What is a Phlebologist?

A Phlebologist is a physician who specializes in the diagnosis and treatment of vein disorders.

What are Varicose Veins?

Varicose Veins are veins that become abnormally swollen and twisted due to increased pressure. Varicose Veins are sometimes bluish in color, protrude from the surface of the skin, and usually appear on legs and ankles.

What are Spider Veins?

Spider Veins are small, twisted blood vessels that are visible through the skin. They may be red, purple, or blue and most often appear on the legs and face.

What causes Spider/Varicose Veins?

Healthy veins carry blood to the heart through a series of one-way valves. These valves allow blood to flow in the right direction from superficial veins to deeper veins and to the heart. In addition, these vessels are surrounded by muscles, which contract and help pump blood back to the heart. Normally, veins have a one-way valve to prevent backflow. If a vein has a defective valve, blood flows backwards and pools inside the vein causing pressure within the vein, weakening the walls. An inherited weakness of the vein wall (genetic) and circulation hormones that relax the smooth muscle of the vein wall are the most common causes. Females have high levels of such a hormone, progesterone. Pregnancies, hormone replacement therapy, use of oral contraceptives as well as advancing age and occupations requiring a standing position are additional aggravations of varicose vein disease.

What are the symptoms of Varicose Vein Disease?

Affected areas may have aching, cramping, throbbing, burning, tingling, itching, heaviness, and/or fatigue. Inflamed veins will be tender and sometimes warm to touch. More advanced disease can cause swelling, skin thickening, discoloration and ulcerations around the foot and ankle.

What is a Duplex Ultrasound examination?

Duplex Ultrasound is a pain-free, non invasive test for a phlebologist to see the anatomy and check the flow characteristics of the veins beneath your skin. Useful information is then gathered and used to adequately diagnose your specific vein problem and to plan and guide treatment.

What is laser sealing of veins?

Laser is light energy, which can be used to seal shut abnormal main superficial trunk veins, (GSV/SSV/AASV veins being most commonly diseased). Heat energy is used inside of these veins. When sealing the GSV, (abnormal in 70% of people with varicose veins), usually treatment starts at a location in the vein around the knee. It is then treated from its junction to the deep system at the level of the groin down to the entry site near the knee. Ultrasound guided injections may be used to complete the closure of the GSV below the insertion site if also diseased.

What is sclerotherapy?

Sclerotherapy is the treatment of varicose veins by injection of the veins with chemicals that cause their destruction. Spider veins generally disappear in three to six weeks, while larger varicose veins may take three to four months to respond. Many patients who have this treatment for cosmetic reasons also notice their legs feeling less tired and heavy especially at the end of the day.

Is sclerotherapy safe?

Majority of patients have no complications from sclerotherapy. Some patients can develop changes in skin pigment in veins injected. This is usually a temporary side effect with 90% of this “staining” disappearing after 1 year and 98% after 2 years. Less commonly, patients can develop new, superficial tiny blood vessels in previous areas injected. This “matting” usually dissipates over time if all sources of reflux have been eliminated surrounding the involved area. Serious complications such as skin ulcerations, anaphylaxis (allergy) to sclerosant, deep vein clots, and unintentional arterial injections are extremely rare.

This procedure requires a high degree of technical skill and special training to get the best results with fewest amount of complications.

How are tiny spider veins treated?

There are now machines that use a hair thin, insulated probe to thermocoagulate and instantly eliminate vessels on any skin type and on any part of body. One of these machines is called the “Vein Gogh”, requiring no anesthesia. Frequently this is used in combination with sclerotherapy and/or lasers, to eliminate facial/chest spider veins.

What is visual sclerotherapy vs. ultrasound guided sclerotherapy?

Visual sclerotherapy refers to injection of surface veins that are visible to the naked eye. Some veins that need to be treated are below the surface of the skin and cannot be injected safely without assistance from an ultrasound image of the vein.

How will the blood in my veins get back to my heart after all of the abnormal veins are removed or destroyed?

The backward flow of blood in varicose veins and main superficial trunk veins, (greater saphenous vein- GSV, small saphenous vein- SSV, anterior accessory saphenous vein-AASV), actually interferes with the normal venous return of blood. Removal of these areas of abnormal circulation actually improves circulation of blood in the treated leg. It is this improvement in limb circulation that causes improvement of symptoms of tiredness and heaviness in the limb.

Why can’t I just have the branches injected or removed if the main superficial trunk is abnormal?

For the treatment of visible veins to last awhile, the source that may not be visible to the naked eye must be controlled as well. Some insurance carriers will not pay for treatment of branch varicosities if an abnormal main trunk is not treated at the same time or before the branches are treated.

Why wear compression stockings?

Gradient compression stockings are used to prevent Deep Vein Thrombosis, (DVT), during long plane flights and car/bus rides. This is especially important for people with varicose vein disease because they may have an increase risk for getting a DVT. They can also temporarily reverse the effects of vein disease by lessening the discomfort, heaviness, swelling, and skin changes. They do this by improving blood flow back to the heart especially during leg muscle contractions. Many insurance companies require a trial of compression stockings before approving other more definitive therapies. Compression stockings are also used to prevent and treat ulcerations caused from chronic venous insufficiency and in some patients with a DVT to hasten its resolution and prevent complications.

What is a venous skin ulcer?

An ulcer caused by venous reflux is called a “venous stasis ulcer”. Early signs that a venous stasis ulcer may develop include a darkening of the skin in the area of the ankle. Gradually the skin may become leathery or waxy in appearance. Without treatment of the venous disease, the skin may breakdown and bleeding may occur.

Is there anything one can do to prevent spider/varicose veins?

Getting plenty of exercise is the best way to ward off spider or varicose veins. Exercise helps keep your weight under control and your leg muscles toned, so your blood flows freely. Avoid sitting and standing still for long periods of time. If your job prevents frequent walking, stretch your leg muscles often to increase circulation.

Can I be cured of my varicose veins?

Varicose veins are a problem that can be successfully treated but the disorder cannot be permanently cured. The treatment of abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need “maintenance” treatments after their initial treatment is completed.