advancing vein care
a publication by
treatment of varicose and spider veinspatient information
SAMPLE
2 AmericanCollegeofPhlebology
introduction
Ifyousufferfromvaricoseandspiderveins,youarenotalone.
Itisestimatedthattherearemorethan80millionAmericanswhosufferfromsomeformofvenousdisorder.Whilesomepeopleseektreatmentforcosmeticimprovement,manyseekrelieffrompain.Helpisavailable.Phlebologyisthefieldofmedicinethatdealswithveindiseasesanddisorders.WhilephlebologyhasbeenanestablishedmedicalspecialtyinEuropeformorethan50years,seriousinterestinphlebologyhasonlydevelopedoverthepasttwodecadesintheUnitedStates.In2005,phlebologywasrecognizedbytheAmericanMedicalAssociationasamedicalpracticespecialty.
TheAmericanCollegeofPhlebology(ACP)wasfoundedin1985andisthelargestphlebologysocietyintheUnitedStates.TheCollegewasestablishedtoimprovethestandardofpatientcarerelatedtothetreatmentofveindisorders.ACPmembersarephysiciansandalliedhealthcareprofessionals,withbackgroundsinavarietyofmedicalspecialties,whoshareacommoninterestandexpertiseinthediagnosisandtreatmentofveindisease.
Thisbrochurecontainsinformationabouttheevaluationandtreatmentofvaricoseandspiderveinsinthelowerextremities.Specialattentionisgiventorecentadvancementsintheseareas.
Sincemostveins lie deeptotheskin’ssurface,veindisorders are not always visibletothenakedeye.
SAMPLE
www.phlebology.org 3
what are varicose veins?
Althoughveinsandarteriesarebothpartofthecirculatorysystem,theyworkinverydifferentwaysfromeachother.
Bloodispushedthroughoutthearteriesofthebodybypressurecreatedfromthepumpingoftheheart.Veins,unlikearteries,carrybloodagainsttheforceofgravity.Theyrelyonlegmusclecontractionandone-wayvalvesinsidetheveinstocarrybloodbacktowardtheheart.
Ifthevalvesinveinsfail,gravitykeepsbloodfromflowingbacktotheheartefficiently.Thisproducesabackup,orcongestion,ofblood.Asaresult,pressurebuildsupandthediseasedveinsbecomeenlarged,eventuallybulgingtotheskin’ssurface.Thesamediseaseprocesscanaffectveinsofanysize;howeverwhenlargerveinsfail,theyaretypicallycalledvaricoseveins.Whensmallerveinsareaffected,theyaretypicallycalledspiderveins.
Paininthelegsisfrequentlyrelatedtoabnormallegveins.Severevaricoseveinscancompromisethenutritionoftheskinandleadtodermatitisorarash,discoloration,orevenulcerationofthelowerleg.Sincemostveinsliedeeptotheskin’ssurface,veindisordersarenotalwaysvisibletothenakedeye.Asaresult,diagnosticultrasoundisoftenusedtodeterminethecauseandseverityoftheproblem.
Normal Vein Varicose Vein
SAMPLE
4 AmericanCollegeofPhlebology
what causes varicose veins?
Somepredisposingfactorsincludeaging,standingoccupations,andleginjuryortrauma.
Heredityisthenumberonecontributingfactorthatcausesvaricoseandspiderveins.Womenaremorelikelythanmentosufferfromabnormallegveins.
Upto55%ofAmericanwomenmaybeaffectedintheirlifetime.Hormonalfactorsseenduringpuberty,pregnancy,menopause,andtheuseofbirthcontrolpillsaffectthedisease.Itiscommonforvaricoseveinstobecomemoreprominentduringpregnancyandworsenwithsuccessivepregnancies.
Heredityisthenumberonecontributingfactorthatcauses varicose and spider veins.
SAMPLE
www.phlebology.org 5
how can phlebology help?
Varicoseveinsareknowntocausesymptomsthatmayincludelegaching,pain,heaviness,fatigue,ankleswelling,musclecramping,restlessness,itchingandburning.
