KEY QUESTIONS TO ASK
Q: How do healthy veins work?A: Veins are responsible for returning blood to the heart. It can be helpful to compare veins and arteries to understand how veins work. Consider the following chart:
| Arteries | Veins |
| Carry blood rich in oxygen. | Carry blood low in oxygen. |
| Carry blood away from the heart to the hands and feet. | Carry blood back to the heart from the hands and feet. |
| Have thicker elastic walls that are designed to handle higher pressures. | Have thin walls that do not handle high pressure. |
| The heart pumps to move blood through them. | Blood is moved through veins by action of muscle contraction. |
| Arteries do not have valves. | Veins have one-way valves. |
Q: Are all leg veins the same?
A: No. There are three major systems of veins in the leg:
1. The superficial system: Just like the name implies, veins of this system are fairly close to the surface of the skin. Blood in these veins should flow into the veins of the deep system. An example of a superficial system veins are the long saphenous vein and the short saphenous vein.
2. The deep system: Veins in this system are again, as the name implies, deep beneath the skin. These are usually quite large compared to superficial veins and are the veins involved with the condition called deep vein thrombosis. The deep vein system contains much higher pressures than the superficial veins. An important example of a deep system vein is the femoral vein.
3. The perforator veins: Perforator veins connect the deep and the superficial systems of veins at four or five places down the leg. In addition to connections between the deep and superficial systems that the perforators provide, the saphenofemoral junction provides a direct connection between the two systems.
Q: If blood in veins is traveling back toward the heart, does that mean that blood is traveling against gravity?
A: Yes. Blood does travel against gravity but there are also one-way valves that are supposed to prevent blood from traveling with gravity.
Q: If that is the way veins are supposed to work, what can go wrong?
A: Valves are the most common source of vein problems. As previously noted, vein valves are supposed to permit only one-way flow of blood, but sometimes valves don’t work properly and permit blood to flow backwards (the wrong way) and allows blood to “stand” in veins instead of returning to the heart as it should. Fluid and other components of blood are allowed to leak out into the surrounding tissue potentially causing spider veins and varicose veins.
Q: What causes vein valves to malfunction?
A: There are many possibilities. The most common factor is a family history of vein problems or being born with weak vein valves. Other causes include pregnancy, hormonal changes, obesity, medical history and minor trauma. Age is also a contributing factor with 1 out of 2 people age 50 and older being affected. About 50% to 55% of American women and 40% to 45% of American men suffer from some form of vein problem.
Q: Can vein valves be fixed or even mend themselves?
A: No. Unfortunately, once a vein valve malfunctions it cannot repair itself and there is no other way to repair the very delicate flaps of tissue.
Q: How would I know if my vein valves aren’t working properly?
A: The possible problems range from spider veins to varicose veins and you could also have many physical symptoms such as leg swelling, fatigue, throbbing, pain, burning, itching, heaviness, aching and restlessness that seem most pronounced after standing on your feet for a long time. Discoloration in the ankle area and even leg ulcers in cases of chronic venous insufficiency also may be present.
Q: I began experiencing vein problems with my pregnancy. Will the problems go away once I deliver the baby?
A: Many women first experience vein problems with pregnancy. Use of compression stockings is generally advised but check first with your obstetrician. Pregnancy causes increases in hormone levels and blood volume; also the increasing fetus puts pressure on the largest vein of the body, the vena cava. Pressure on the vena cava, in turn, causes increased pressure on the veins of the legs. Normally, within 3 months after delivery, improvement in varicose veins can be seen; however, once venous valves are damaged, they do not repair themselves and varicosities can worsen with subsequent pregnancies or even just with the passage of time. This is especially true if damage has occurred at the saphenofemoral junction or in perforating veins.
Q: I’m not pregnant now, but I plan to have more children. Should I wait to have my varicose veins treated until no more pregnancies are planned?
A: There’s no need to wait. While we do not advise treatment during pregnancy, treatment between pregnancies is desirable, and makes subsequent pregnancies much more comfortable for those who suffer from various forms of venous disease.
Q: Does the cause of my vein problems matter?
