Capitol Vein Blog

Friday, April 28, 2017

Varicose veins typically cause symptoms of aching, heaviness, throbbing and generalized discomfort in the leg due to the elevated pressure from back flow in the veins. Patients notice symptoms exacerbated later in the day, and even when going to bed at night may develop restless legs. Varicosities develop because the small one-way valves in the veins that propel the venous blood up the leg become defective. The downward push of gravity creates pressure leading to the swollen veins at the surface of the leg, but the origin of this downward push is usually internal veins that feed the surface veins.

We encourage patients to ease the discomfort of varicose veins by maintaining a good level of activity, elevating the legs when possible, and using medical grade support hose. Steady contraction of calf muscles, done by toe raises or walking, helps propel blood up the leg and encourage good circulation. Leg elevation reduces the push of gravity and allows the veins to temporarily shrink, easing the symptoms. The support hose also effectively reduce the pressure in the veins and promote normal venous blood flow up the leg.

Ultimately, correction of the underlying reflux (backflow) in the veins is the best treatment to permanently eliminate the symptoms of varicose veins. Individualized treatment is enabled by the use of high quality venous ultrasound that shows the vein valve abnormalities in great detail. Endovenous ablation (VNUS Closure) is often used to treat internal veins that cause the painful surface veins, while phlebectomy or sclerotherapy eliminates the visible varicose veins.

It is important that you understand the qualifications and experience of the physician you select to treat your veins. Vascular surgeons have extensive training in both arteries and veins and have the judgement to provide you with the best options for a successful result.

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.