Like the wrinkles that furrow one’s brow, varicose veins, for many, are an inescapable part of aging. Varicose veins are veins that become swollen and large, usually due to defective valves in the vein. The enlarged veins, often with a dark purple or blue coloration, protrude from the surface of the skin and frequently have a worm-like appearance. Although females are more likely to develop varicose veins, both sexes are susceptible to developing symptoms.
“Varicose veins are very common,” says Dr. Cheryl Hoffman, director of interventional radiology at the UCLA-Santa Monica Medical Center. “Greater than 20 percent of women and 7 percent of men suffer from venous disease in the United States.”
While varicose veins don’t signify a life-threatening condition, they can cause discomfort. Common symptoms of varicose veins include aching pain, swelling and itching in the legs. In the past, the removal of varicose veins required invasive surgery. New minimally invasive procedures, however, have provided a breakthrough in how venous diseases are treated.
Smart Business spoke with Hoffman about when a doctor should be consulted about varicose veins, how varicose veins are treated and what types of minimally invasive therapies are now available.
What causes varicose veins?
There is usually an incompetency to the valves of the veins that causes reflux. Gravitational forces then overcome the veins and blood pools, causing a distension to the vein. This can lead to a dilation of the vein, worsening valve function and retrograde, or reversal of flow, within that vein all of which can lead to venous stasis, varicose veins and ulceration.
How can people reduce their chances of getting varicose veins?
Usually it is genetic. However, wearing compression stockings, especially when engaging in standing activities, can help to decrease the effects of gravitational forces on superficial venous valves. Typically, though, it is something that just develops over time. In addition to advanced age, other factors that increase a person’s chance of developing varicose veins include having family members with vein problems, obesity, pregnancy and hormonal changes, which can be spurred by taking birth control or other medicines containing estrogen.
Can varicose veins lead to serious medical problems?
There is no life-threatening danger; unlike the deep veins, which can have blood clots that eventually go to the lungs. But there is severe pain and disability that can result from varicose venous disease, what we call superficial venous abnormality. Patients can have serious disability from superficial valvular incompetence and varicose veins.
When should a doctor be consulted about varicose veins?
When a patient has phlebitis, an inflammation of one of the superficial veins, typically he or she goes to a physician because there is pain associated with this condition.
Also, when edema, skin changes and ulceration occur, patients are directed toward medical care. However, prior to that point, before these changes become severe, it is a good idea to seek medical attention because now we have minimally invasive therapies that can prevent the serious complications of varicose veins. Therefore, I would advocate for a patient to seek evaluation once a dominant varicose vein is identified.
How are varicose veins treated?
Currently, our technologies allow us to close these veins using very small stab-like entry points. No longer are large incisions needed. Therefore, the cosmetic results are outstanding.
Endovenous laser therapy and radio frequency ablation therapy are two forms of therapy that are used to close varicose veins. Basically, when we go up through the veins we can use either a laser or a radio frequency probe to close the veins. Old fashioned surgery with large incisions is no longer needed to successfully treat chronic venous superficial vein disease. Minimally invasive therapies can now be used through very small 2- to 3-millimeter incisions.
Can varicose veins return even after treatment?
Yes, because it is a long-term chronic disease. Veins that are not a problem when the first veins are treated can become a problem over time. However, by getting therapy to some of the large dominant outflow veins, the chances of having further problems to other veins, which are currently not a problem, are minimized.
DR. CHERYL HOFFMAN is director of interventional radiology at the UCLA-Santa Monica Medical Center. Reach her at email@example.com or (310) 319-4033.