Dans Papers - June 8, 2007 - Life After Varicose

Approximately once per month, one of the physicians in my group receives a desperate call from someone who is overwhelmed by rapid bleeding from a "burst" varicose vein in their leg. While this is not the usual scenario that leads a person to seek treatment for their varicose veins, it is frightening and requires emergency treatment. Many people accept the appearance of the varicose veins in their legs thinking that treatment will be too involved or too painful. But, delaying treatment for this problem may result in profuse bleeding when you least expect it. More commonly, untreated varicose veins lead to increasingly aching, or throbbing legs especially after several hours of standing.

Varicose veins affect more than 25 million Americans. They are much more common in women than men. The typical symptoms can include pain, fatigue and leg swelling. Blood clots can also form in varicose veins, which is called phlebitis. This is a very painful and temporary problem, which is almost never life-threatening. Varicose veins are usually caused by a back flow or "reflux" of blood into superficial veins (just under the skin) from deeper veins under the muscles. This reflux of blood causes increased pressure in the small veins and branches under the skin, which causes them to bulge. There is pain that increases as the person stands or walks over a period of hours and improves when the legs are elevated. In some cases, the overlying skin can become chronically irritated and develop a rash or discoloration. The abnormal vein blood flow is usually hereditary, but can be worsened by prolonged standing and pregnancy. Many have been led to believe that this condition is a natural factor of aging, but all age groups are affected. Without treatment, the symptoms can worsen and may result in the skin forming open ulcers, which usually appear at the ankles.

Spider veins may also result from abnormal venous circulation, but these are less likely to cause long-term problems. They are socially disabling for many women causing them to avoid certain clothing or activities like swimming or sun bathing. While support hose are helpful, clearly they are not welcomed at the beach.

The good news is that there are now many treatment options and most of these can be performed in doctors' offices. The main superficial (saphenous) vein that runs along the inside of the leg is usually the culprit. Back flow or reflux into this vein from the groin or thigh veins is the underlying problem. Luckily, this saphenous vein can be closed through a needle and catheter system in less than 30 minutes. In many cases, the closure of the saphenous vein leads to the varicose and spider veins shrinking and becoming less prominent. If there are larger, bulging branches can then be removed at the same time through tiny skin nicks. Smaller spider veins can be easily treated with injections of salt or chemical solutions (sclerotherapy) that cause them to gradually fade. Some physicians treat spider veins with a topical laser, but the best results are seen in people with very fair skin. Pigmented skin absorbs the laser light when it shines on the skin limiting those who can be treated this way. All of these procedures are possible with little or no sedation. Local anesthesia or numbing of the skin is often all that is necessary.

After treatment one of my recent patients, a hair stylist, commented that she had never realized how uncomfortable her legs had been for so many years. Another patient came to the office for her post-operative visit with a big smile and reported how light her leg now felt. These testimonials are common and most people wish that they had sought treatment sooner.

So, if you are living with your varicose veins, but not really living then consider having a consultation with an experienced vein surgeon. Delaying treatment just prolongs suffering and may lead to the development of more varicose veins and worsening symptoms.

Lisa Alford, M.D. is a Vascular Surgeon. Suffolk Vascular Associates at Port Jefferson is located at 1110 Hallock Avenue, Port Jefferson Station. Call (631) 476-9100 or visit www.suffolkvascular.com for more information.