FAQ's
Venous Disease
FAQs about Closure procedure
What are varicose veins?
Varicose veins--which afflict 10% to 20% of all adults --are swollen,
twisted, blue veins that are close to the surface of the skin. Because
valves in them are damaged, they hold more blood at higher pressure than
normal. That forces fluid into the surrounding tissue, making the affected
leg swell and feel heavy.
Unsightly and uncomfortable, varicose leg veins can promote swelling
in the ankles and feet and itching of the skin. They may occur in almost
any part of the leg but are most often seen in the back of the calf or
on the inside of the leg between the groin and the ankle. Left untreated,
patient symptoms are likely to worsen with some possibly leading to venous
ulceration.
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What causes varicose veins?
The normal function of
leg veins - both the deep veins in the leg and the superficial veins
- is to carry blood back to the heart. During walking, for instance,
the calf muscle acts as a pump, compressing veins and forcing blood back
to the heart.
To prevent blood from flowing in the wrong direction, veins have numerous
valves. If the valves fail (a cause of venous reflux), blood flows back
into superficial veins and back down the leg. This results in veins enlarging
and becoming varicose. The process is like blowing air into a balloon
without letting the air flow out again- the balloon swells.
To succeed, treatment must stop this reverse flow at the highest site
or sites of valve failure. In the legs, veins close to the surface of
the skin drain into larger veins, such as the saphenous vein, which run
up to the groin. Damaged valves in the saphenous vein are often the cause
of reversed blood flow back down into the surface veins.
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Why does it occur more in the legs?
Gravity is the
culprit. The distance from the feet to the heart is the furthest blood
has to travel in the body. Consequently, those vessels experience a great
deal of pressure. If vein valves can't handle it, the backflow of blood
can cause the surface veins to become swollen and distorted.
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Who is at risk for varicose veins?
Conditions contributing
to varicose veins include genetics, obesity, pregnancy, hormonal changes
at menopause, work or hobbies requiring extended standing, and past vein
diseases such as thrombophlebitis (i.e. inflammation of a vein as a blood
clot forms.) Women suffer from varicose veins more than men, and the
incidence increases to 50% of people over age 50.
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What are the symptoms?
Varicose veins may ache, and
feet and ankles may swell towards day's end, especially in hot weather.
Varicose veins can get sore and inflamed, causing redness of the skin
around them. In some cases, patients may develop venous ulcerations.
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What are venous leg ulcers?
Venous ulcers are areas
of the lower leg where the skin has died and exposed the flesh beneath.
Ulcers can range from the size of a penny to completely encircling the
leg. They are painful, odorous open wounds which weep fluid and can last
for months or even years. Most leg ulcers occur when vein disease is
left untreated. They are most common among older people but can also
affect individuals as young as 18.
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What is the short term treatment for varicose veins?
ESES
(pronounced SS) is an easy way to remember the conservative approach.
It stands for Exercise Stockings Elevation and Still. Exercising, wearing
compression hose, elevating and resting the legs will not make the veins
go away or necessarily prevent them from worsening because the underlying
disease (venous reflux) has not been addressed. However, it may provide
some symptomatic relief. Weight reduction is also helpful.
If there are inflamed areas or an infection, topical antibiotics may
be prescribed. If ulcers develop, medication and dressings should be
changed regularly.
There are also potentially longer-term treatment alternatives for visible
varicose veins, such as sclerotherapy and phlebectomy.
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What is sclerotherapy?
A chemical injection, such as
a saline or detergent solution, is injected into a vein causing it to "spasm" or
close up. Other veins then take over its work. This may bring only temporary
success and varicose veins frequently recur. It is most effective on
smaller surface veins, less than 1-2mm in diameter.
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What is Tumescent Enhanced Sclerotherapy?
Tumescent Enhanced Sclerotherapy is a newly developed, office based technique that takes traditional sclerotherapy a step further by applying tumescent anesthetic solution with a pressure pump designed for the procedure. Learn more about TES
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What is ambulatory phlebectomy?
As with sclerotherapy,
ambulatory phlebectomy is a surgical procedure for treating surface veins
in which multiple small incisions are made along a varicose vein and
it is "fished out" of the leg using
surgical hooks or forceps. The procedure is done under local or regional
anesthesia, in an operating room or an office "procedure room."
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What is vein stripping?
If the source of the reverse
blood flow is due to damaged valves in the saphenous vein, the vein may
be removed by a surgical procedure known as vein stripping. Under general
anesthesia, all or part of the vein is tied off and pulled out. The legs
are bandaged after the surgery but swelling and bruising may last for
weeks.
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When is Closure used?
Closure is used, like vein stripping,
to eliminate reverse blood flow in the saphenous vein, but without physically
removing the vein, and can be performed without general anesthesia. Like
other venous procedures, the Closure procedure involves risks and potential
complications. Each patient should consult their doctor to determine
whether or not they are a candidate for this procedure, and if their
condition presents any special risks. Complications reported in medical
literature include numbness or tingling (paresthesia) skin burns, blood
clots, temporary tenderness in the treated limb.
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What is the main difference between arteries and veins?
In
simplest terms, arteries pump oxygen-rich blood FROM the heart, veins
return oxygen-depleted blood TO the heart.
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What are the three main categories of veins?
Deep leg
veins return blood directly to the heart and are in the center of the
leg, near the bones. Superficial leg veins are just beneath the skin.
They have less support from surrounding muscles and bones than the deep
veins and may thus develop an area of weakness in the wall. When ballooning
of the vein occurs, the vein becomes varicose. Perforator veins serve as
connections between the superficial system and the deep system of leg veins.
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