Vein Disease FAQs St Louis Varicose Veins treatments

No, this test is not painful, it is just an ultrasound. Gel is rubbed on the leg and the ultrasound wand is then run up and down the leg. It is noninvasive and you are comfortable while the test is performed.

What can I do to reduce varicose veins in my wife’s legs? Would elevating her legs while lying in bed and massaging her legs from ankles to thighs help at all?

Elevation and massage should help with the symptoms, but will not alter the course of her varicose veins. If she is experiencing symptoms, she would do well to visit a vein specialist for a comprehensive evaluation. While symptoms of vein disease can be attended to with massage and other measures like compression stockings and over the counter medications, there are underlying causes that aren’t addressed by those.

Can spider veins cause the feeling of leg heaviness? What options are available for the treatment of spider veins?

Yes, spider veins can cause symptoms including swelling and a feeling of heaviness in the legs. Despite their small size, a large number of spider veins can contribute to Venous Insufficiency. In my opinion, sclerotherapy is clearly the treatment of choice for spider veins of the legs.

I have a lot of spider veins on my legs, but no pain and no visible varicose veins. However, if I get bruised it takes months to heal and my feet are always cold, even in the summer. Should I get a reflux exam to find out what’s going on?

For most patients, the spider veins are the tip of an iceberg. They also have venous insufficiency/reflux, therefore it is always important to perform a Doppler study and look for reflux. There is a small percentage of patients that have just a few spider veins and minimal or no reflux.

We do recommend to patients to try and minimize the amount or duration of wearing high heels whenever possible. Although high heels do not specifically lead to spider veins at the ankles, their chronic use can lead to overall vein problems. The reason is that high heels minimize the full range of motion of the foot and ankle when walking, and therefore decrease the amount of blood flow by what is called the “muscle pump” of the calf. This can lead to an increase in venous pooling in the limbs, and eventually to vein problems.

I can see that I have varicose veins. Are all varicose vein sufferers diagnosed with venous insufficiency? How are these two conditions related?

Venous insufficiency is the cause of varicose veins. A venous reflux exam also known as vein ultrasound determines which veins are insufficient. Essentially every patient that has varicose veins has reflux. The exam is not just important to determine if the patient has reflux, it is important to determine the patient’s vein anatomy in order to plan the appropriate treatment strategy. The ultrasound machine is just like the ones OB/GYN use on pregnant patients, but it is done while the patient is standing. The ultrasound has doppler function that can tell if blood is flowing backward or refluxing which determines whether the vein needs to be treated.

Duplex venous ultrasound is the current reflux exam of choice. While there are a variety of other reflux exams, they are either of historical interest or for research purposes but do not add anything clinically. Of note, a reflux study must be performed while standing. Some offices charge an extra fee for a “vein mapping” however that can usually be done during the initial duplex venous exam.

With rare exception, the answer is “NO.” In the past, our misunderstanding regarding the cause of varicose veins emphasized mechanical causes, such as the weight of a baby during pregnancy and tight fitting clothes. We now understand that the causes are most strongly genetic (hereditary) and the female hormones which allow increased flexibility of vein size. Unfortunately, the particular past neglect of venous attention created a sort of void which became available for many myths to form. Currently, our goal is not only better treatment, but also education to correct the many myths that remain popular.

Spider veins are like varicose veins but smaller. Spider veins begin as tiny capillaries and appear as blue or red squiggles. They are small red, blue, or purple veins that commonly appear on the surface of the thighs, calves and ankles. ⅓ of the adult female population is troubled with this common problem. They are associated with “feeder” veins and can also be associated with the larger underlying varicose veins. The medical term for spider veins is telangiectasia.

Spider veins usually take on one of three forms. The appearance of spider veins includes: a spider shape with a group of veins radiating outward from a central point, tree branch pattern, and thin separate lines which are sometimes called thread veins.

Varicose veins are the blue or purplish enlarged veins you typically see bulging out of one’s leg. Varicose veins are a very common condition in the United States and affect approximately 15 % of men and 40 % of women. Varicose veins occur in the legs and lower extremities because standing and walking increases the pressure in the veins in the lower half of your body. Genetics play a large role in varicose veins, and they can occur in people in their 20s.

