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 protected] or (310) 319-4033.