Q. What are varicose veins?
A. Varicose veins are dilated, twisted veins in the legs, usually caused by small leaking valves that could be anywhere in the leg, from the groin down to the ankle.
Think of a waterfall causing a stream down the hill. The downward pressure results in dilatation and bulging of the veins, leading to unsightly varicose veins. In most patients, varicose veins also result in the appearance of many spider veins.
Q. What causes the leaking that results in varicose veins?
A. The veins in the body have tiny, invisible, one way valves within them. These valves allow the flow of blood to travel only up to the heart. If any of these valves do not function properly, blood flows downward, from the big veins to the small veins. This gradually increases pressure in the small veins, making them larger and twisted.
Anytime varicose veins are treated, whether by surgery (called complete stripping) or by any other method, the leaks must identified and controlled. For many patients who have undergone stripping of their varicose veins in the past, these incompetent perforators were ignored. This resulted in the early recurrence of varicose veins in most patients.
Q. Why did I get varicose veins?
A. Causes of varicose veins include family history, pregnancy, obesity, standing on one’s feet for long periods without moving around and injury.
Q. Do varicose veins cause any health problems?
A. Initially, varicose veins are only of a cosmetic concern, but later on, they can cause clotting (phlebitis), bleeding, ulcers and severe skin changes (dermatitis).
Q. What is the complete stripping technique?
A. Complete stripping means pulling varicose veins out through multiple incisions from the groin to the ankle. It leaves permanent scars and could cause a permanent numbness in the legs or feet. This technique usually sacrifices an important vein in the leg called the Saphenous vein, necessary for future bypasses in the heart and legs. Cosmetically, stripping leaves unacceptable results in most patients.
Q. Is stripping a cure for varicose veins?
A. Not at all. The chance of recurrence after the stripping technique is quite high. I see numerous patients every year who have undergone 1 to 4 strippings, and they have recurrences of varicose veins in the same leg.
The reason for the recurrence is that the leaks, i.e. the source of the problem causing the veins, was not addressed by the stripping surgery.
Q. Why are women more likely to get varicose veins than men?
A. About 90% of my patients are women. Heredity and pregnancy are the two most important factors in determining whether a person gets unsightly veins. Pregnancy causes pressure in the pelvic region, resulting in leaking (incompetent) valves that result in unsightly veins.
Q. Does obesity play a roll in the appearance of varicose veins?
A. Yes, just like pregnancy, any factor that increases pressure on the veins could result in the formation of varicose veins and spider veins.
Q. Is it always important to seek treatment for varicose veins?
A. Although the initial concern for patients is cosmetic in nature, almost invariably varicose veins enlarge and can cause complications. Symptoms such as cramps, aching and heaviness in the legs are frequent complaints. Without treatment, serious complications, such as ulcers, clotting and bleeding, some of which are potentially life threatening, could occur.
Q. Why do I have spider veins?
A. A great majority of spider veins arise from varicose veins. This does not mean that a patient with many spiders will also have large, bulging veins in the leg. Many varicose veins are quite small and must be checked under good lighting with the legs elevated. A common occurrence is spiders on the outside of the thighs which typically arise from tiny varicose veins coming from the back of the knee.
To get rid of most spiders effectively, one must close the tiny varicose veins and the responsible leak, otherwise the spiders will soon return. The same rule applies if laser is selected for the treatment.