Today both medical necessity and health insurance are major factors in determining the course of treatment for a condition. Treatments exclusively for improving the patient’s appearance are considered cosmetic and will not be covered by insurance. If, however, there are symptoms like pain, swelling, and fatigue and a physician can determine that treatment is required to restore or preserve the patient’s health and well-being the treatment will be considered a medical necessity. Under those circumstances, most health insurance and Medicare plans will cover the procedures and treatments.

I have spider veins on multiple areas of my body, and I’d really like to have more than just the ones on the legs treated. Can spider veins on the face/neck area, hands, and arms be treated, and what procedure do you recommend?

Spider veins of the face are usually treated with laser light therapy but some of the bluish veins around temples are often treated better with sclerotherapy. Spider veins of the hands and legs tend to do better with sclerotherapy but some tiny reddish vessels are well treated by a cutaneous laser or light treatment.

Are endovenous laser ablation and radiofrequency ablation suitable for varicose veins in the upper part of the thigh? I consulted my surgeon for alternative techniques, he said sclerotherapy would not work. Would these other methods be suitable?

Endovenous ablation is appropriate if there are leaking valves in saphenous system. If, however, your Saphenous system is normal, then sclerotherapy may be more appropriate. Sclerotherapy is for smaller veins. Foam sclerotherapy is also very effective in the treatment for larger varicosities.

Is there a difference between PAD and varicose veins, and are there tests to confirm? Also can you have Venous closure surgery if you have PAD?

Peripheral arterial disease (PAD) usually refers to atherosclerosis in the walls of arteries, causing blockage which can manifest as pain in walking, fatigue in the calves with walking, poorly healing wounds, leg ulcers, or severe pain in the feet. Varicose veins and venous insufficiency are very different problems. A skilled physician usually can differentiate venous disease from arterial disease very quickly with a patient history and clinical exam.

Some patients will have both arterial and venous disorders and some arterial testing may be in order. Sometimes the arterial testing is measurement of blood pressures or flow at different levels in the legs. At other times, arterial ultrasound studies may be of value. VNUS Closure procedures and LASER procedures can be done on patients with arterial occlusive disease as long as the blood flow is adequate for healing, but should be performed only after a careful evaluation of the patient for adequacy of arterial blood flow to the tissues.

It’s been a year since my surgery and I still have bruising. Does that mean it is permanent?

Probably not. Most likely what you are seeing is not really bruising, but what we refer to as staining. This is a light brownish discoloration, which looks like a light bruise. This is caused from trapped blood in the areas of the treated veins. Typically, the body slowly reabsorbs this over time, and while the process is generally over a period of many months, it is not unusual for it to last longer. Although it may be difficult, the best thing to do is to be patient. You need to have a 1 year follow-up with your vein doctor to ensure there is no residual problem which may be slowing the re-absorption process, and which may be easily treated.

While there is no specific answer to this important question, the following guidelines should help: First, the question comes up because air travel is a known risk factor for the development of vein thrombosis and phlebitis. The concept is to minimize multiple risks for these complications. The risk of phlebitis is rather low after a vein operation, however the nature and extent of the procedure is the most important aspect to consider. Other pre-existing risks need also be taken into account.

These include a previous history of phlebitis, a known hematologic hypercoagulable state, the general activity of the individual, and several co-morbid conditions. While data suggests that the risk of flying increases over 2 1/2 hours, a planned shorter flight may be extended due to airline schedules, etc.. I feel it is safe for a limited phlebectomy to fly after 2-3 days, where an extensive large vein sclerotherapy or endovenous vein ablation in my practice would lean towards 7-14 days.

I had vulvar/labia veins during my 3rd pregnancy had to spend a lot of time in bed, pain/heaviness etc. that continued 3 yrs postpartum so I had vein surgery 9 months ago the vein doctor said I had pcs and removed some huge veins, now 6 months pregnant & veins are back, help!

Wear a pelvic support garment. Your OB/GYN should give you a prescription and a medical equipment supplier would measure and fit you. I have also heard that the Spanx(r) garments and compression with elastic biker shorts with a pad against the vulva will help some.

I am only 21 years old but I have painful veins on my left leg. I have had them since I was very young, and they only become worse. They are only on one leg. What is the best option to treat the appearance? Thank you.

You need to see a qualified Phlebologist for a clinical evaluation. Some patients need treatment for varicose vein problems in their teenage years. A few patients have abnormally formed veins at birth which become more evident with time. It is important to have a thorough clinical and ultrasound exam in order for anyone to give you further advice.

