What Causes Leg Pain From Varicose Veins?
It’s not uncommon for patients to be amazed by the symptoms that can be explained by vein disease. Venous insufficiency represents the underlying condition for many patients with symptomatic spider and varicose veins.
First and foremost, not all patients with varicose veins have pain. Instead, common complaints are leg heaviness, leg swelling, restless legs. These symptoms occur daily and get worse by the end of the day as blood tends to pool in the legs from poor venous circulation. Importantly, this discomfort can be separate from where visible varicose veins are noted because it comes from below the surface. In fact, some patients are found to have venous insufficiency in the absence of visible varicose or spider veins. Not surprisingly then, eliminating spider veins and varicose veins alone provide little relief when venous insufficiency is present. Similarly, spider veins and varicose veins are likely to be recurrent without addressing any underlying problem first.
Diagnosing Varicose Veins?
The key point here is that surface spider and varicose veins are just the tip of the iceberg. A vein specialist needs to consider all your symptoms and findings on physical examination to determine the possibility of venous insufficiency. Preventing long-term changes requires more than eliminating spider veins at the skin surface. The most important tool for this diagnosis is a complete duplex venous ultrasound to evaluate the anatomy, flow and size of your leg veins. A duplex ultrasound should be performed by a certified vascular tech and interpreted by vascular imaging experts.
What Is The Best Treatment For Varicose Veins?
Patients with common presentations of spider and varicose veins are separated into 3 common categories. These help form the basis of treatment recommendations:
- Cosmetic: Patients without underlying venous insufficiency or symptoms. The primary treatment goal is the elimination of spider and reticular veins using sclerotherapy or laser removal.
- Symptomatic Venous Insufficiency: Patients will benefit from treatment for the underlying condition. In the absence of leg ulcerations or swelling, the primary treatment is exercise, weight loss (if needed), and compression grade 2 medical stockings. If conservative measures have not controlled symptoms, then medical treatments are evaluated
- Advanced venous insufficiency: These patients present with further signs of vein disease (CEAP 4-6) which includes leg edema, stasis dermatitis, skin discoloration, or venous leg ulcerations. Bleeding varicose veins are also a sign of advanced vein disease and compression stockings alone are likely to be insufficient for resolution of symptoms.
Our vein center is accustomed to treating all stages of vein disease and maintains the latest diagnostic tools for an accurate assessment of your condition. The vascular labs are staffed with registered vascular technicians working alongside our team of board-certified physicians. Our team is committed to the highest quality of care from the moment you schedule a visit.
Sclerotherapy vs Laser treatment
In general, our vein doctors prefer sclerotherapy for the treatment of spider veins due to the increased number of vein types that can be treated with sclerosant injections. Sclerotherapy is effective in both small and larger sized veins, including reticular and varicose veins. Laser therapy is not as effective as sclerotherapy with larger reticular or varicose veins. However, there are some situations where laser therapy is preferred. This includes spider veins on the face or feet where injection can be contra-indicated. Additionally, very fine veins that are difficult to inject will be suitable for laser treatment. Ultimately, your vein doctor will plan treatments according to your individual anatomy and in some cases, both forms of treatment may be required.
Who Treats Spider Veins?
A vein specialist is a doctor that specializes in treating varicose veins and the underlying condition, venous insufficiency. Ideally, your vein doctor in Wayne should have completed formal training in endovenous procedures during his/her residency and fellowship training. Qualified vein specialists will possess a training background in vascular surgery, interventional radiology or interventional cardiology. A recognition of competency is achieved with board-certification in one of these specialties and should be readily available to discerning patients. Other specialties including pain management, internal medicine, or family medicine do not hold any formalized training in surgical or minimally-invasive endovascular procedures. Their board-certifications are well deserved, however not in the treatment of varicose veins.
Minimally Invasive Varicose Veins Treatments
The most surprising fact to many patients seeking varicose vein removal is that surgery is not needed. Many patients recall stories about their parents undergoing extensive vein stripping procedures with painful and extended recovery periods. Those days are long gone. Instead, today’s procedures are minimally-invasive and suited for all types of vein conditions.
These minimally invasive treatments for varicose veins include:
- VenaSeal: Like most other vein treatments today, VenaSeal is also catheter-based technology. However, unlike ablation, the catheter is used to inject a medical adhesive that fuses the diseased vein closed. Over time, the vein is reabsorbed by the body.
- Radiofrequency ablation: Catheter-based technology that delivers radiofrequency generated heat to the blood vessel walls. The procedure is done with only small amounts of local anesthetic and can be completed in less than 30 minutes.
- Sclerotherapy: A medicated solution is injected in either liquid or aerated form (foam sclerotherapy). This medication acts as a sclerosant and disrupts the walls of diseased veins causing them to collapse and eventually be absorbed.
- Ambulatory Phlebectomy: This requires the most skill and patience, but still is minimally invasive. Tiny incisions are made over large, protuberant veins so that they can be directly removed. Unlike stripping, these procedures are done within the office and patients do not require any downtime. The best part, any large visible varicose veins are immediately removed leading to dramatic skin improvements.
- Clarivein: Another catheter-based technique with some special uses in certain varicose vein anatomy. In this case, mechanical force and sclerosant are used to eliminate diseased veins.
What Are The Latest Treatments For Varicose Veins?
The key objective on modern vein treatments is minimally-invasive. Vein stripping or surgical procedures have been replaced by simpler, faster and more effective treatments that require no downtime or anesthesia. Our favorite techniques are found at all the best vein clinics and are reviewed here:
- Radiofrequency ablation: Catheter-based technology that delivers radiofrequency generated heat to the blood vessel walls. The procedure is done with only small amounts of local anesthetic and can be completed in less than 30 minutes.
- VenaSeal: This is the latest innovation in vein treatment and is equally effective as RF ablation. VenaSeal is also a catheter-based technology. However, unlike ablation, the catheter is used to inject a medical adhesive that fuses the diseased vein closed. As such, it requires no tumescence for anesthesia.
- Sclerotherapy: A medicated solution is injected in either liquid or aerated form (foam sclerotherapy). This medication acts as a sclerosant and disrupts the walls of diseased veins causing them to collapse and eventually be absorbed.
- Ambulatory Phlebectomy: This requires the most skill and patience, but still is minimally invasive. Tiny incisions are made over large, protuberant veins so that they can be directly removed. Unlike stripping, these procedures are done within the office and patients do not require any downtime. The best part, any large visible varicose veins are immediately removed leading to dramatic skin improvements.
- Clarivein: Another catheter-based technique with some special uses in certain varicose vein anatomy. In this case, mechanical force and sclerosant are used to eliminate diseased veins. Interesting fact, our very own Dr. Brotman was present for the first ClariVein® procedure on humans in the United States.
