Managing Varicose Veins and Venous Reflux Disease
By Irfan Imami, MD, FACS // August 9, 2012
(VIDEO BY: paramountmd)
Varicose veins, those large bulging veins extending up and down your legs, are not only unattractive but also sometimes quite painful. However, the most significant aspect of varicose veins is that they can be dangerous to your health.
Varicose veins affect more than 25 million Americans, and more than 50 percent of women and 40 percent of men suffer from some type of vein anomaly. Veins are normally compromised in patients in their early 20s and 30s, initially appearing as spider veins, and are very common among individuals 50 years and older.
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Venous Reflux Disease
The majority of patients that I see with varicose veins are eventually diagnosed with a condition called Venous Reflux Disease (VRD). From an anatomical perspective, the legs have a network of veins, which contain valves that open and close to assist the return of blood flow in one direction back to the heart. Patients with varicose veins and subsequently diagnosed with VRD have faulty valves most often involving a large superficial leg vein called the saphenous vein. When saphenous reflux is present, blood flow is restricted and there is pooling in the legs, causing everything from unsightly varicose veins to severe pain swelling, fatigue, skin discoloration and ulcers from skin and soft tissue breakdown.
Sometimes called venous insufficiency, VRD normally affects individuals who stand for prolonged periods of time, or engage in heavy lifting. Studies also show a strong familial predilection for VRD. Other risk factors include obesity, hormonal changes, sun exposure, multiple pregnancies and previous lower extremity deep vein thrombosis caused by blood clots in the deep vein complex of the legs.
Treatment of varicose veins is dependent on the severity of the VRD and the resultant complications and the patient’s tolerance for the unsightliness of the varicosities. For minimal symptoms the easiest treatment is to wear compression stockings. These special socks gently squeeze the leg, helping the muscle pump to work more effectively.
If compression stockings do not help, the abnormal vein(s) must be eliminated or “closed.” This is best accomplished by a procedure called venous ablation, which is a 15-minute procedure performed in the surgeon’s office under local anesthesia through a tiny incision. A small tube is introduced into the affected vein via the incision, and then a laser fiber is passed through the tube into the dilated, diseased vein. Once in place, the laser delivers localized heat to the vein wall, closing down and permanently blocking the vein, and blood flow immediately ceases.
Ablation, which results in minimal pain and downtime, treats only the abnormal vein that is allowing blood to flow backwards. Since this vein has lost its ability to carry blood in the correct direction, and there is a robust network of other veins in the leg that continue to function, the ablated veins are no longer needed.
It’s important to note that patients should always seek treatment for varicose veins if the vein begins to bleed, sores or rash type symptoms appear on the leg or near the ankle, and if the area is swollen, red or tender, and warm to the touch.
Insurance Coverage Dependent on Disease Severity and Complications
Insurance does not normally cover cosmetic treatments for varicose veins. However, Medicare and most health insurances do cover venous ablation procedures specifically if a physician determines that VRD is causing functionally restrictive symptoms such as pain and swelling, or other significant associated complications like skin discoloration and breakdown.
Steps to Help Prevent Varicose Veins
- Wear sunscreen to protect skin from the sun.
- Exercise to improve leg strength, circulation, and vein strength.
- Control weight to avoid placing additional pressure on your legs.
- Don’t stand or sit for long periods of time. If you must stand, shift your weight from one leg to the other. If you must sit, stand up, move around or take a short walk every 30 minutes.
- Wear elastic support stockings and avoid clothing that constricts the waist, groin, or legs.
- Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone your calf muscles to help blood move through your veins.
- Eat a low-salt diet rich in high-fiber foods. Eating fiber reduces the chance of constipation, which can contribute to varicose veins. Eating less salt can help with swelling that comes with varicose veins.
Therapy For Varicose Veins When Surgery Is Not Needed
- Support stockings – Wearing compression stockings is an important part of any vein treatment. They should be worn from the time you get up in the morning to the time you go to bed.
- Anti-inflammatory medication. Medications such as Ibuprofen (Motrin) can help alleviate your symptoms.
- Exercise regularly and elevate legs often.
- Watch your diet. Shedding excess pounds can take pressure off veins. Follow a low-salt, high-fiber diet to prevent the swelling that may result from water retention.
ABOUT THE AUTHOR
Irfan R. Imami, MD, FACS, ABPH, FAPWCA is certified in Vascular Surgery by the American Board of Surgery. He completed his general surgery residency at the University of Florida, followed by a vascular surgery fellowship at the Henry Ford Hospital system in Detroit. Prior to moving to Melbourne, he was a consulting surgeon at the Nebraska Heart Institute. Dr. Imami performed the first percutaneous abdominal anuerysm repair under local anesthesia in the state of Florida. He also specializes in varicose veins and is Board Certified in Phlebology (treatment of veins). He is a member of the Melbourne surgical group, Tepas Healthcare, office phone: (321) 733-1901.
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