Is bruising normal after vein stripping? The bruise is nowhere near the incision sites, so I was wondering if that is normal or not? The bruise is on my inner thigh, the incisions are below the knee and one in my groin.

Some bruising is expected after a vein stripping procedure. Additionally, bruising is gravitational, and can spread to areas outside of the surgery to a different part of the body, e.g. lower down a led or even to a flank secondary to sleeping on one’s side. Unless there is an underlying condition, post-operative bruising is self-limited and usually resolves within a couple of weeks.

Will this side effect of having varicose veins be effectively treated with varicose vein surgery?

The increased venous pressure from leaking valves in the veins can certainly lead to pain and achiness and heaviness in the legs. This is typically worse toward the end of the day and improved with rest and elevation and usually by the morning. Patients may also complain of restless legs syndrome and other unusual symptoms.

I had a phlebectomy that was not successful, then laser ablation and sclerotherapy within 2 months of each other. I now have shooting pain in my leg… is this something that is normal?

Yes, Endovenous Laser can be used to treat refluxing perforator veins. Insurance companies often times will not cover this treatment as they consider it experimental. However, in some cases doing an appeal with your insurance company can result in coverage.

I’m scheduled for weight-loss surgery, and I have large varicose veins on both legs. Will losing the weight change the pressure in my legs enough to make the varicose veins go away, or will I need surgery or other treatments?

Congratulations on moving forward to become healthier! As you lose weight, your legs will feel better. However, if you have abnormal function of the valves of the veins, it will not be reversed. In that case, you may be a good candidate for minimally invasive procedures to treating the cause of varicose veins such as an EVLT or endovenous laser ablation.

I have some friends who’ve had varicose and spider veins treated, some with surgery and some with injections. Some people said that insurance covered it but others said that it didn’t. What determines insurance coverage for vein treatments?

Varicose veins are part of a medical condition known as venous insufficiency and when symptomatic are usually covered by insurance. Some people may not even be aware that some very common symptoms such as leg fatigue, tingling or restlessness, and/or swelling in the legs can be caused by venous insufficiency. The only way to know if you have venous insufficiency is to have an Ultrasound evaluation. Spider veins without any symptoms are considered cosmetic and are typically not covered by insurance.

It is safe in the proper hands. However, with newer technologies the risks and side downtime associated with even this safe surgery are not zero. With the advent of endovenous procedures such as laser and radiofrequency ablation there is no need for ligation and stripping. The newer procedures are safer without the downtime.

These may be what are commonly referred to as reticular veins. While they may be normal in patients with thin skin, they may also be due to increased venous back pressure causing them to become more prominent. The best thing to do is to see a Phlebologist a vein specialist who specializes in the diagnosis and treatment of vein disease.

I have 7 cuts in my leg between knee and ankle from vein stripping and 3 above…I have just awful tingling and numbness esp. at inner ankle, but all cuts and areas are sensitive 6 months after surgery. What do I do?

With routine daily use of support hose and time, patients who have tingling with the numbness usually will find the symptoms resolve. Some patients who undergo vein procedures, especially vein stripping, may experience some residual numbness that does not resolve. If it is very bothersome you can talk to your doctor about possibly taking Neurontin or other medication for nerve pain.

Spider veins do not lead to skin cancer. Spider veins are one sign of venous insufficiency. Venous insufficiency can lead to leg ulcers, however spider veins themselves do not turn into leg ulcers.

What is the reasoning behind waiting to resume more vigorous physical activity after varicose vein surgery? Does it have to do with the pounding impact of the leg to the ground, or does it have to do with your blood flow or the increase of the heart rate?

There is a small risk of getting a burn, however using tumescent anesthesia this risk is reduced greatly. Tumescent anesthesia is essentially a mixture of salt water and numbing medicine that surrounds the entire length of the vein. The mixture will absorb the stray heat of the laser and protect the surrounding soft tissues. There are two reasons for waiting for one week before resuming certain vigorous activities. The first is activities that require heavy lifting such as weight lifting should be avoided because when one strains to lift it will increase intra-abdominal pressure. The increase pressure puts pressure on the veins in the leg to open. The second is that is certain activities such that could be potential traumatic can lead to bruising and increase inflammation which will delay healing

After traditional ligation-stripping surgery (which is becoming outdated fast) patients need to wait about 2-3 weeks before resuming exercise. However after newer surgical treatments endovenous vein ablations with EVLT (EVLA/ELVeS) people can resume brisk walking and moderate bike riding can be done in a couple of days. However, I recommend that patients refrain from certain vigorous exercise for one week after the procedure, i.e. weight lifting or anything that increases intra-abdominal pressure and sport or activity that cause contact.

