Venous Conditions

normal vein vs. dilated vein

Information About Venous Disease

Your legs are made up of a network of veins. Healthy leg veins contain valves that open and close to assist the return of blood back to the heart. Venous reflux disease develops when the valves that keep blood flowing out of the legs and back to the heart become damaged or diseased. This can cause blood to pool in your legs and lead to symptoms such as pain, swelling, swollen limbs, leg heaviness and fatigue, skin changes and skin ulcers, and varicose veins.



Vein Anatomy

Venous Reflux Disease Symptoms


Venous Conditions

Click below to view a 30 second video-clip about venous reflux





Spider Veins

Spider veins, medically known as telangiectases, are dilated capillary veins less than 2mm in diameter. They are small, blue to red appearing blood vessels that lie close to the surface of the skin and occur either in lines or web-like patterns. They are usually visible on the legs but sometimes are visible around the nose and lips and are commonly referred to as "broken veins." They can ache, burn or itch now and then, but they are usually not symptomatic. Spider veins are not harmful and are simply unsightly.

Varicose Veins

Varicose veins are ropy appearing blue vessels under the skin, usually ¼ inch or larger in diameter. They are most often branches from the saphenous trunk veins, and have enlarged due to the excess pressure in the saphenous system. Varicose veins are unsightly and often painful. A clotted varicose vein causes the classic phlebitis, hot and red and painful skin at the site of the clot. Besides the visible symptoms, physical symptoms are tiredness, restless legs at night, heaviness in the leg, pain, aching, itching, throbbing and swelling, burning or a cramping sensation

Vein Procedures


After a comprehensive evaluation that includes physical examination and, often duplex ultrasonography, our vein specialists will determine the optimal treatment that best serves our patient's needs. These services often include:


Sclerotherapy

Sclerotherapy is a procedure used to treat varicose veins and spider veins. A tiny needle is used to inject a solution directly into the vein. The solution irritates the lining of the vessel, causing it to swell and stick together, and the blood to clot. Overtime, the body will absorb the treated vein. Mild discomfort may occur, and a cramping sensation may be felt for 1 to 2 minutes when larger veins are injected. The number of veins injected in one session is variable, depending on the size and location of the veins, and the patient's overall medical condition. Anywhere from one to several sclerotherapy sessions may be needed for any vein region. Medically prescribed support hose and/or bandages may need to be worn for several days to several weeks to assist in resolution of the veins. In general, spider veins respond to treatment in 3 to 6 weeks, and larger veins respond in 3 to 4 months.

Ambulatory Phlebectomy

Ambulatory phlebectomy is a method of surgical removal of surface varicose veins. This is usually completed in our office using local anesthesia. Incisions are small and stitches are usually not necessary. After the vein has been removed by phlebectomy, a bandage and/or compression stocking is worn for a short period.

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Venous Ablation

Highlights of the Closure® procedure

  • Relief of symptoms
  • Resume normal activity within a day
  • Outpatient procedure
  • Local or general anesthesia
  • Good cosmetic outcome with minimal to no scarring, bruising or swelling

The Closure® procedure
Closure Procedure Illustration The VNUS® Closure procedure, an alternative treatment option to traditional vein stripping surgery, brings state-of-the-art technology to an age-old disease.

The Closure procedure is performed on an outpatient basis. Using ultrasound, your physician will position the Closure catheter into the diseased vein, through a small opening in the skin. The tiny catheter delivers radiofrequency (RF) energy to the vein wall. As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins.

Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. Your doctor may encourage you to walk, and to refrain from extended standing and strenuous activities for a period of time.

Patients who undergo the Closure procedure typically resume normal activities within a day.

Click below to view the VNUS Medical Technologies ClosureFast procedure


The Closure® procedure — A Treatment That Work
Clinical results indicate that the Closure procedure can be effective at closing the vein and significantly reducing patient symptoms.

(Note:These results were obtained using VNUS Closure and VNUS ClosurePlus; RF products with expandable extrodes)

At two years following treatment, patients who had undergone the Closure procedure reported superior quality of life compared to vein stripping patients.1

The Closure procedure has proven to be highly effective, with 87% of veins treated remaining closed at 5 years. 2 Results also demonstrate long-term relief of symptoms.2

Patient Symptoms Reported at Follow-up2



Three randomized trials of the Closure procedure versus vein stripping, including the multi-center comparative trial published August 2003 in the Journal of Vascular Surgery, show very similar results.2,3,4 In the most recent trial every statistically significant outcome was in favor of the Closure procedure, resulting in1:

  • Experienced less post-operative pain and bruising
  • Resumed normal activities within one day
  • Returned to work more than a week earlier than vein stripping patients

Visual Results:5

Photo courtesy of Michael A. Vasques, MD

Percent of Legs without Varicose Veins at Follow-up

The Closure procedure is shown to be effective as vein stripping in delaying the reappearance of varicose veins.

