HOUSTON, Texas (Ivanhoe Newswire) - For many, they're a cosmetic concern. For others, they can lead to dangerous health issue like circulatory problems blood clots, and ulcers. Caused by faulty valves that can lead to blood pooling in the legs, varicose veins affect up to 25 percent of women and up to 10 percent of men. A newer procedure is getting rid of the veins with a lot less pain.
Varicose veins, they can be ugly, painful, or both.
"It does run in my family," varicose vein patient, Linda Grim, told Ivanhoe.
For twelve years, Linda Grim had persistent swelling and was on her way to inheriting the unwanted heirlooms.
"At one point my right foot had at least a full shoe size different than my left foot," Grim explained.
Methodist Hospital's Dr. Eric Peden said this minimally invasive ablation procedure is becoming the new standard for many doctors.
"For me this is my preferred treatment," vascular surgeon, Eric Peden, MD, told Ivanhoe.
It's the VenaCure 1470. Linda's having it done right now.
"That white we see is basically treating the vein and burning the vein wall," Dr. Peden said.
It causes varicose veins to collapse on themselves and vanish.
Dr. Peden said there are similar catheter procedures, but with vena-cure, "the tip is covered so it doesn't stick to the vein wall. It should lead to less damage to the surrounding tissues, which means less discomfort for her afterwards and less bruising."
Linda hopes the 25 minute treatment cures her constant swelling. In the meantime, she's walking out of the doctor's office pain free and varicose vein free.
"I don't really feel any pain right now," Grim concluded.
Dr. Peden said just about everyone with varicose veins can be treated with it. He said the procedure is covered by insurance if a patient is symptomatic and hasn't responded to other conservative treatments."
RESEARCH SUMMARY
BACKGROUND: Varicose veins are enlarged, gnarled veins. It can happen to any vein, but it is most common in the feet and legs because standing and walking increases the pressure in the veins of the lower body. Some people are only concerned about the cosmetic aspect of varicose veins, but others can have discomfort and aching pain. They can lead to more serious problems, for example, varicose veins can signal a higher risk of circulatory problems. (Source:www.mayoclinic.com)
SYMPTOMS: Usually varicose veins do not cause pain. Signs of varicose veins can include veins that are blue or dark purple in color, and veins that seem to be twisted and bulging. Painful symptoms can occur in some individuals. They include: achy or heavy feeling in the legs; burning, throbbing, muscle cramping and swelling in the lower legs; itching around one or more of the veins; worsened pain after standing or sitting for a long time; and skin ulcers near the ankle, that can mean you have a serious form of vascular disease that requires medical attention. (Source: www.mayoclinic.com) Exercise, elevating the legs, or wearing compression stockings are some ways to help relieve pain. Causes of varicose veins can include age, sex, family history, obesity, and standing for long periods of time. As a person ages, the veins can lose elasticity that will cause them to stretch. The valves in the veins will become weak and will allow blood to move backward instead of toward the heart. The blood will pool in the veins and the veins will become larger and varicose. Women are more likely to develop the condition. Hormonal changes during pregnancy, pre-menstruation, or menopause can be factors. If other family members have varicose veins, then there will be a greater chance of inheriting them. Also, being overweight puts added pressure on the veins, resulting in them becoming varicose. (Source: www.mayoclinic.com)
NEW TECHNOLOGY: If a patient does not respond to self-care, then the doctor may suggest other treatments including: Sclerotherapy, laser surgeries, catheter-assisted procedures, vein stripping, ambulatory phlebectomy, or endoscopic vein surgery. In Sclerotherapy, the doctor injects the veins with a solution that scars the veins. Laser surgeries will close off smaller varicose veins. In catheter-assisted procedures the doctor will insert a catheter into the vein and heat the tip. The heat will destroy the vein by causing it to collapse and seal shut. Vein stripping involves removing a long vein through small incisions. Ambulatory phlebectomy is when the doctor removes smaller veins through tiny skin punctures. Endoscopic vein surgery is only needed in advanced cases involving leg ulcers. The doctor will use a thin camera inserted in the leg to visualize and close the veins, then he will remove the veins through small incisions. (Source: www.mayoclinic.com) The newest technology available to treat varicose veins is the FDA approved VenaCure 1470nm laser. It is a water specific laser. It targets water as the chromosphere to absorb the laser energy. The vein structure is mostly water, therefore, it is theorized that the 1470nm laser is able to heat the vein effectively with little chance of collateral heating. (Source: www.venacure-evlt.com) The laser is delivered through the NeverTouch gold-tip fiber, which maximizes efficiency and minimizes post-operative pain and bruising. It is designed to eliminate the risk of direct contact between the laser fiber and vein wall. (Source:www.investors.angiodynamics.com)
INTERVIEW
Eric Peden, MD, Vascular Surgeon at Methodist Cardiovascular Surgery Associates, talks about a new way to treat varicose veins.
Could you start by telling us what varicose veins are?
Dr. Peden: Varicose veins are dilated veins in the skin that tend to bulge and can cause problems. They are usually caused by veins having bad valves inside of them that leak backwards and fill up. They are unsightly and can cause pain and discomfort towards the end of the day.
