Feeling Blue?

With spring just around the corner (we know, we’re a bit optimistic), readers may be longing to shed the winter gear, even slip into a pair of shorts. “… Hmm … oh, good, they still fit. But those big, blue veins. What can I do …?”

There is good news for people who want to get rid of varicose veins. New techniques for diagnosis and treatment are minimally invasive and almost always successful.

Dr. Neil Sullivan, vascular surgeon and owner of Vasculart in Portsmouth, describes three types of visible veins. The tiny red lines on the legs, ankles and sometimes the face are called spider veins. Somewhat larger, blue veins are reticular veins. The larger knotted or bulging veins are true varicose veins.

Veins are part of the body’s circulatory system, explains Sullivan. Blood is pumped by the heart and flows to all parts of the body, then circulates back to the heart. There is an automatic “shut-off” valve in each vein to permit the blood flow to reverse direction. It’s an amazing system and it works well. But sometimes a valve malfunctions and blood pools in that vein. That vein becomes “varicose.”

Usually this condition is not dangerous; other veins take over the work of the damaged vein. Sullivan makes an important and reassuring point, given the stories that sometimes circulate in the media. The blood clots that form in varicose veins are not the clots that travel to the heart and lungs.

But varicose veins are unsightly and often uncomfortable. The legs may feel heavy. There can be pain and tenderness. Older people, in particular, may develop lesions at the ankle as a result of varicose veins. Such ulcers can take months or even years to heal.

Given the new techniques for diagnosis and treatment, putting up with varicose veins is no longer necessary. Treatment used to mean “stripping” the vein, actually removing it surgically. This procedure was painful and required a lengthy recovery period. “Stripping should be in the dustbin of history,” says Sullivan, though he notes that not everyone would agree.

Dr. Normand Miller, vascular surgeon and owner of Vein Centers of New England, also says that stripping is no longer necessary. He explains that new approaches to vein treatment developed after ultrasound became available about 20 years ago. Ultrasound is a diagnostic tool that makes it possible to pinpoint the exact location of the troublesome veins. It creates a visual map of the affected area.

Miller says that, with the new techniques for diagnosis and treatment, “There is no problem that can’t be handled in the office.” General anesthesia is not needed for these minimally invasive ways to eliminate varicose veins. The recovery period is minimal.

Laser ablation is one such technique. Local anesthesia is applied to the affected area and a 1/4- inch incision is made. A laser fiber is inserted into the feeding vein. The laser heats the vein and it collapses; it is then welded shut. The process takes about 45 minutes. Another technique injects an agent that, as it is slowly absorbed, seals the treated veins. The VNUS Closure treatment (a patented procedure) delivers radio frequency to the vein wall, causing it to heat, collapse and seal shut. Miller says that varicose veins are best treated with injection-based or light-based therapy. Treatment of facial veins is light-based.

Varicose veins are common in this country. About 60 percent of women have varicose veins and the trend is upward. Men also have varicose veins, though at a lower rate. Often, however, men don’t seek treatment until the veins are large and somewhat more complex to treat.

The condition seems to be the price we pay for walking on two legs. Standing puts pressure on the circulatory system, which must overcome gravity to return blood from the feet and legs. Pregnancy sometimes causes varicose veins — again, it’s the added pressure on the legs and feet — but the condition often clears up a few weeks after childbirth. Heredity may be a factor.

As for prevention, the message is a familiar one — exercise and a healthy weight. Exercise reduces the pressure on lower extremities. When in a confining space, try to move around and stretch. Flex the ankles every hour. Those who must stand a great deal are advised to wear compression stockings. These are different from the support stockings you can buy at the hosiery counter. They are designed to apply greater compression at the ankle, with gradually declining pressure up the leg.

Miller assures readers that it would be extremely rare for varicose veins to lead to a systemic threat. But blockages in deep veins are serious and can lead to inflammation of a vein (phlebitis) or to a blood clot embedded in one of the major veins. Venous disease should be evaluated by a vascular surgeon.

“Varicose veins can be easily treated,” concludes Dr. Miller. “With the new minimally invasive, same day procedures, there is no longer reason to live with this unattractive and uncomfortable condition.” NH