Common Questions About Varicose Veins and Removal Treatments
Varicose veins are veins that become abnormally swollen and large, usually due to defective valves in the vein. Varicose Veins are sometimes bluish in color, protrude from the surface of the skin, and frequently have a winding or worm-like appearance. Varicose veins typically take years to develop. The condition is often inherited and women are four times more likely to develop varicose veins than men. Varicose veins can be brought on by:
- Obesity, which causes greater pressure on vein valves that can lead to weakening
- Pregnancy, menopause, and birth control pills due to changes in hormone levels
Increase in the diameter of a vein results in the malfunction of valves inside of the vein that are designed to prevent blood from flowing backward in the vein. An inherited weakness of the vein wall (genetic) and circulating hormones that relax the smooth muscle of the vein wall are the most common causes. Females have high levels of such a hormone, called progesterone. Pregnancies, obesity, hormone replacement therapy, the use of female oral contraceptives as well as occupations that require a standing position are additional causes of varicose veins. Since females usually have multiple risk factors for the development of varicose veins, about three fourths of the persons who have varicose veins are women and 25% are men.
Varicose veins are a problem that can be successfully treated but the disorder cannot be permanently cured. The treatment of the abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need to return for maintenance treatments after their initial treatment is completed.
Sclerotherapy is the treatment of varicose veins by injection of the veins with chemicals that cause destruction of the veins. Many patients who select this treatment option for cosmetic reasons notice improvement in the way that their legs feel after treatment.
In order to control the backward flow of blood in these large veins, the vein that is the source of the visible varicosities must be sealed shut or removed. The vein may be sealed shut using energy sources such as a laser, or radiofrequency energy electrical energy, or by ultrasound guided sclerotherapy injections.
Visual sclerotherapy refers to injection of surface veins that are visible to the naked eye. Some veins that need to be treated are below the surface of the skin and cannot be injected safely without the aid of ultrasound imaging assistance.
Most patients do not experience any complications from sclerotherapy. However, some patients develop changes in skin pigment in locations where the veins are injected. Some patients may experience chemical burns of the skin while a rare patient may develop an allergy to the medication. Serious complications such as deep vein blood clots and unintentional arterial injection occur rarely.
Light energy (laser) or electrical energy (radiofrequency) may be used to seal shut abnormal main superficial trunk veins. Both treatments involve the application of heat energy to the inside of the long or short saphenous veins. Usually, treatment of the great saphenous vein (GSV), also called the long saphenous vein (LSV), and the longest vein in the body running along the length of the leg, starts at a location in the vein at or below the knee. The GSV is then treated from its junction to the deep system at the level of the groin down to the entry site near the knee. Ultrasound guided injections may also be used to seal the GSV or LSV.
Vein treatment programs are designed to treat visible varicose veins and to treat abnormal veins that may not be visible but that may be the source of the visible varicosities. If varicose veins are the only abnormality detected by the treating physician, the treatment involves surgical removal of the visible varicose veins (micro-incision phlebectomy) or the injection of chemicals (sclerosants) into the vein (sclerotherapy).
For the treatment of the visible veins to last a long time, the source that may not be visible to the naked eye must be controlled as well. From a practical standpoint some insurance carriers will not pay for treatment of branch varicosities if an abnormal main trunk is not treated at the same time or before the branches are treated.
The properly fitted gradient compression stocking can temporarily reverse the effects of vein disease and lessen the discomfort as well as skin damage. Many insurance companies require a trial of stocking use before approving definitive therapy.
Most studies have shown that sclerotherapy is far superior to surface laser treatment for spider veins. If you undergo laser treatment, make sure that you have undergone a proper evaluation by a medical practitioners experienced in venous disease.
Neither foam sclerotherapy nor conventional sclerotherapy is covered by insurance regardless of symptoms. However, if you do have symptoms of pain or discomfort in your legs, most primary care physicians will provide a referral for an Initial Consultation even if the eventual treatment choice may not be a covered service.
Most insurances cover the cost of endovenous procedures as well as a microphlebectomy. Some may require a prior approval.