A: Yes. It is very important to determine exactly what is causing your vein problems. Without a thorough analysis, you could end up with expensive or ineffective treatments that inadequately address your problem. At Atlanta Vein Specialists we realize the importance of a thorough diagnosis. That is why your initial visit will include a medical history and ultrasound examination that shows exactly what type of problem may exist and where. Dr. Mahadevan, personally, will interpret the ultrasound and assess any underlying problem and recommended a treatment method along with a comprehensive explanation of the treatment.
Q: What are varicose veins?
A: When the valves in veins malfunction, gravity keeps blood from flowing back to the heart efficiently. When this occurs, there is a back up, or congestion, of blood. Pressure builds up and the diseased veins become enlarged, eventually bulging to the surface. This problem is venous insufficiency and can affect veins of any size. When larger veins fail they are referred to as varicose veins. When smaller veins are affected, they are referred to as spider veins. Most commonly, varicose and spider veins occur in the legs because of the force of gravity, the pressure of body weight, and the task of carrying blood from the bottom of the body back to the heart.
Q: What are the symptoms of varicose veins?
A: Symptoms can vary but the most common physical signs of varicose veins are unsightly bulging or ropey-looking veins. Other common symptoms include: pain, easily tired legs, heaviness, swelling, restlessness, numbness, and itching or irritation. Severe varicose veins can compromise the nutrition of the skin and lead to dermatitis or rash, discoloration, or even ulceration of the lower leg. In some cases, bleeding from the swollen vein may occur. At worst, venous disease can lead to blood clots.
Q: Can varicose veins get worse over time?
A: Yes. A condition called chronic venous insufficiency can develop. Discoloration of the skin in the ankle area and painful venous ulcers can develop that are usually very difficult to cure and may reappear even when they do heal. Another possible risk is superficial thrombosis, a condition in which a vein close to the surface of the skin becomes inflamed and develops a clot.
Q: What is chronic venous insufficiency?
A: Chronic venous insufficiency refers to a condition in which there is ongoing venous valve malfunction resulting in venous reflux. Symptoms can include edema (swelling), skin discoloration that occurs specifically in the ankle area, and possible venous ulcer formation.
Q: I have very small, colored veins that are jagged and look like small tiny branches of a tree or spider webs. What condition is this?
A: The veins you are describing are commonly referred to as spider veins. Spider veins are similar to varicose veins but they are smaller. They are red or blue in color and are closer to the surface of the skin than varicose veins. They can cover either a very small or very large area of skin. Like the larger varicose vein counterparts, spider veins are a result of increased pressure and vein valve malfunction, only on a smaller scale. They can occur singly or in great numbers. Spider veins are often considered to be unsightly and can cause leg pain and/or a feeling of heaviness in the legs. There is no correlation between the amount of spider veins and leg discomfort. Someone may have an extensive number of spider veins and experience little to no discomfort; another person may have only a single spider vein, yet feel a fair amount of pain.
Q: If I have only spider veins, do I need an ultrasound examination?
A: Yes. Spider veins can be a symptom of problems with larger veins that cause spider veins to appear. An ultrasound will determine if this is the case. If larger veins are problematic, they should be treated before the smaller veins. By doing so, you will have greater success in the treatment of the smaller veins. In some cases, smaller veins go away by themselves once the larger veins are treated.
Q: What kind of treatment is recommended for small vein problems?
A: Sclerotherapy is a technique that has been practiced for many years. Problems are infrequent and very minor in an overwhelming number of patients. The veins are injected with a chemical solution (called a sclerosant) that irritates the lining of the vein. In response the veins collapse, seal shut, and are reabsorbed into the body.
Q: Does sclerotherapy for spider veins hurt?
A: Minimally. The injections are made using a micro-needle and the sclerosant is well tolerated by the body so there is little discomfort.
Q: What can I expect if I decide on having sclerotherapy?
A: Generally, multiple injections are made during each treatment with minimal discomfort. The number of treatments depends on the individual, but generally 2-4 treatments are needed. Results are visible, usually after 3-6 weeks. Wearing compression stockings for 48 hours following each treatment is recommended for best results.
Q: How successful is sclerotherapy?
A: The actual veins that are treated should never come back; however, the same condition that led to spider veins in the first place is on-going if a larger source of the problem is not detected and treated. Other spider veins may develop so you need to think of sclerotherapy as a maintenance program with treatments needed every few years or less, depending on the individual. Remember, spider veins can be a sign of underlying venous diseases so it’s best to have an ultrasound examination before beginning your sclerotheraphy.