Treatment 1 Year 2 Years
Closure6 90% 87%
Vein Stripping7 86% 75%
Ligation7 86% 57%
1 Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (Closure) versus ligation and stripping in a selected patient population (EVOLVES study). J Vasc Surg 2003;38:207-14.
2 Merchant RF, et al. J Vasc Surg 2005; 42: 502-9
3 Stötter L. Schaaf I, Fendl R, Bockelbrink A. Randomized Study to Compare the Closure Procedure, Invagination Stripping and Cryo Stripping for Treatment of the Greater Saphenous Vein. Abstract submitted to German Society for Phlebology for presentation Sept. 2003.
4 Rautio T, Ohinmaa A, Perälä J, Ohtonen P, Heikkinen T, Wiik H, et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: A randomized controlled trial with comparison of costs. J Vasc Surg 2002;35:958-65.
5 Photos Courtesy of Michael A. Vasquez, MD.
6 Merchant RF, DePalma RG, Kabnick LS. Endovascular Obliteration of Saphenous Reflux: A Multicenter Study. J Vasc Surg 2002;35:1190-6.
7 Jones L et al. Neovascularisation is the Principal Cause of Varicose Vein Recurrence: Results of a Randomized Trial Of Stripping The Long Saphenous Vein. Eur J Vasc Endovasc Surg 1996;12:442-445

Introducing the VNUS ClosureFASTTM catheter
VNUS ClosureFAST As leaders the field of vein disease treatment, we are proud to offer our patients the latest in treatment technology.

Our facility is proud to announce the availability of the VNUS ClosureFASTTM catheter.

The new generation VNUS ClosureFAST catheter was introduced and received FDA clearance in August 2006 and is a culmination of approximately four years of research and development. The ClosureFAST catheter is designed to significantly reduce procedure time and enhance ease-of-use for the physician. Like the original VNUS Closure catheter, the ClosureFAST catheter uses RF energy and VNUS RF generators to deliver controlled energy and monitor treatment temperature for the purpose of closing diseased veins. The Closure procedure using the ClosureFAST catheter minimizes the post-procedure pain and bruising commonly associated with the competitive endovenous laser treatment.

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FAQ

QUESTIONS & ANSWERS: Venous Disease

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.

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, contracting 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.

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.

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.

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.

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.

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.

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.

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."

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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QUESTIONS & ANSWERS: The Closure® procedure

What is superficial venous reflux?
Superficial venous reflux is a condition that develops when the valves that usually keep blood flowing out of your legs become damaged or diseased. This causes blood to pool in your legs. Common symptoms of superficial venous reflux include pain, swelling, leg heaviness and fatigue, as well as varicose veins in your legs.

What is the Closure procedure?
The Closure procedure is a minimally invasive treatment for superficial venous reflux. A thin catheter is inserted into the vein through a small opening. The catheter delivers thermal energy to the vein wall, causing it to heat, collapse, and seal shut.

How does it work to treat superficial venous reflux?
Since valves can't be repaired, the only alternative is to re-route blood flow through healthy veins. Traditionally, this has been done by surgically removing (stripping) the troublesome vein from your leg. The Closure procedure provides a less invasive alternative to vein stripping by simply closing the problem vein instead. Once the diseased vein is closed, other healthy veins take over and empty blood from your legs.

How is the Closure procedure different from vein stripping?
During a stripping procedure, the surgeon makes an incision in your groin and ties off the vein, after which a stripper tool is threaded through the saphenous vein and used to pull the vein out of your leg through a second incision just above your calf.

In the Closure procedure, there is no need for groin surgery. Instead, the vein remains in place and is closed using a special (Closure) catheter inserted through a small puncture. This may eliminate the bruising and pain often associated with vein stripping (i.e., that may result from the tearing of side branch veins while the saphenous vein is pulled out). Vein stripping is usually performed in an operating room, under a general anesthetic, while the Closure procedure is performed on an outpatient basis, typically using local or regional anesthesia.

Is the Closure procedure painful?
Although some people are more sensitive than others, patients generally report little pain. Some have said they can feel a little heat when the catheter is energized.

Will the procedure require any anesthesia?
The Closure procedure can be performed under local, regional, or general anesthesia.

How quickly after treatment can I return to normal activities?
Many patients typically return to normal activities within a day.1 For a few weeks following the treatment, your doctor may recommend a regular walking regimen and suggest you refrain from very strenuous activities (heavy lifting, for example) or prolonged periods of standing.

(Note: These results were obtained using VNUS Closure and VNUS ClosurePlus; RF products with expandable extrodes)

How soon after treatment will my symptoms improve?
Most patients report a noticeable improvement in their symptoms within 1-2 weeks following the procedure.

Is there any scarring, bruising, or swelling after the Closure procedure?
Patients report minimal to no scarring, bruising, or swelling following the Closure procedure.

Are there any potential risks and complications associated with the Closure procedure?
As with any medical intervention, potential risks and complications exist with the Closure procedure. All patients should consult their doctors to determine if their conditions present any special risks. Your physician will review potential complications of the Closure procedure at the consultation, and can be reviewed in the safety summary. Potential complications can include: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, adjacent nerve injury (tingling or numbness) and/or skin burn.

Is the Closure procedure suitable for everyone?
Only a physician call tell you if the Closure procedure is a viable option for your vein problem. Experience has shown that many patients with superficial venous reflux disease can be treated with the Closure procedure.

Is age an important consideration for the Closure procedure?
The most important step in determining whether or not the Closure procedure is appropriate for you is a complete ultrasound examination by your physician or qualified clinician. Age alone is not a factor in determining whether or not the Closure procedure is appropriate for you. The Closure procedure has been used to treat patients across a wide range of ages.

What happens to the treated vein left behind in the leg?
The vein simply becomes fibrous tissue after treatment. Over time, the vein will gradually incorporate into surrounding tissue.

Is the Closure treatment covered by my insurance?
Many insurance companies are paying for the Closure procedure in part or in full. Most insurance companies determine coverage for all treatments, including the Closure procedure, based on medical necessity. The VNUS® Closure procedure has positive coverage policies with most major health insurers. Your physician can discuss your insurance coverage further at the time of consultation.

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1 Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (Closure) versus ligation and stripping in a selected patient population (EVOLVES study). J Vasc Surg 2003;38:207-14.

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