What are varicose veins?
Varicose veins are abnormal veins that become more and more visible because of their color and/or size.
Blood flows through the veins on its way back to the heart. The blood must flow through the veins against gravity. To help with the movement of blood against gravity the veins have valves to keep the blood from flowing down toward the feet. Varicose veins are veins with broken valves that allow the blood to flow the wrong direction and pool in the legs. The blood flowing in the wrong direction stretches the vein longer and larger. Stretching the vein longer makes it begin to curve back and forth in the leg.
Do I have varicose veins?
If you think you might have varicose veins you probably do. Even the tiny red web-like veins referred to as spider veins are a form of varicose veins. 20% of people with “just spider veins” actually have problems with their larger veins. These larger veins need to be treated to make treatment of the spider veins more effective.
What is the difference between spider veins and varicose veins?
Spider veins are small, sometimes tiny, and varicose veins are big. That is the basic difference. Both are caused when valves are damaged and the veins begin to get larger. Both are treated by removing the veins from the circulation. When you understand that varicose veins and spider veins are part of the same disease it is not surprising that 20% of patients who have “just spider veins” will actually have significant reflux (reverse or backward blood flow) in the larger veins. In these individuals, treatment of only the spider veins will be unsatisfactory as they will quickly recur. For all these reasons it is important to have your veins carefully evaluated by a Phlebologist.
Do men get varicose veins?
Yes. Approximately 30% of the population gets or has varicose veins. This estimate depends on many factors. We see more women in our practice than men, but there are many reasons for this, including pregnancy and hormone changes. Women’s legs are seen more often than men’s. Women also have different expectations about the looks of their legs than men, therefore they generally want their varicose veins treated sooner in the disease process than men do. When we see men with varicose veins it is often at a later stage of the disease. Their veins look a lot worse and they may have more symptoms or actual problems with the veins.
Why are varicose veins harmful?
The varicose veins you see at the surface are the visual result of a disease that started in the veins you can’t see that are deep in your legs. Left untreated, vein disease progresses. The damage starts by making your legs feel bad – aching, heaviness, itching, throbbing, burning, fatigue or restless legs. Then it begins to cause real damage – swelling, thickening of the skin, increased risk or dangerous blood clots, skin discoloration and skin damage leading to open sores on the ankles and lower legs. The open sores are called venous stasis ulcers. These are the reasons it is important to treat varicose veins before they become severe, even if you are not very concerned about the looks of your legs.
How did I get varicose veins?
You probably inherited them from someone in your family. Some of us have inherited weak or dysfunctional valves in our veins. Sometime during our lives this begins to show itself as varicose veins. Since the valves don’t work correctly, or not at all in some areas, blood in these abnormal veins is actually allowed to flow away from the heart instead of back toward the heart. This causes increasing pressure in the veins and the veins stretch. The veins increase in diameter and length. Since your leg does not get longer the veins have to bunch up, curve back and forth, and eventually look like the bulging, tortuous veins we know as varicose veins.
There are factors that increase your likelihood of developing venous reflux (blood flowing the wrong direction) such as standing or sitting for long periods of time without moving much, hormonal changes, pregnancy, or doing a lot of lifting while standing. These factors only speed up the process in someone who already has the inherited tendency for varicose veins. It has been said that obesity is a risk factor but there is now data to show that by itself obesity may not be a risk factor. Inactivity is a risk factor, and this often is associated with obesity.
Sometimes direct trauma to the leg, such as a blow to the leg, can rupture a vein valve and start the process of varicose veins. Surgery can also damage veins.
Can varicose veins be prevented?
You cannot change an inherited tendency for any specific condition and varicose veins cannot be prevented. But there are things you can do to slow the progression of varicose veins. Maintaining a healthy weight, and exercise program is probably the most important preventive measure. If you have a job where you sit a lot, or stand in one place for long periods of time, you should get up and move around as frequently as possible. You will also feel better at the end of the day if you wear medical grade compression stockings. These are different than support hose you buy at the department store. Compression stockings can be purchased in our office at a discount or you can buy them in a pharmacy or medical store.
What are the symptoms of varicose veins?
Chronic venous insufficiency (C.V.I.) can cause a number of symptoms. These may include itching, burning, throbbing, pain, day or night cramps, heaviness, fatigue, and even restless legs. Some skin rashes on the lower legs may be caused by C.V.I. Sometimes the discomfort is worse just before or during menstruation, during or after exercise, or when the weather is especially hot. Varicose vein disease can also cause swelling, skin discoloration, skin rashes, severe bleeding from veins that are very close to the surface, permanent scarring of the skin especially around the ankles, and can lead to painful and dangerous skin ulcers around your ankles.
Does pregnancy cause varicose veins?
Yes and no. Many women go through pregnancy without getting varicose veins. But, many women without varicose veins develop venous reflux and varicose veins during the pregnancy. Why do some women get them and some don’t? Some women have the inherited weakness in the valves that predisposes them to varicose veins. Then during the pregnancy as the level of progesterone rises to maintain the pregnancy and get the pelvis ready to stretch during the birthing process, the veins stretch as well. The pregnant uterus also can obstruct the flow of blood out of the legs. This enlarges the pelvic and leg veins. When the veins get larger in diameter the valves don’t reach all the way across the vein and reflux will begin. If the reflux lasts long enough it may permanently damage the valve. This is why varicose veins sometimes go away when the pregnancy is over. Repeated insults to the valves may result in permanent damage to these vein valves. This is why women who become pregnant several times increase the likelihood of having permanent damage to the valves and developing varicose veins that do not go away.