I think I have a varicocele. It’s not very painful, but occasionally feels uncomfortable and it’s ugly, so I’d like to have it removed. What are the recommended treatment options? Isn’t it just a varicose vein? Thanks.

Although phlebologists are well-trained in treating all types of veins, when it comes to a varicocele, it is best left in the hands of a urologist, who specializes in male infertility. Some of my patients found temporary relief by icing the area and wearing tight bicycle neoprene shorts. This however, is just a temporary treatment and surgery may be indicated especially if it is painful or there is concern about future fertility.

What is the difference between ambulatory phlebectomy and transilluminated powered phlebectomy? What would each be used for?

Ambulatory phlebectomy is less invasive that a transilluminated phlebectomy. The latter uses a light source to visualize the location of the veins. The former is usually done as an adjunct to an ablation.

From what I see online it seems that minimally-invasive options like endovenous ablation are always being recommended for varicose veins, and I can see why, but is there ever a time where surgery is preferred? Are there benefits to surgery?

From my perspective the times for when surgery (and I guess by surgery you mean ligation with or without stripping) is very limited. Possibly with an episode of acute superficial phlebitis involving the GSV near the junction would be one time when it might be considered. I cannot think of any major benefits or surgery over the minimally invasive procedures. Recurrences, complications, and patient acceptance are all better with the new less invasive surgeries.

Weight loss can decrease the venous pressure in the veins of your legs. It can result in some varicose vein symptoms improving because of lower venous pressures within the veins but it cannot cause them to disappear. While lower extremity varicose veins may not resolve, the lower pressure may result in less pain, tenderness, swelling, and slower progression of disease.

What exactly causes varicose and spider veins to develop, and can venous reflux exams tell me if I am going to have them now or later in life?

This is an excellent question! Patients with venous reflux are highly likely to develop varicose veins in the future. Chronic venous insufficiency is a progressive disease process. The changes in the wall of the vein can lead to failure of the valves of the vein. Over time the veins in the lower leg are exposed to increased pressure due to the valves not working and varicose and spider veins result. The biggest factor determining whether venous reflux and then varicose veins will occur is heredity.

No, this test is not painful, it is just an ultrasound. Gel is rubbed on the leg and the ultrasound wand is then run up and down the leg.

I have a few varicose veins on my legs, which I’d like to have removed. My doctor suggested I might have a venous reflux exam, as well. I already know I have varicose veins; so why would I need an exam? Also, how are the venous exams performed?

It is important to find out where the problems are in veins throughout the legs including the veins you cannot see. Often, the most important problems with the veins are in the veins in the deeper fatty tissues and sometimes in the muscle. The venous color duplex ultrasound exam is performed to evaluate for failure of valves in the veins causing venous reflux or for causes of obstruction in the veins. The venous color duplex ultrasound exam is performed with an ultrasound machine while the examiner makes images of the veins and evaluates blood flow. The soft tissues of the leg are squeezed gently during the exam to stimulate venous blood flow. This is a simple painless exam that takes about half of an hour.

I have a patch of veins on my left leg which keeps in my constant pain on the outer part of my leg. I hurts when I try to walk up or down steps what can I do about this situation?

There are several things that could be done for tender veins on the side of your leg. First you should be evaluated by a doctor, usually with an ultrasound exam, to determine the best treatment for your veins. The first treatment to try will be medical grade compression stockings. These are stockings which are prescribed to a specific level of compression. Often compression stockings can provide some relief for discomfort from varicose veins. Often a more definitive treatment such as treating the underlying cause of the vein problems such as an endovenous laser ablation and or sclerotherapy will be required to get relief from the symptoms.

I have both spider veins and varicose veins. Will endovenous laser ablation treat both of these problems?

Spider veins of the face are usually treated with laser light therapy but some of the bluish veins around temples are often treated better with sclerotherapy. Spider veins of the hands and legs tend to do better with sclerotherapy but some tiny reddish vessels are well treated by a cutaneous laser or light treatment.

