Venous Insufficiency
Varicose veins are common in the general population, with up to 20% of men and 65% of women having varicosities. These veins can range from small cutaneous telangiectasias ("spider veins") to protuberant, dilated and tortuous varicosities with pain, swelling, dermatitis, pigmentation and ulceration. The cause of varicose veins is multifactorial, with genetics, long periods of standing, and hormones (primarily estrogen and progesterone) all playing a role. These factors lead to incompetent venous valves that allow reflux of blood toward the feet with upright posture. The reflux in turn leads to dilated and elongated superficial veins and also explains the symptoms of swelling, heaviness and fatigue. When chronic venous insufficiency becomes severe, symptoms worsen and can ultimately lead to skin breakdown.
Evaluation of varicose veins begins with a careful history and thorough examination, with the patient both lying down and standing. Duplex ultrasound is then usually required to confirm clinical suspicion and assess the deep veins for reflux and valvular abnormalities. These studies can be challenging and are best performed in a vascular lab experienced with the procedure. Our Sotoyome vascular laboratory is one such facility, with extensive experience in varicose vein ultrasound.
Treatment can be conservative, usually in the form of compression stockings and aggressive leg elevation. However, patients often find compression stockings too demanding to wear consistently, ultimately decreasing their overall quality of life. Other options include (1) sclerotherapy, where small, superficial varicosities are injected with hyperosmolar agents that cause scarring and disappearance of the vein, (2) stab-vein avulsion, where segments of superficial varicosities are removed through 1-2 mm incisions, and (3) traditional saphenous vein stripping. More recently, methods to deliver radiofrequency or laser energy to the saphenous vein through small catheters have been developed and are now in widespread use. These methods offer the benefits of stripping without incisions, and they decrease patient discomfort.
Venous surgery has advanced significantly in the last 5-10 years. It is much less invasive than in the past, and it can be performed almost exclusively on an outpatient basis.
Members of Redwood Regional Vascular Associates are very experienced in treating all forms of varicose vein and venous insufficiency disease. We have recently added an outpatient procedure area at our Sotoyome facility, with state-of-the-art ultrasound and radiofrequency (VNUS) vein ablation equipment, allowing us to treat patients in a relaxed, comfortable, outpatient manner.
Mayo Clinic
Society for Vascular Surgery - Varicose Veins Information
VNUS