Should I wait until all my pregnancies are over before getting my veins treated?
The evidence says no. Varicose veins carry several risk factors; one of the most dangerous is an increased risk of blood clots. Pregnancy also increases your risk of blood clots. The two together compound the risk. Having the veins treated before the next pregnancy will probably decrease this risk.
If you have varicose veins treated between pregnancies you will most likely protect yourself from more severe varicose veins and you will decrease your risk of blood clots. You will also be more comfortable through your pregnancy and be able to stay more active. All this is good for you and your baby.
But won’t the varicose veins just come back when I get pregnant again?
It is true varicose veins may show up during your next pregnancy. But the veins we treat will not come back. Those veins are gone. The number and severity of the veins you get with your next pregnancy will be reduced if you get them treated before you get pregnant again. This is because the venous hypertension (high pressures in the veins that result from varicose veins) has been treated.
It is important to realize that people who get varicose veins will continue to get varicose veins. What this means is if you have weak valves in your veins, other valves in veins that now seem normal may become damaged and they will become dilated and visible. But when veins are treated, the overall pressure in the veins are decreased and the rate of deterioration slows. It will probably be many years before you have significant problems again.
How are varicose veins treated?
In general, varicose veins are treated by blocking blood flow through the diseased veins, or removing the diseased veins from the circulation. This removal or blocking can be done in a variety of ways. In the past, veins were removed with a surgery called ligation and vein stripping. It was a major surgery and was not nearly as effective as today’s methods. Most Phlebologists use a form of endovenous thermal ablation to cause veins to collapse and scar closed. Sclerotherapy, a procedure where solutions are also injected into veins to make them collapse, is also used by most Phlebologists.
Once the diseased veins are removed, the venous system functions much more efficiently. The veins work better even though some of them are gone because blood now flows through healthy veins.
Don’t I need those veins that are being blocked or removed?
No. Those veins are abnormal and are causing problems in your circulation. By removing these diseased veins, the blood is forced into the veins that are healthy with valves that are working properly. This improves your blood circulation.
Does insurance cover the cost of treatment?
Chronic Venous Insufficiency (C.V.I.) is a disease. Once you have been given that diagnosis, treatment of your varicose veins becomes a medically necessary procedure. Most insurance companies cover the diagnostic ultrasound and exam. Each insurance company has different requirements that mandate “medically necessary.” Our insurance specialists will personally speak with someone at your insurance company regarding your diagnosis and what they will cover. We will know ahead of time if pre-certification or authorization from your primary doctor is necessary.
How much does it cost?
Everyone is different. We need to see your legs, and we will need to do an ultrasound exam before we can give you a definite idea of how much it will cost. If you are using your health insurance to pay for your treatment it will depend on the terms of your individual policy. We do have cash prices we can discuss at the time of your initial office visit. The key is to get your vein disease properly diagnosed, and then we will be able to discuss the cost of your treatment.
Are the treatments painful?
Current treatments for varicose veins are minimally invasive and some can cause mild discomfort. Dr. Bowers compares the discomfort level to having a mole removed in the doctor’s office. It is not totally painless because there are “numbing shots” involved. This is the most uncomfortable part of the EVLA procedure. During sclerotherapy there are a number of injections but the needles are tiny. After a sclerotherapy treatment there may be a burning sensation that lasts from a few seconds to a few minutes. This is also usually mild.
After the EVLA, since the goal of the procedure is to permanently remove the vein, there will be an inflammatory reaction that can cause bruising and some mild discomfort for a few days. After a few days, as the scar inside your leg matures, there may be a pulling sensation when you first get up to move around. This loosens up quickly and soon goes away.
Some people might think describing the discomfort you can expect is not a good marketing tool. At Bowers Vein Institute we want to be as truthful as possible. If your expectations are realistic, your experience will be more pleasant. After experiencing an EVLA, many of our patients make comments like “wow, that was a lot easier than I expected” and “you are done already?” and “I worried a lot for nothing!”
Schedule your free consultation now and one of our insurance specialists will contact your insurance company to check benefits for treatment. Call (727) 632-3650 today! We accept the following insurance plans:
- Blue Cross Blue Shield
- Mail Handlers
- Simply Health Care
- United Healthcare
Vein Specialist William Bowers, MD,FACS, RPVI, RPhS is the founder and Medical Director of Bowers Vein Institute in Pinellas Park, Florida. The Bowers Vein Institute is a cutting edge, state-of-the-art center that provides comprehensive care for patients with reticular, spider, varicose veins, and other venous diseases. The facility offers the latest in minimally invasive procedures that effectively eradicate veins without the need for traditional surgery. Above all else, the team at Bowers Vein Institute puts patient care first. This not only means ensuring that patients receive the effective vein treatment they need, it also entails providing a comfortable, friendly, and professional environment for each and every patient. The staff takes pride in adhering to these extremely high standards of patient care.
Restless Leg Syndrome?
Venous insufficiency not only causes varicose veins, it can be the underlying cause for many other conditions, including restless legs syndrome.