Symptomsoftenworsenwithprolongedstanding.Skinchangesmayoccur.Theseincludebrownishdiscolorationovertheveinsorneartheankle.Apurplediscolorationrelatedtocongestionofsmallveinsaroundthefootandanklemayalsodevelop.Varicoseveinsmayalsoleadtocomplicationssuchasbloodclots,bleeding,rashes,andulceration.Veintreatmentcausesabnormalveinstodisappearandsymptomstoimprove.Itpreventsmoreextensiveveindiseasefromdevelopingandalsohelpstokeepseriouscomplicationsfromoccurring.
SAMPLE
6 AmericanCollegeofPhlebology
Up to 55%ofAmericanwomenmaybeaffectedintheirlifetime.
when and how are veins treated?
Themostcommonlyaskedquestionsare:“Doveinsrequiretreatment?”and“Whattreatmentisbest?”
Veinsthatcauselegpain,swelling,recurrentsuperficialbloodclots,bleeding,orulcerationareprimecandidatesfortreatment.Veinsthatcauseothersymptoms,suchasaching,heaviness,andfatigue,orthatarecosmeticallyunappealing,mayalsobenefitfromtreatment.Therearetwogeneraltreatmentoptions:conservativemeasures,suchascompressionstockingsandherbalpreparations;andcorrectivemeasures,suchasendovenousthermalablation,chemicalablation,surgery,sclerotherapy,andlightsource/lasertreatment.Inmanycases,acombinationoftreatmentmethodsworksbest.
SAMPLE
www.phlebology.org 7
endovenous thermal ablation
EndovenousThermalAblationisatreatmentalternativetosurgicalstrippingofvaricoseveins.Withultrasoundvisualization,asmallcatheterortubeisinsertedintothedamagedvein,usuallythroughaneedle.Thermalenergy,orheat,isthendeliveredinsidethevein,whichcausestheveintocollapseandsealshut.Theprocedureistypicallydoneinthedoctor’sofficeunderlocalanesthesia.Afterwards,alegwraporprescriptioncompressionstockingisusuallyplacedonthetreatedlegfor1-2weeks.Patientsareabletowalkimmediatelyaftertheprocedureandmostindividualsareabletoreturntoworkthenextday.
Schematicofendovenouslasertreatment.
Varicoseveinsbeforeandafterthermalablation.Individualresultscanvary.
SAMPLE
8 AmericanCollegeofPhlebology
endovenous chemical ablation
Alsoknownasultrasound-guidedsclerotherapy,endovenouschemicalablationisanothertreatmentalternativetosurgicalremovalofvaricoseveins.Withthisprocedure,achemicalirritant,calledasclerosant,isinjectedintotheveinwhilethedoctorobservestheinjectionprocessonanultrasoundscreen.Thisallowsveinsthatarebelowthesurfaceoftheskintobetreated.Sincetheseveinscannotbeseenvisually,theywouldotherwiserequiresurgicalremoval.Thistechniquecausestheveintocollapseandsealshut,andmaybeperformedwithliquidorfoamedsclerosant.Theprocedureisusuallyperformedinadoctor’sofficeandmaynotrequirelocalanesthesia.Itisnotuncommonforalegwraporprescriptioncompressionstockingtobeplacedonthetreatedlegfor1-2weeks.Patientsareabletowalkimmediatelyaftertheprocedureandmostindividualsareabletoreturntoworkthenextday.
surgery
Surgicaltechniquestotreatvaricoseveinsincludeligation(tyingoffavein),stripping(removingaveinbypullingitoutwithaspecialinstrument),andambulatoryphlebectomy(removingveinsthroughtinyincisions).Surgerymaybeperformedusinglocal,spinalorgeneralanesthesia.Nowdonealmostexclusivelyasanoutpatientprocedure,patientswillusuallygohomethesamedayastheprocedure.Itisnecessarytowearlegwrapsand/orcompressionstockingsforseveralweeksaftersurgery.Normalactivitiesmaygenerallyberesumedafterseveraldays.
