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Venous Disease - Varicose Veins

Description of Clinical Program
What are varicose veins?

Varicose veins are dilated superficial veins that are normally invisible underneath your skin. There are normally two systems of veins in your leg: a superficial system and a deep system. The deep system of veins communicates with the superficial system through "perforating veins". The superficial veins may become dilated due to a blockage in the deep system of veins, or from an overflow of blood from the deep system (through the perforating veins). Varicose veins can cause an unsightly appearance, as well as cause symptoms in the legs. Patients complain of fatigue, heaviness and aching of their legs, especially when standing erect for long periods. This problem is the most common vascular problem in the lower extremity, affecting 10-20% of the population.

How do you diagnose varicose veins?

Most people who have varicose veins can tell you by looking at their legs. However, there a number of tests that can tell the physician the cause of varicose veins. Physical examination can often determine whether there is a blockage in the deep system of veins, or if the perforating veins are incompetent (leaking). Other tests can be ordered to confirm this diagnosis. These include venous ultrasound (duplex) and plethymography (done with blood pressure cuffs). When the cause of the varicose veins is determined, different treatment options are available.

What can be done about varicose veins?

Most varicose veins can be treated with conservative (non-operative) treatment. This includes elastic support stockings and elevation of the leg (above the heart) when sitting. However, there are times when an operation may help in the treatment of varicose veins. An operation can be indicated when a patient has severe symptoms of aching legs or has developed infections or ulcers in the legs due to their varicose veins. In addition, many patients seek a surgical cure for cosmetic reasons, to remove the unsightly veins.

What are the surgical options for the treatment of varicose veins?

The most common procedure for treating varicose veins is sclerotherapy. This involves wrapping the leg and injecting a solution (sclerosant) with causes the veins clot and scar.

The veins can also be tied off (ligation) or removed from the leg completely (stripping). This requires a series of incisions on the leg that will cause small scars. There are also other more advanced reconstructive surgeries with can be performed on the veins in special circumstances.

Laser therapy has been utilized for the treatment of telangectasias (spider veins) of the legs. However, the results of laser therapy has been disappointing.

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