New Treatments for Varicose Veins
If you're "vein" or in pain, varicose veins are more easily treated now than in the past.
By Jean Lawrence
Reviewed By Brunilda Nazario
As a curious child, you might remember staring at an older relative's thick stockings at the blue, gnarled veins lying under the skin like bumpy snakes. Known as varicose veins, these blood vessels, which return blood from the legs to the heart, are actually a more superficial system.
The real, working venous system for the legs lies deeper, says to Robert A. Weiss, MD, assistant professor of dermatology at the Johns Hopkins School of Medicine in Baltimore. This is good news, because it means that if the surface veins begin to clump up and bulge, they can be removed or destroyed without ruining circulation to the leg.
The National Institutes of Health estimates that 60% of all men and women suffer from some form of vein disorder. A quarter of varicose vein sufferers are men, although Weiss notes that it is almost always women who seek help for spider veins.
Spider veins, the more delicate red or blue tracings that can pop up on the skin's surface like kinky spider webs, are a minor form of varicose veins and can precede development of the more unsightly variation or cause cosmetic concerns of their own. Sun exposure can make spider veins worse by breaking down collagen under the skin.
Both varicose and spider veins result when valves designed to keep blood from running backward away from the heart and back down into the leg fail or become loose and flabby -- allowing backwash, which stretches veins and even slowly leaks into ankle and leg tissue, causing swelling.
Aside from the "purple snake" effect, varicose veins can cramp or throb at night. So much blood pools into the legs, that it can cause the legs to feel heavy and leaden. If clear fluid from the expanded vessels seeps into tissues, it can choke off circulation to the skin, causing an itchy rash or even a painful ulcer, Weiss warns.
As a rule, varicose veins are more unpleasant and ugly than dangerous.What Causes Varicose Veins?
The exact cause of this unwanted "body art" is not known, but a genetic tendency toward weak, vein valves plays a big role, Weiss says. Hormones also play a part, accounting for the increased incidence in women. Puberty, pregnancy (pregnant women are very prone), and menopause, as well as taking estrogen, progesterone, and birth control pills, can weaken vein valves and change leg circulation.
During pregnancy, Weiss says the increased blood volume the mother is circulating for herself and her fetus can make veins bulge. Sitting with a full uterus on the top of the thighs also does not help blood return to the heart (varicose veins that pop up during pregnancy usually deflate in three months, although new pregnancies can bring them on again, sometimes to stay).
Aging, obesity, and prolonged standing can also cause leg veins to balloon.Diagnosis and Treatment
If you had a mother or grandmother treated for varicose veins and thought the treatment sounded worse than the disease, take heart. Times are changing. "We now use duplex ultrasound to look at the circulatory system of the leg," Weiss says. This means taking a sharp, two-dimensional picture instead of a doctor listening to blood flow in the leg with a Doppler device and trying to decide which veins are affected and where.
Duplex ultrasound is also a boon, says Sandy S. Tsao, MD, an instructor of dermatology at Harvard Medical School and assistant in dermatology at Massachusetts General Hospital in Boston. She says this is because knowing the condition of the exact vein affected can help the doctor determine which treatment to use.
In the old days, a flexible metal rod was inserted into the vein at the groin level, passed through the vein and taken out the other end, where a metal cap was screwed on. The rod was then pulled back through the leg, stripping the vein out through the groin incision. With the vein gone, the deeper circulatory systems took over and the wormy mass was not longer visible.
Stripping is hardly ever done anymore. "We have really widened the frontiers!" Tsao exclaims. Now, a thin catheter may be inserted into the affected vein and the whole inside of the vein, called the lumen, heated by radio waves, which shrinks the tough collagen in the vessel wall and causes it to collapse and re-absorb. Anesthesia mixed with fluid is injected first to make the procedure painless and, at the same time, press the blood out of the vein. Scarring is almost imperceptible, although there may be some bruising and the vein may take eight weeks to re-absorb.
Lasers are also used to send bursts of concentrated light into the vein, collapsing it. When the laser hits the skin, there is a tinge of discomfort, but the doctor quickly cools the skin off. Another, even newer technique is called foam sclerotherapy, Weiss explains. An agent, such as a detergent or emulsifier, is agitated with air, forming foam the consistency of watery shaving cream (a little air in veins is acceptable, unlike Hollywood would have you believe). The foam is then injected into the problematic vein, gradually causing the walls to swell and stick together, blocking off the vein. The deeper venous systems take over the blood flow.
Tsao, however, says she would prefer use of foam sclerotherapy for spider veins. Varicose veins she said are larger bore vessels and require more aggressive therapy.
Another, older, but still often used technique, is called ambulatory phlebectomy, in which the vein is extracted with a crochet-hook-like device. And it's quick. Once it's out, there's no waiting for the vein to re-absorb. "Some people still prefer this to waiting," Weiss says.
What are the chances of a blood clot? Doctors prefer to do these procedures on people with normal clotting capability. People taking warfarin and aspirin require special consideration.
As for the varicose veins returning, yes, there is a chance. "If you have the genetic susceptibility, smaller ones could form," Weiss says. "You should be relatively disease-free, though." And you can always do another procedure.Can Holistic Remedies Help?
Where grandmother probably took a trip to the doctor and mother a trip to the medicine cabinet, younger sufferers now want to hit the health food store. Molly Kimball, RD, sports nutritionist at the Ochsner Clinic's Elmwood Center in New Orleans, recommends a diet low in carbs and rich in fiber to keep weight down and all circulatory systems going strong.
A 100 mg coenzyme Q10 helps with circulation and tissue oxygenation, she says. Omega 3 oils (1,000 mg daily) help with elasticity of blood vessels. Also much touted for varicose veins are gingko biloba and vitamin K. "You can start at 60 mg twice daily and go to 120 mg twice daily on the gingko," Kimball says. Tsao and Weiss are both doubtful about the gingko, however. "There have been no formal studies of the effects on varicose veins," Tsao says. And if you have normal levels of vitamin K, you don't need more, she adds.
The best way to prevent varicose veins if they are in your family is to not stand for long periods, Weiss advises. Other tips include:
Now here's the bad news. Wearing support hose -- yes we're talking the dreaded pantyhose -- is recommended for anyone with visible veins or for people who have had a procedure done. "Wear them every waking hour," says Tsao.
Star Lawrence is a medical journalist based in the Phoenix area.
Published Sept. 15, 2003.
SOURCES: Robert A. Weiss, MD, assistant professor of dermatology, Johns Hopkins School of Medicine, Baltimore. Sandy S. Tsao, MD, instructor of dermatology, Harvard Medical School, Boston; dermatology assistant, Massachusetts General Hospital, Boston. Molly Kimball, RD, sports nutritionist, Ochsner Clinic's Elmwood Center, New Orleans. National Heart, Lung, and Blood Institute, U.S. National Institutes of Health, Bethesda, Md.
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