Capitol Vein Blog

Tuesday, February 7, 2017

Don't Forget Varicose Veins as a Cause of Leg Pain

Varicose veins are common cause of obscure leg pain, and it’s quite interesting to learn how often we see symptoms improve once venous hypertension is resolved. Even in the absence of superficial visible varicosities, internal venous reflux can lead to neuropathic symptoms of foot and toe tingling, numbness and even coldness in the presence of strong pedal pulses.


As seen here the veins within the muscle compartments can dilate in response to valve insufficiency, causing pressure on neighboring sensory nerves. 

Often patients being  treated with neuropathy medications can reduce or even eliminate their medication needs once the venous insufficiency is treated. Of course, there are other causes of neuropathy, such as diabetes or degenerative back disease, and treating venous issues may not impact these symptoms much at all.


When we first evaluate a patient in who we suspect venous disease is an issue, we first do a venous duplex ultrasound to provide us a roadmap of the circulation. This, then, help determine where the backflow in the veins is occurring and what treatment might be beneficial. Ablation of a refluxing saphenous vein can often be the only procedure that is required to normalize venous flow and eliminate symptoms. This office based procedure is done under local anesthesia and allows immediate return to normal activity.

Once patients develop venous reflux, due to weak vein valves, the constant pressure of gravity tends to exacerbate the condition, leading to larger veins, more discomfort, and the potential for permanent skin damage and even blood clots. Earlier intervention can limit the longer term harmful effects of varicose veins.

As vascular surgeons with many years of advanced training in venous disease, both Dr. Rosenberg and McNeill will give you the best information and advice on the management of your venous disease.

Wednesday, January 11, 2017

Pregnancy and Varicose Veins...Know the Risks

I just read a very interesting article in Venous Times discussing the risk factors for blood clots in women and pregnancy. We know that varicose veins increase the risk of venous thromboembolism (venous blood clots) because the flow in these large ropy veins is abnormal. The study in the Venous Times  confirms that within the first six weeks after delivery, clot risk remain high due to elevated hormone levels. As to the increased risk associated with varicose veins, we strongly believe that women with symptomatic varicosities should undergo evaluation and treatment between pregnancies, as opposed to waiting until she is done with all pregnancies. Each successive pregnancy causes more and more vein damage with exacerbation of symptoms and additive risk.

Not only will varicose vein treatment, usually with VNUS Closure or microphlebectomy, alleviate symptoms of aching, heaviness, throbbing and fatigue in the leg, it will also reduce the risk of phlebitis as blood flow is normalized.

The various office based procedures we use to treat varicose veins are all done under local anesthesia and allow immediate return to normal activity. Your medical insurance plan usually considers these treatments medically necessary because the risk of non-treatment is progressive vein enlargement with the potential for skin damage, skin ulcers and DVT.

Again, women in child bearing years should undergo varicose vein evaluation and treatment between pregnancies so further pregnancies are better tolerated. As vascular surgeons with many years of extensive experience treating venous disorders, both Dr. Rosenberg and Dr. McNeill are best suited to give you the thorough evaluation you need for optimal results.

Friday, December 16, 2016

Don't Neglect Your Varicose Veins

Varicose veins are caused by are not only unsightly, but cause leg pain, cramps, risk of blood clots and skin damage due to elevated pressures in the veins. Blood should flow up the leg against gravity, but as the one-way valves weaken, blood is forced downward from groin to foot. It's similar to inflating a balloon--as the air pressure is increased, the balloon inflates and deforms. Similarly, as the vein pressure is increased, the veins swell, enlarge and deform.

Fortunately, treatment is highly effective, long lasting and simply done in the office under local anesthesia. Importantly, your insurance plan often cover the treatment because we all recognize that if left untreated, varicose veins progress and increase the risk of longer term side effects. We see patients with these kind of veins come in with sudden blood clots (phlebitis) and rashes that could be prevented by treating these veins at an early stage.

Endovenous ablation with VNUS Closure is the "gold standard" treatment for saphenous vein reflux, the usual cause of varicosities. VNUS Closure lets us use a heated wire to shrink the refluxing vein, thereby establishing normal blood flow and circulation to the leg. Microphlebectomy is also used to remove small surface veins. The photo you see above is of a patient who underwent both procedures, and as you can see, the results are impressive.

A newer procedure, VenaSeal, allows us to seal the vein using a glue instead of a heated wire. The advantage of this is a couple of fewer needles for local anesthesia, but importantly, insurance does not cover this particular treatment. Insurance is actually quite good for the VNUS Closure and phlebectomy.

If you have concerns about your veins and have varicose veins that are bulging and unsightly, let us give you advice and management guidelines that will help prevent longer term problems.