What to know, what to do
Let’s say you’ve been a longtime hiker, walker, or runner. You make a point of carving out time in your busy day to get outside and move, because you know how great it makes you feel. You look forward to these outings and consider them a vital part of your overall health program. But over time, your legs have begun to feel tired and achy after a workout, and sometimes even puffy. What’s going on? You’re exercising, you’re active, so you should feel better, not worse.
You are surprised when you learn you have symptomatic vein disease, which affects nearly 30 million Americans. And even though activities like walking are highly recommended as good preventive measures against vein disease, the condition can happen to anyone.
Let’s take a look at what our hard-working veins actually do, and how things can eventually head south.
Gordon F. Gibbs, MD., founder and Chief Medical Executive of American Vein and Vascular Institute, says, “Arteries carry oxygenated blood from the heart to the brain and periphery of the body. Veins return the blood from the periphery back to the heart. The arteries are pressurized each time the heart beats, which forces the blood forward. The veins do not have a pump to keep the blood moving, so they rely on one-way valves that open and close to keep the blood moving in the correct direction.
“When these valves fail or leak, they can cause an overload of pressure in the veins that often causes them to enlarge and elongate, resulting in varicose veins. This process is called venous insufficiency or venous reflux. Increased pressure in veins can also cause pain, swelling, heaviness, aching, restlessness and cramping in the legs.”
Longstanding venous insufficiency, says Dr. Gibbs, can cause skin discoloration in the legs and even skin ulceration.
Some of us are more likely to develop venous disease than others. “Venous reflux is a genetic condition that is exacerbated by lifestyle,” says Gibbs. “Fundamentally, if your parents or other relatives have venous reflux, you’re more likely to develop it. But that risk increases when people are sedentary, overweight, or have a standing/sitting occupation.
“Pregnancy is a perfect storm for causing vein problems,” says Gibbs, due to increased blood volume, a growing womb that compresses veins in the pelvis and increased progesterone levels, which cause muscle relaxation in the mother’s tissues and in the vein walls, resulting in vein dilation.
So here you are, no longer able to enjoy your exercise of choice without pain and frustration. Your symptoms may progress to a feeling of heaviness in your legs, large veins you can now see and itchy, discolored skin. What are your options and what can you expect with treatment?
Dr. Gibbs says, “Contemporary treatment of veins is much more effective and less painful than what was historically offered in hospitals. Our goal in treatment is to move blood away from the abnormal veins affected by reflux and into veins with normal valve function. In doing so, the pressure on the inside of the veins is reduced and the symptoms are also improved.
“Conservative therapy includes lifestyle modifications like leg elevation, increasing activity level, improved diet, taking anti-inflammatory medications and regular use of compression stockings.”
If procedures are indicated, says Gibbs, a detailed ultrasound examination helps determine the road map of which vessels are normal and which are diseased. Procedures are done in an office-based setting under local anesthetic and require minimal downtime. Many patients return to work the same day as the procedure.
“We usually treat the largest, most symptomatic veins first, usually with a procedure called an ablation, which involves placing a small catheter or tube through a nick in the skin into the vein, then heating it to purposefully injure and close the vein.”
A newer type of ablation called Venaseal involves using a catheter to inject a honey-consistency super glue into an abnormal vessel, says Gibbs, which permanently seals the vein.
“Sclerotherapy is another tool where a liquid or foam medication is injected into abnormal veins, causing inflammation and occlusion. This is useful for spider veins or medium sized veins and is often used in conjunction with ablation techniques to improve the patient’s symptoms and the appearance of the legs.”
A traditional surgical approach called microphlebectomy can be used to remove large bulging varicose veins from the legs.
“Most patients have some tenderness in the area that has been treated,” says Dr. Gibbs, “but rarely require pain medications stronger than ibuprofen or Tylenol. Because the veins are between the skin and the muscles, the muscle is not affected by the procedures, so return to normal activities is rapid.”