varicose or spider veins. If you think you have a problem, you should consult a vein specialist. Even without the presence of varicose veins, if you suffer from aching leg pain, fatigue/heaviness of the legs, or swelling and pruritis (itchy legs), you may be suffering from venous insufficiency. These symptoms usually get worse as the day progresses, and you may get some relief by elevating your legs. Other symptoms include restless legs, night cramps, and, in severe cases, skin color changes and bleeding skin ulcers.
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How can I prevent varicose veins?
There are no medically proven ways to completely prevent varicose veins. Common sense, however, tells us that relieving pressure on the veins as well as promoting muscle strength helps to keep the blood flowing in the correct direction. Exercising, losing weight, elevating your legs when resting, and not crossing them when sitting all have potential benefits. Wearing loose clothing and avoiding long periods of sitting or standing also are thought to be helpful. Wearing high-heeled shoes is not advisable because they don’t allow the calf muscles to fully contract. Other than varicose vein treatment, medical compression hosiery is the most helpful method of decreasing the symptoms of varicose veins.
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Is vein therapy covered by insurance?
Many insurance carriers cover vein treatments based on a medical necessity for symptom relief. The knowledgeable staff of Advanced Vein Therapies will assist you in understanding your benefits and, if you like, will seek pre-approval for your treatment.
If your insurance carrier does not cover treatment, we will review fees with you, and arrange payment options. For your convenience, Advanced Vein Therapies accepts major credit cards.
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How long does recovery take?
Immediately after varicose vein treatment, you will be able to resume most normal activities; exceptions are heavy lifting, extreme exercise, and application of heat to the treated extremity. Usually you can resume heavy exercise in approximately two weeks. Complete recovery times vary from person to person.
For spider vein treatment there is no significant recovery time and patients experience minimal if any bruising.
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Do men get varicose veins?
Yes. Women, however, experience more vein problems than men mainly because of the unique additional risk factors for females, including estrogen levels and pregnancy. [Back to top]
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Is vein therapy safe during pregnancy?
We recommend avoiding vein therapy while pregnant or if you are breastfeeding, since the procedures are elective and medications may be necessary. Additionally, we recommend waiting several months after pregnancy for treatment, since varicose veins may improve or resolve in that time.
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What is Deep Vein Thrombosis (DVT)?
Deep Vein Thrombosis refers to the formation of a blood clot (thrombus) in the deep veins of the body, most commonly the lower extremities. A thrombus may form as a result of a blood-clotting abnormality, an injury, or a period of prolonged inactivity (such as a long airplane ride or bed rest). One of the dangers of a DVT is that a thrombus can break loose and travel through the bloodstream to the lungs, resulting in a life-threatening pulmonary embolism. Another danger of DVT is known as post-thombotic syndrome. This occurs when the valves of the deep venous system are damaged, resulting in long-term symptoms including pain, swelling, and discoloration of the skin.
A person with deep vein thrombosis may or may not have symptoms. Symptoms include tenderness, pain, or swelling. Treatment usually includes the use of blood-thinning medications (anticoagulants) that prevent new clots from forming or prevent existing clots from getting larger. Newer catheter-directed therapies are available, including devices that either remove clots or administer drugs directly into a clot. Procedures of this kind typically are done by an interventional radiologist.
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What is Economy Class Syndrome?
Economy Class Syndrome refers to the occurrence of deep vein thrombosis (blood clots in the deep veins of the legs) in air travelers, placing them at risk for pulmonary embolism (blood clot traveling to the lungs). Pulmonary embolus can cause sudden death. It is thought that the cause of venous thrombosis in air travelers is related to immobilization and dehydration. There are multiple underlying medical conditions that place some individuals at even higher risk. In order to avoid the economy class syndrome, it is prudent to maintain adequate hydration, move around the cabin as much as possible and perform calf muscle exercises. Additionally, there is medical evidence to suggest that wearing medical compression stockings reduces the risk of blood clots. If you are at high risk for forming blood clots, your physician may prescribe aspirin or low molecular weight heparin (LMWH).
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Are all lasers equal?
All lasers are not created equal. While all of the lasers on the market attempt to damage the targeted vein wall in order to close it shut, the methods by which they do so differ. The first generation of lasers targeted the blood within veins, which resulted in excessive heat. Though the heated blood would eventually damage the vein wall as intended, the excessive heat caused tiny holes in the vein which then leaked blood and caused bruising. Newer laser systems such as CoolTouch CTEV™ directly target the water within the vein wall, causing it to shut close. Because it can do this with far less heat, there is much less bruising.
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What are some of the current lasers for treating venous insufficiency?
1320 nm Nd:YAG Laser
- CoolTouch CTEV™ by New Star, Cool Touch
Diode Lasers
- Venacure™ Laser Vein Treatment by Angiodynamics® Incorporated.
- EVLT® and the DELTA Laser by Diomed.
- Vari-Lase Endovenous Laser System by Vascular Solutions, Inc.
- Donrnier D940 Laser by Dornier MedTech
- ELVeS™: Endo Laser Vein System by Biolitec
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Is there a difference between radiofrequency ablation and laser treatments for varicose veins?
Both methods work very well and have excellent results. The only difference is that radiofrequency ablation causes less bruising and pain
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How common are varicose veins and venous insufficiency?
It has been estimated that approximately half of the U.S. population has venous disease. Of these, 20 to 25% of the women and 10 to 15% of men have visible varicose veins. There are at least 20 million people in the U.S. with varicose veins.
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What is an interventional radiologist?
An interventional radiologist is a doctor specially trained in performing minimally invasive treatments using imaging guidance. These highly trained physicians perform a wide variety of procedures, including opening up blocked arteries and veins with angioplasty balloons and stents. Conversely, if a person is bleeding, interventional radiologists can block up the bleeding vessels with catheters by injecting occluding materials. Interventional radiologists perform many different types of biopsies and abscess drainage procedures often helping patients avoid major surgeries. Newer techniques that are being performed and refined include the treatment of cancers by injecting chemotherapy agents directly in the blood vessels supplying tumors as well as devices that “burn” tumors. An interventional radiologist pioneered endovenous laser ablation for the treatment of venous insufficiency. For more information about interventional radiology please visit the Society of Interventional Radiology’s website at: http://www.sirweb.org/
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