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What are varicose veins and what causes them?

Varicose veins are enlarged superficial veins of the legs that look like twisted, bulging chords under the skin. Normal functioning veins contain one-way valves that help push blood forward from the feet to the heart. Varicose veins occur when these one-way valves no longer function, allowing blood to flow towards the feet due to the effects of gravity. The blood begins to pool within the veins and over time the veins dilate and lead to symptomatic varicose veins. More importantly, varicose veins are a sign of chronic venous insufficiency. If left untreated, this can lead to throbbing leg pain, swelling, leg fatigue, skin changes, blood clots (deep vein thrombosis), restless leg syndrome and venous ulcers.

What are spider veins?

Spider veins are blue and reddish thin walled veins that appear very close to the skin surface but are not bulging like varicose veins. Spider veins can spread over a range of skin areas and often cover the legs and even the face. They can be treated with sclerotherapy (injection of a chemical into the vein) or with laser treatment.

Who is at risk for chronic venous insufficiency?

Chronic venous insufficiency can affect anyone, regardless of age, gender or race. Women over the age of 50 and those who have had children are more likely to develop signs and symptoms of venous disease. The disease is often hereditary and can affect several members of the same family.

Factors that may increase your chances of developing venous insufficiency and varicose veins include:

  • Family history of varicose veins
  • Occupations that require prolonged standing
  • Excess weight
  • Lack of exercise
  • Current or previous pregnancies

How are varicose veins treated?

There are a number of ways to treat varicose veins, some of which are rarely used today. Traditionally, vein stripping surgery was performed under general anesthesia and required a hospital stay. It was a painful surgery that, while effective, often led to recurrence of varicose veins.

In this procedure, the saphenous vein in the leg is burned closed thereby redirecting the venous blood into the deeper veins of the leg and back towards the heart. Other treatment options such as sclerotherapy and microphlebectomy are also used to provide the optimum result for the patient.

Does laser ablation involve a long downtime?

Endovenous laser treatment (EVLT) is a minimally invasive procedure performed for the treatment of varicose veins using only a local anesthetic. The procedure is performed in about one hour and patients are able to walk and perform light activity the same or next day. For more rigorous activity like exercise and heavy lifting, patients are advised to wait for two weeks following the procedure. In addition, exposure to the sun and hot baths should be avoided during this same period. Compression stockings will need to be worn for 2-4 weeks after the procedure to provide the best long-term results.

What if I need the saphenous vein for heart bypass surgery in the future?

Since varicose veins are considered damaged due to the malfunctioning valves, they can no longer be used for heart bypass surgery and thus it is safe to burn them closed. Heart surgeons will have other blood vessels to choose from should surgery be needed in the future.

Is the treatment of varicose veins considered cosmetic, and if so, will my insurance cover it?

While varicose veins are not attractive, the vast majority of people seek treatment due to pain, swelling, itching, and fatigue in their legs. Restless leg syndrome, night cramps, skin changes, and ulcers are additional reasons people seek treatment.

After an evaluation by ultrasound, our Interventional Radiologists will determine the cause of your varicose veins and discuss your treatment options. Many insurance companies will cover the treatment of varicose veins when it is associated with the above symptoms. However, prior to treatment, conservative management by wearing graded compression stockings for 2-3 months is generally required by most insurance companies. Treatment of varicose veins for cosmetic purposes is generally not covered by insurance.

Why should I get my varicose veins treated at Penn Interventional Radiology?

As the pioneers of minimally invasive procedures, Interventional Radiologists invented the procedure of endovenous laser ablation for the treatment of varicose veins in 1998. Penn Interventional Radiology has a vast experience in the treatment of diseases of the arteries and veins and is uniquely qualified to ensure that you are receiving the most advanced care available today in the treatment of venous insufficiency.

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