Introduction

Varicose veins are a commonly misunderstood medical condition. On one hand, patients are told that varicosities are a cosmetic problem. On the other hand, because of the explosion in varicose vein treatment and the resultant intense marketing associated with it, many patients are justifiably concerned that by seeking a consultation they may be talked into undergoing an unnecessary procedure. The truth is somewhere in between. Let see if we can help sort things out.

First Some Basics About Varicose Veins

Arteries are responsible for bringing blood into the legs. Cigarette smoking, diabetes and abnormal cholesterol levels are some of the factors that can lead to arterial problems that may have serious consequences.
Veins, on the other hand, are relatively forgiving. Their function is to return blood back to the heart. That is accomplished primarily by contraction of your leg muscles and the paper-thin “check valves” that keep flow going in one direction up the leg.

Varicose veins Complications

It is important to know that there are both deep and superficial veins. Deep venous problems can potentially be serious where most problems involving the superficial veins are not. For that reason, when undergoing a venous consultation it is important that you put yourself in the hands of someone trained and credentialed to evaluate both. More than once I have seen a patient treated for varicose veins who was worse after treatment because the problem was actually an unrecognized clot in the deep veins.

Ok, but what is a varicose vein?

Many patients are unclear on whether they even have varicose veins. Any vein that “bulges” above skin level that can be felt with a fingertip should be considered a varicose vein or “varicosity”. They are definitely not a cosmetic problem. The only question is whether they warrant treatment or not.

If you have varicose veins and are sure they are not causing problems, then there is no need to undergo immediate treatment. The problem is that many patients suffer side effects from varicosities without being aware of them.

Who should seek a consultation for their varicose veins?

Let’s start with pain.
If you experience an abrupt onset of localized (greater than an inch) of severe pain over a previously asymptomatic varicose vein, especially if it is associated with a palpable lump or redness, it may represent superficial clot or superficial thrombophlebitis. You should seek medical attention especially if there is evidence that the pain and redness is spreading. A venous ultrasound is necessary to make sure the clot has not involved the deep veins or has extended into the main superficial vein on the inside of the thigh that has the potential to become a lung clot or pulmonary embolus.

Most symptoms associated with varicose veins are less dramatic, even subtle. Venous disease is a gradual process and understandably the body adapts to those changes over the years. It is not uncommon to hear from a patient who underwent treatment how much better their legs feel. They just didn’t appreciate to what degree their varicose veins had been affecting them.

Symptoms of heaviness, throbbing and aching especially after prolonged standing are classic symptoms of abnormal venous pressure associated with varicose veins. For example, teachers, retail workers, hairdressers and any other occupation that involves standing are the most susceptible to these symptoms. If that is the case with you, it makes sense to learn what your treatment options are rather than continue to live with your discomfort.

Leg swelling (edema)

There are many reasons for your legs to swell, varicose veins among them. Normal legs in the morning that are puffy or swollen at the end of the day are a cause for concern. The problem could be vein related even if you do not have visible varicose veins. The underlying problem could be in either the deep or superficial veins. Again, it is important to make sure the provider or ultrasonographer is properly experienced and credentialed to perform a thorough evaluation. A superficial vein screening for varicose veins just won’t cut it for leg edema!

Skin changes

Over the long term venous disease can start to affect the skin in the lower leg that can make one susceptible to open sores or venous stasis ulcers. No need to panic since the changes are never acute. It is a gradual process due to chronic leaking of blood into the tissues that eventually leads to “fibrosis” or thickening of the tissue in the lower leg. Once that occurs even minor trauma can result in an ulcer that may take months to heal even with the best of care.

What exactly should I be looking for?

Brown discoloration or hyperpigmentation especially above the medial ankle bone represents the breakdown of blood products that have leaked through the vein wall as a result of high venous pressure. It is the beginning of an irreversible process that commonly goes unrecognized even by health care professionals. If there is any question that you are developing such skin changes, check with your primary care provider and request that they recommend a vascular surgeon or vein specialist that can properly evaluate you.

The picture below is typical for hyperpigmentation and the blue line is the underlying abnormal vein that has gone unrecognized.

pigmentation

Skin inflammation or venous eczema
is commonly misdiagnosed if there is no outward evidence of venous disease such as visible varicose veins. The pictures below demonstrate a patient who suffered from recurring episodes of eczema that even resulted in her undergoing an unnecessary biopsy. The blue marks represent the abnormal superficial vein and underlying varicosities that led to the patient’s problem. Treating the vein resulted in immediate clearance of the skin condition that had been recurring for years!!

stasis and blue

Leg Ulcers
Venous stasis ulcers are a major health care problem in this country. They can be caused by an episode of deep vein thrombosis (DVT) or by years of untreated varicose veins. Many of these patients will undergo treatment at even the best of Wound Care Centers without having undergone a comprehensive venous ultrasound. Once an ulcer has been confirmed to be secondary to venous disease, there are several relatively simple treatments that can facilitate healing and reduce the incidence of recurrence.

Bleeding
is not a common complication of varicose veins. Many patients seek treatment because they worry that a particularly large protruding varicose vein might hemorrhage after minor trauma. This is an unlikely event and in itself should not be a reason to seek treatment. Hemorrhage usually arises from the small blue veins around the ankle. When it occurs, it is usually quite dramatic. Believe or not, most episodes occur in the bathroom especially after a hot shower. More than one terrified patient (or family member) has called an ambulance to have the “victim” transported to the hospital. As terrible as it sounds, these episodes are always self-limiting. Elevate your leg and have someone apply digital pressure on the bleeding site and it will usually stop.

If you have experienced such an episode, there is a good chance it will reoccur. A venous ultrasound will determine the source of venous pressure and commonly a simple injection will solve the problem.

Restless legs
There are a myriad of medical conditions that can lead to restless leg syndrome. With all the marketing associated with the treatment of varicose veins one would think that it is the primary source of these symptoms. That is simply not the case. However, if you suffer from RLS and are symptomatic enough to warrant medical attention and are even considering going on medication, you should undergo a venous ultrasound and have both your deep and superficial venous systems evaluated prior to commencing treatment.

To Sum it all up:
Hopefully this has given you some perspective about varicose veins and when to seek treatment.

There are several excellent vascular surgeons and vein specialists in Alaska who are qualified to help you with your problem. Do some research or ask your primary care provider for advice on where to go.

If you have specific questions on venous disease, you can email me at officeadmin@gci.net and I will do my best to answer them.

If you are ready to make an appointment, please call  907 929 2939, speak to Claudia and she can schedule a consultation.

Many thanks!

Dr. Roupenian