Pink Prescriptions - August 2018

Your Bodily Fluids and the Story They Tell

Prescriptions 1 0818

Although considered by many to be a purely cosmetic concern, varicose veins are more than unsightly veins. If left untreated, large varicose veins may progress over time and lead to swelling, darkening of the skin, and pain.

1) What are varicose veins? Varicose veins are superficial veins in your legs that have enlarged due to increased pressure that builds up while standing. Varicose veins are tortuous, often bulging, and larger than spider veins. They vary in color from green, blue, to red, and cause heaviness, pain, aching, burning, leg swelling, and social embarrassment.

2) What are the causes? Abnormal veins, such as varicose and spider veins are present in nearly 40 percent of the adult population. They occur more frequently in women, but are also common in men, and are seen in all age groups, from the 20s through the 80s. Heredity, age, standing occupations, and weight gain, including that from pregnancy, are among risk factors associated with developing vein problems. Obesity, physical trauma to the legs, and hormone therapy can further aggravate your veins.

Healthy Valves Prevent Backwards Flow: Normal veins in your legs are tubes that carry blood away from your feet toward your heart. One-way valves are located inside your veins and should only allow blood to flow up, out of your legs to your heart. When valves become Prescriptions 2 0818damaged, or diseased blood flows backwards due to gravity, blood builds up, or pools, in your leg veins. The backward flow of blood in your veins is known as reflux and places excess pressure on the vein walls. This causes veins to expand and become varicose, the increased pressure causes further enlargement of the varicose veins, and fluid leaks out of the veins resulting in swelling, permanent skin discoloration, and ulceration in advanced stages.

3) What is the treatment for varicose veins? The treatment often depends on which veins are abnormal and how severe the symptoms are to the patient. Conservative treatment, which includes lifestyle changes such as weight loss, exercise, elevation, and wearing compression stockings, should always be initiated before procedures are considered. These methods have been proven successful in reducing the pressure that builds up in your veins and can improve your symptoms. If you have a job that requires standing, periodic rest with leg elevation may help with mild to moderate symptoms; periodic flexing of the legs may also help move pooling blood back towards the heart. For more severe varicose veins, compression stockings are prescribed. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. These stockings can also help heal skin sores and prevent them from returning. For many patients, compression stockings effectively treat varicose veins and may be all that is needed to relieve pain and swelling and prevent future problems. 

4) What if conservative treatments don’t work? Varicose vein intervention has undergone a paradigm shift in the last decade with a remarkable transition from traditional open vein stripping to state-of-the-art, minimally-invasive laser procedures. Laser vein treatment is accomplished by inserting a small plastic tube, or catheter, equipped with a laser tip into the diseased vein. The energy from the laser reacts with the tissue, causing the leaking (incompetent) vein to close and seal shut preventing further backwards blood flow. Since the diseased vein was already nonfunctional, the blood flow has already rerouted to healthy veins, and the closed off vein is no longer needed. Laser closure procedures are proven to be approximately 95 percent effective and cause minimal discomfort.

In addition to laser treatment, some patients with large varicose veins may require the removal of bulging veins. This is accomplished by making tiny incisions, generally in the comfort of an office setting, using numbing medication. Procedures average 45 to 60 minutes with little-to-no downtime, allowing the resumption of normal activities the next day.

5) What are spider veins and how are they treated? Spider veins (telangiectasias) are similar to varicose veins, but smaller and are found closer to the skin’s surface. They take their name from their appearance, which resembles a spider’s web. Usually red or blue in color, they vary in size and can be found in other areas of the body besides the legs, including on the face. In some cases, spider veins may be related to an underlying medical problem known as venous insufficiency or reflux (backwards flow of blood in the veins). In either situation, symptoms associated with spider veins range from itching or a dull ache to a throbbing pain and bleeding. An ultrasound may be necessary to determine if you have underlying problems in a deeper vein.

While laser therapy is very effective for large varicose veins, sclerotherapy remains the most popular method of eliminating spider veins, and has been the “gold standard” for decades. Newer advanced techniques in sclerotherapy allow treatment of larger spider vein and varicose veins. An FDA approved medication is injected directly into the spider veins using a tiny, pin-sized needle. The solution causes an irritation to the inner lining of the vein causing it to close off. The vein stops carrying blood and therefore disappears with time. Most people who have sclerotherapy have minimal discomfort and satisfying results. However, this is a staged process and initial bruising should be expected. Sclerotherapy is a good treatment for spider veins but it’s not a cure—100% clearing of spider veins is not a realistic goal. The treatment sessions last approximately 20 minutes and are done at four-week intervals to achieve optimal results. Special vein lights allow visualization of feeding veins that may not be visible to the naked eye and can lead to reoccurrence if not treated. The special vein lights also make treatments quicker and, therefore, less expensive.

6) What are the health and beauty benefits of varicose and spider vein treatment? In addition to the physical discomfort, swelling, fatigue, and skin discoloration, individuals suffering from unsightly varicose and spider veins often dread baring their legs. Whether you are going to the beach, a neighborhood party, or for a walk, wearing a pair of shorts often creates anxiety. If you’ve been living with spider or varicose veins, going to just any laser or sclerotherapy center may not be the best option or even a good one. Treatment of any medical condition requires knowledge, skill, and judgment from your doctor. Treatment of vein disease is no exception. A board-certified vascular surgeon is the best-qualified specialist to discuss treatment options and work with you to get your legs beautiful and healthy again.

Prescriptions 3 0818Anthony J. Avino, M.D. is board certified vascular surgeon who specializes in minimally-invasive vascular procedures at Savannah Vascular Institute and can be reached at 912-352-VEIN (8346) or This email address is being protected from spambots. You need JavaScript enabled to view it.. For more information, log onto

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