Q: Is sclerotherapy an effective treatment for varicose veins?
A: No. Many people have tried that approach but results shown in medical literature does not support the effectiveness of such treatment. Treating a large vein using sclerotherapy can be problematic because only a few portions of the large vein may close or the vein may not close at all. This makes it much more difficult to thread a catheter into the vein later to complete the job.
Q: Will I need surgery on my varicose veins?
A: An ultrasound examination is essential in determining what treatment method is needed. In some cases, elevating your legs or wearing compression stockings may be all you need to relieve the symptoms of varicose legs. When this isn’t enough, a surgical procedure can relieve the symptoms. Thirty to forty years ago, surgery was synonymous with “vein stripping” involving general anesthesia and hospitalization. The good news is that today, we have a very effective new approach for treatment that takes the place of that type of surgery without all the pain.
Q: What kind of surgical procedure is available today?
A: At Atlanta Vein Specialists we provide a treatment called endovenous ablation. Using a laser called CoolTouch CTEV ™, we are able to perform the treatment in our office. A small single needle incision is made in the leg and a fiber is inserted into the varicose vein. The laser is activated and as the fiber is moved through the vein it gently heats and safely closes the vein. Once the vein is closed the blood that was circulating through it is simply rerouted to other healthy veins. The varicose vein essentially vanishes as it is absorbed by the body.
Q: How much pain is involved with endovenous ablation?
A: At Atlanta Vein Specialists, we use a local anesthetic at the sites being treated. Additionally, we provide conscious sedation or “twilight sleep.” By using both local and monitored anesthesia, you should not experience any pain or discomfort. Additionally, patients experience less anxiety than those who are given a local anesthetic only.
Q: What is the recovery time for endovenous ablation?
A: Because the ablation is minimally invasive, there is no down time. Following the procedure, your leg is wrapped in a bandage for 24-48 hours. Following that, you will need to wear a compression stocking for a few weeks to assure that the vein is “shut down.” (The compression prevents vein reflux which caused the problem in the first place.) You will be able to walk out of the office within 45 minutes after the procedure. Normal activity can be resumed within 24 hours. In most cases, our patients return to work the next day. While daily walking is recommended, strenuous exercise, weight lifting or jogging should be avoided for a couple of weeks.
Q: Isn’t the greater saphenous vein the one used in heart bypass surgery? What if I would need it for that?
A: It is true that many times the greater saphenous vein is used in cardiac surgery; however, if the vein is diseased, as it is in the case with varicose veins and chronic venous insufficiency, it is typically unusable for heart surgery. In addition, there are other possible sources of veins for arteries in the body to use for that purpose.
Q: Doesn’t my body need the veins that are treated with any of the procedures you have described?
A: No. For every visible vein in your leg, there are many more beneath the skin. Remember, even the tiniest spider vein appeared as a result of its not doing its job. In truth, the body does much better without veins that malfunction. Healthy veins help to return venous circulation back to normal.
Q: Is there any restriction in activities following endovenous ablation?
A: There are a few. It’s strongly recommended that you limit activities that require contraction of the abdominal muscles because it causes an increase in venous pressure in your legs. Such activities include jogging, heavy lifting, sit-ups, crunches and excessive stair climbing. Since we want the treated vein to close, we want to subject it to as little pressure as possible until it has a chance to heal. Walking is encouraged. You’ll be back to your more strenuous activities in 10 -14 days.
Q: How long do these procedures usually take?
A: The actual procedure takes about 45 minutes. Sometimes it can take a bit longer depending on whether the path of the vein includes many branches or is excessively twisting.
Q: I have seen advertisements about “permanent painless non-surgical” methods to treat varicose veins. Isn’t that an easier solution?
A: While the claims may sound appealing, you should be aware that non-surgical methods to treat varicose veins have a high reoccurrence rate. That is why it’s wise to treat the problem correctly the first time.
Q: Will my insurance or Medicare pay for endovenous ablation.
A: In almost all cases, yes. It's important to remember that there are no separate hospital charges to pay because these procedures are done in our office. One of our services is to obtain pre-certification from your insurance company
Q: Will my insurance or Medicare pay for sclerotherapy?
A: Unfortunately no. They consider it to be a cosmetic procedure.