Are they just cosmetic or are there health implications that go along with them?
Dr. Peden: Varicose veins come with sort of a wide spectrum of problems. Some patients who have them have no problems at all from them. Some people have little unsightly spider veins. Some people have big bulgy veins that are bad and some people get all the way to the point where they are incapacitated from the bad venous disease. So, it is hard to say in particular, how they are. It really depends on the person.
What are some of the things you can run into?
Dr. Peden: If people have problems with varicose veins, they describe their legs as achy and full, tired at the end of the day; really a sense of almost bursting if they are trying to walk too much or standing for a long time. They can also affect you while you are sitting.
Does it have cardiovascular implications as well?
Dr. Peden: Some people think of varicose veins as being really dangerous for their health, but they do not lead to blood clots, to patients having problems where they lose circulation of the leg, or heaven forbid to an amputation. It does not lead to that level. There can be though progression of problems with veins to the point where people get ulcers that can't heal and have continued troubles.
Talk about the diagram a little bit. What are we looking at here?
Dr. Peden: When people have problems with their veins, it is important that we break that down to the part of the vein they have troubles with. This poster shows that the dark blue or the deep veins, those are the important veins we think about, are returning the blood to the heart and if people get a blood clot, that is where it typically happens. The gray veins are the superficial veins, or the saphenous veins, are really important for draining the skin and tissue under the skin down to the deep system and return it to the heart.
The varicose veins have happened where on that?
Dr. Peden: The common problem that people have is that there are valves inside these veins. We are really dependent on movement. As we are walking, the muscles are pumping against the skin to drive the blood up through the veins. Inside are little valves that open and close to keep the blood moving in the right direction. When that happens, the circulation is normal. So, if the veins are blocked then the blood can't return. Fortunately, that is pretty uncommon. Mostly people have problems with the valves inside the veins. When they are walking the blood tends to pool because as it is driven up it falls right back down, then these little branches that are supposed to drain back up instead and those become varicose veins.
We talked a little bit about the traditional procedure. What was the standard of care?
Dr. Peden: So probably a generation ago, most people who would have had treatment for their varicose veins, would have had vein stripping. In that procedure, there basically was an incision made up at the groin and an incision made down at the ankle and then the whole vein was removed from the body. That was the stripping part. It is a gruesome operation because of the bruising and trauma to the tissue. Then for the big varicose veins, people would come by and make about an inch long incision over all those veins and then pull the veins out. It is a very effective procedure, but it just takes a while to get over.
How long of a hospital stay are we talking for that?
Dr. Peden: People would commonly be in the hospital for a couple of days. As that progressed, it became an outpatient procedure, but one with significant need for pain medication once you got home.
You hear about varicose veins and how it is a concern for women, but that is not always the case. Can you talk about the differences between men and women when it comes to varicose veins?
Dr. Peden: Varicose veins are extremely prevalent particularly in the Western hemisphere. We know that in terms of looking for veins, you can see visible veins in people that are abnormal in about 25% of women and probably about 10% to 15% of men. There is a lot of it out there and if you look with an ultrasound, you find even more venous disease. So, it's not just disease for women, but clearly more prevalent in women.
And are there things that people can do? Are there lifestyle decisions or choices that people make that can lead to having varicose veins or other ones that can lead to not having them?
Dr. Peden: In terms of why people get varicose veins, we think the main cause is genetics. So if your mother had them, then she is kind of passing those on. It comes from the mother to the daughter. Then the daughter has them and passes it on to her next generation of children. It tends to happen in men too but not as prevalent. It definitely seems to be more in women and it really comes down to lifestyle stuff. The people that have problems where they have to stand for long periods of time or sit for long periods of time tend to have less activity, less of the blood pumping back up and tend to be more likely to get problems with varicose veins and symptoms from them.
Smoking or drinking, is any of that kind of stuff contribute to it at all?
Dr. Peden: Activity is really good for maintaining venous health, but it turns out that obesity, smoking, drinking are not directly related to varicose veins.
If you get varicose veins, are there things you can do at home to help them at all, either with the pain, the discomfort, or the appearance?
Dr. Peden: Once you develop varicose veins, you've got them. Unfortunately, there are no topical salves, ointments, or pills that you can take to take those away. The common thing that people will do is use compression stockings to try and squeeze the veins to keep them from filling up the blood. When they fill up with blood that is when they tend to be more symptomatic. Other than maintaining an active lifestyle, there is really not a lot you can do at home to make those better.
What are some of the other myths that you hear from patients who are interested in getting their varicose veins taken care of?
Dr. Peden: I think a lot of people are hesitant to get varicose veins treated because they worry that it is mostly a cosmetic procedure and that they are not going to be able to get that reimbursed by insurance. So many people come in and are surprised that they can actually get reimbursed by their insurance. For the majority of people who have symptoms from the varicose veins and findings from an ultrasound that we can say are medically problematic, will be reimbursed by insurance.
FOR MORE INFORMATION, PLEASE CONTACT:
Eric Peden, MD
Vascular Surgeon
Methodist Cardiovascular Surgery Associates
(713) 441-5200
Ekpeden@tmhs.org