First off you must take into account hand veins are not the same as leg veins. Treating hand veins are almost always cosmetic and not medically necessary. I would explore why you do not want the hand veins to begin with. Are they unsightly, painful, make your hands look old? Are there other skin changes on your hands such as sun or age spots that are contributing to the way your hands look? If you fully understand that treating hand veins is purely cosmetic than I would recommend establishing care with someone that treats veins and has treated hand veins in the past. Veins in the hand can be treated with sclerotherapy.

Leg crossing has by myth been accused of causing all varieties of circulatory problems. Interestingly, there has not been a scientific article confirming this ingrained and still-propagated rumor. Even more fascinating, there is strong and growing evidence the leg crossing favors circulation, especially the vein system! Many studies well designed have demonstrated that sitting with legs crossed reduces stagnation and pooling of blood.

Phlebectomy hooks would be the general name for the tool. There are many types including Varaday, Ramelet, and Mueller to name a few.

Patients with varicose veins have a predisposition to forming varicose veins. Therefore, despite treatment, you will always be predisposed to having varicose veins. However, once a varicose vein has been removed or ablated by sclerotherapy or laser… it is gone! It can never return. It is possible for a new vein to go bad and appear, even in the same area as the old vein. I often tell patients that it is like having bad teeth. You can fill a cavity or pull a tooth, but it doesn’t mean another tooth may not go bad years down the road. In practice with over half a million patients over 20 years, we have found that only about 25% of patients have another vein that needs treatment within half a decade.

I’m wearing compression stockings for bilateral ankle swelling that began 3 months ago and only have a varicose vein in the left leg. My vascular surgeon doesn’t think the surgery will reduce the swelling in the affected leg. What to do?

Swelling may be caused by venous insufficiency in the leg but not likely the cause of swelling in an unaffected leg. Bilateral ankle swelling may have many causes. You need an evaluation to determine the reason for the swelling before proceeding with an ablation procedure. The swelling could cause medical conditions such as kidney, liver or heart problems. It also may be caused by trouble moving fluid out of tissues, which is called lymphedema. All of these conditions should be investigated.

There are several options available. The old standby is the Lyra or KTP laser. It works, but it can take several treatments and it hurts. The Veinwave which use Radio Waves works as well or better and is more comfortable. IPL, Intense Pulsed Light, can help for veins but only on the smallest veins. IPL also can help with skin pigment.

I have prominent dark blue veins that appear across my chest and my arms. They are not in pain but I find them unsightly. Is there any treatment or procedure that can diminish them?

There is no reason one should have to suffer with the presence of unsightly veins anywhere on the body; they can absolutely be treated. The typical treatments for chest and arms would be laser treatment and/or injection sclerotherapy, both of which have excellent results. Your vein specialist may recommend one treatment or the other, or a combination.

Varicose veins on the arms are quite rare. Prominent normal veins can be confused with varicose veins. If the affected veins are varicose, one failed trial of sclerotherapy may not mean sclerotherapy using additional techniques would fail.
 Surgical excision remains an option, but I would first make sure that the veins are abnormal and varicose, and I would consider alternate sclerotherapy methods.

Vein procedures often can be performed fully ambulatory under local anesthesia. If you are having a more involved procedure, the type of anesthesia depends. The choice of anesthesia during surgery is a decision made between the patient and the surgeon. Depending on the procedure, there may be a wide range of options while some types of surgery require a more specific choice. It depends on what procedure you have, if it is in a clinic or a hospital and other factors. Some are general anesthesia; some are local with sedation.

In general, medical care and surgery is designed to be minimally invasive, including reduction of risks and downtime. This is very much the case in vein procedures which most often can be performed fully ambulatory under local anesthesia.

Spider veins are thin surface veins that turn blue or red under the strain of the venous reflux and affect the appearance of the location where they occur. Spider veins are considered a cosmetic problem, rarely causing physical discomfort, and can be addressed with a variety of non-invasive, techniques. Sclerotherapy is a treatment using a tiny needle to inject a solution called sclerosant into the veins, irritating the lining of the veins, causing them to close. Sclerotherapy is also used to treat both varicose and spider veins that are seen on the surface of the leg. Veinwave works using radio waves that are pulsed directly to the desired area, so treatment is quick and pain free. Any adult man or woman in good general health who has thin spider veins, or tangled, thread-like veins known as “telangiectasia,” is a good candidate. Also anyone who is looking for a quick procedure and wants to avoid the possibility of bruising or scarring should consider the Veinwave treatment.