Bundled up against the cold and snow this winter, your legs and how they appear are probably the last things on your mind. This, however, is exactly the right time to start addressing your varicose veins and all the problems associated with symptomatic venous insufficiency, a condition in which the veins have problems returning blood from the legs back to the heart.
Risk Factors
If you suffer from leg swelling, pain, cramps, fatigue, heaviness, itching, restlessness, dark skin changes (especially at the ankles), ankle ulceration, ropey varicose veins and spider veins, you most likely have significant venous reflux or insufficiency. Risk factors include:
- family history of venous disease and varicose veins;
- female gender
- advancing age;
- obesity;
- pregnancy;
- sedentary lifestyle with extended periods of standing or sitting.
If this sounds like you, now is the time to seek diagnosis and treatment.
Diagnosis
An accurate diagnosis is made initially by physical exam with a physician experienced in treating venous disease. It is confirmed through a sonographic evaluation in a vasculary laboratory, where a trained and skilled technician will use ultrasound to perform a detailed and comprehensive study of the entire venous system (network of veins that carry blood towards the heart).
Treatment
Once the diagnosis is confirmed, you can discuss treatment options with your physician. The most appropriate options for you will be determined based on physical exam findings, severity of symptoms, ultrasound findings and other medical disorders you may have.
Patients with significant venous disease and varicose veins most often have findings of valvular incompetence, or “leaking,” on ultrasound. This leaking, or backward flow of venous blood in the legs, results in increased venous pressure and swelling, heaviness, skin changes and varicose veins (in addition to other symptoms).
Conservative treatment options include:
• daily use of medical-grade support hose;
• weight loss;
• exercise; and
• pain medication.
More invasive options include:
• thermal/heat ablation—either endovenous laser therapy (EVLT) or radiofrequency ablation (RF)—to close the leaking vein;
• surgical stripping in the operating room; and
• stab phlebectomy to remove enlarged branch veins. (Smaller spider veins, which represent a more cosmetic issue, can be treated with injection sclerotherapy in the office.)
The thermal ablative techniques (EVLT or RF) are minimally invasive procedures (covered by most insurance companies) that can be performed in the office setting under local anesthesia in less than 30 minutes. Patients are put in a compression stocking and are sent on their way immediately, able to resume work and normal activities right away.
Whatever treatment is indicated for you, you can be assured of excellent results with office-based procedures (all of which are available at Beth Israel Medical Center, 212-420-5648). So take the first step towards a healthier, more beautiful you—just in time for the next warm weather season—by seeking evaluation and treatment for your venous disease and varicose veins.
To find an excellent doctor who is right for you, please call our Physician Referral Service at 866.804.1007.