Varicose Veins: More Than Just a

Cosmetic Problem

Jeffrey Stein, MDJeffrey Stein, MD

Charlotte Radiology Vein and Vascular CenterCharlotte Radiology Vein and Vascular CenterVascular and Interventional RadiologyVascular and Interventional Radiology

Charlotte RadiologyCharlotte Radiology

February 8, 2012February 8, 2012

What are Varicose Veins?What are Varicose Veins?

abnormally enlarged superficial veinsabnormally enlarged superficial veins tortuous, twisted, widened or tortuous, twisted, widened or

lengthenedlengthened bulging under skin surfacebulging under skin surface due to a defect in the valves within the due to a defect in the valves within the

veins themselves (venous valve veins themselves (venous valve insufficiency)insufficiency)

blood pools in sections of the vein blood pools in sections of the vein causing the vein to bulge and swellcausing the vein to bulge and swell

What are Varicose Veins?What are Varicose Veins?

Normal vein:Normal vein:cusps of valves cusps of valves close & prevent close & prevent backward flow of backward flow of bloodblood

Varicose vein:Varicose vein: cusps cannot cusps cannot

close because vein close because vein abnormally widened abnormally widened and blood can flow and blood can flow in the wrong in the wrong directiondirection

IntroductionIntroduction

may be no symptoms may be no symptoms for some a problem in terms of for some a problem in terms of

appearance appearance may result in mild discomfortmay result in mild discomfort may cause severe painmay cause severe pain may result in additional medical may result in additional medical

problemsproblems

IntroductionIntroduction

Images of varicosities:Images of varicosities:

IntroductionIntroduction

Telangiectasia, more commonly known as Telangiectasia, more commonly known as spider veins:spider veins:

Spider veins on the leg usually appear in one of three patterns:

(a) simple linear

(b) arborizing, which appear branch-like

(c) spider, which appear as a cartwheel shape with a dark center point.

Incidence and prevalence Incidence and prevalence

15% of males over 18 30% of women over 18 increases with age, being present in

more than half the population by age 65

20 Million adults with varicose veins or chronic venous insufficiency (CVI)

Risk Factors Risk Factors

Genetics / Hereditary - those with a family history are at greater risk

family history of varicose veins 15 % of patients

Increasing Age Gender - women are at greater risk

than men related to female sex hormones estrogen and

progesterone which relax blood vessels, allowing the vein valves to separate

pregnancy

Risk Factors Risk Factors

Obesity- excess weight increases pressure on the saphenous vein valves, causing them to weaken

Pregnancy varicose veins may surface for the first time

during pregnancy progesterone smooth muscle relaxation later in pregnancy the uterus exerts greater

pressure on the pelvic and leg veins and may cause or worsen varicose veins

Risk Factors Risk Factors

Standing and sitting- those who have jobs that require them to stand or sit for long periods also are at increased risk

prolonged standing can weaken the walls of veins

prolonged sitting can aggravate inflamed veins

Symptoms

pain leg heaviness aching or tension tenderness along

the course of a vein

burning sensations pruritus / itching

exercise intolerance

restless legs paresthesias night cramps edema skin changes

Complications Complications

Thrombophlebitis

Complications Complications

Stasis Dermatitis/

Varicose eczema

Complications Complications

Stasis Dermatitis/

Varicose eczema &

Lipodermatosclerosis

Management of Varicose Management of Varicose Veins and Venous RefluxVeins and Venous Reflux

Conservative treatment (will not solve the problem but Conservative treatment (will not solve the problem but will help with symptoms):will help with symptoms):

elevationelevation avoid prolonged avoid prolonged

sitting/standingsitting/standing no leg crossingno leg crossing exerciseexercise weight reductionweight reduction compression stocking therapycompression stocking therapy

ManagementManagement

Compression Stocking TherapyCompression Stocking Therapy

ManagementManagement

Treatment options:Treatment options:

Surgical stripping: Surgical stripping: old way of old way of removing the vein. Typically required removing the vein. Typically required a hospital stay and weeks of recovery a hospital stay and weeks of recovery time. time.

Injection sclerotherapy: Injection sclerotherapy: often treats often treats the surface veins, but does not treat the surface veins, but does not treat the underlying problem.the underlying problem.

Endovenous laser treatments: Endovenous laser treatments: much less invasive way of much less invasive way of “eliminating” the vein. The procedure “eliminating” the vein. The procedure seals off the vein while leaving it seals off the vein while leaving it inside of your leg. inside of your leg.

ManagementManagement

Benefits of laser treatments vs. Benefits of laser treatments vs. traditional stripping:traditional stripping:

Minimally invasive, in-office treatment Minimally invasive, in-office treatment alternative to surgical stripping of the great alternative to surgical stripping of the great saphenous veinsaphenous veinNo sedationNo sedationMost procedures take less than 30 minutesMost procedures take less than 30 minutesPatients are able to walk immediately after Patients are able to walk immediately after the procedure and most individuals are able the procedure and most individuals are able to return to work the next dayto return to work the next day

Ultrasound Evaluation: Before

During a consultation, you will meet with the doctor and have an ultrasound to determine which veins are not functioning properly. Your doctor will then discuss your treatment plan and review your insurance requirements. Most procedures are covered by insurance.

Varicose Veins: More Than Just a

Cosmetic Problem If you are interested in a consult, please give us a If you are interested in a consult, please give us a

call. We accept all major insurances. call. We accept all major insurances.

Southpark: 4525 Cameron Valley ParkwaySouthpark: 4525 Cameron Valley ParkwayCharlotte, NC 28211Charlotte, NC 28211

704.333.3794 ext. 2220704.333.3794 ext. 2220

Concord: 212 LePhillip Court NEConcord: 212 LePhillip Court NEConcord, NC 28205Concord, NC 28205

704.786.0052 704.786.0052

www.crveins.comwww.crveins.com