SAMPLE
www.phlebology.org 9
ambulatory phlebectomy
Ambulatoryphlebectomyisamethodofsurgicalremovalofvaricoseveinsatthesurfaceoftheskin.Smallincisionsaremadenexttotheveinandsectionsofveinareremovedthroughthesesmallnicks.Thisisfrequentlydoneinthedoctor’sofficeusingonlylocalanesthesia.Afterwards,alegwrapand/orcompressionstockingiswornforashortperiod.Generally,normalactivitiesmayberesumedafterseveraldays.
sclerotherapy
Sclerotherapycanbeusedtotreatbothvaricoseandspiderveins.Atinyneedleisusedtoinjecttheveinswithoneofseveraldifferentkindsofchemicalirritant,orsclerosant,thatirritatestheliningofthevein.Inresponse,theveinscollapse,sealshut,andarereabsorbedbythebody.
Varicoseveinsbeforeandafterambulatoryphlebectomy.Individualresultscanvary.
Varicoseveinsbeforeandaftersclerotherapy.Individualresultscanvary.
SAMPLE
10 AmericanCollegeofPhlebology
(Sclerotheraphy continued)
Thenumberofsclerotherapytreatmentsneededisvariable,dependingonthenumber,size,andtypeofveinsbeingtreated.Typically,apatientwillreceiveseveralinjectionspertreatmentsession.Theprocedureisalmostalwaysperformedinadoctor’soffice,andgenerally,normalactivitiescanberesumedaftersclerotherapy.Prescriptioncompressionstockingsand/orlegwrapsmayneedtobewornforseveraldaysaftertreatment.
surface laser/ light source treatment
Avarietyoflaser/lightsourcetreatmentsareavailabletoday.Alightbeamcreatesheatinsidetreatedveinsthatcausesthemtobesealedoffandreabsorbedbythebody.Byandlarge,surfacelaser/lightsourcetreatmentsareusedonlytotreatthesmallestofspiderveins.Multipletreatmentsareregularlyrequired.Thisprocedureisalsousuallyperformedinthedoctor’soffice,requiresnolocalanesthesia,andnormalactivitycanberesumedfollowingtreatment.Prescriptioncompressionstockingsmayneedtobewornforafewdaysaftertreatment.
what results can you expect?
Technologicaladvancesinevaluationandtreatmentmethodsallowspiderandvaricoseveinstobetreatedmoreeffectivelyandsafelythaneverbefore.
Nevertheless,thesuccessofanytreatmentmethoddependsontwothings:carefulassessmentoftheunderlyingproblem,andtheskillandexperienceofthephlebologistprovidingthetreatment.Themostimportantcauseofvaricoseveinsisheredity;thus,evensuccessfultreatmentdoesnoteliminatethegeneticdispositionthatmaycauseotherveinstofailinthefuture.
SAMPLE
www.phlebology.org 11
complications of varicose vein treatments
Generallyspeaking,complicationsrelatedtovaricoseveintreatmentarerare.
Seriouscomplications,suchaslifethreateningallergyand/orbloodclots,mayoccurwithanytreatmentforlargevaricoseveins.Infectionmayoccurwithanysurgery,andskinburnsmayoccurwithanyformoflaser/lightsourcetreatmentorsclerotherapy.Minorcomplicationsmayincludetemporarydiscomfort,bruising,swelling,discoloration,orreddishblushingoftheskinfollowingtreatment.Tounderstandmoreaboutthespecificexpectationsofanyvaricoseveintreatment,itisimportanttodiscusstheseoranyotherconcernswithyourtreatmentproviderwhenconsider-ingyourprocedures.Althoughtheserisksaresmall,noprocedureisriskfree.
Itisimportanttodiscusstheseoranyotherconcernswithyourtreatmentproviderwhenconsideringyourprocedures.
SAMPLE
how can I get more information?
Avisittoaphlebologistwillhelpansweryourquestions.Heorshecanevaluateyourcondition,determineifanytestingisnecessary,anddiscussthetherapeuticoptionsavailable.Treatmentneedstobetailoredtoyourindividualneeds,basedonyourphysicalexaminationandmedicalhistory.
Toobtainalistofphlebologistsinyourarea,pleaseuseour“FindaPhysicianorProvider”searchfunctionatwww.phlebology.org,orcontacttheAmericanCollegeofPhlebologybyphoneoremail.
AmericanCollegeofPhlebology101CallanAvenue,Suite210SanLeandro,CA94577
Phone:510.346.6800Fax:[email protected]
Copyright©2014byAmericanCollegeofPhlebology
Printedonrecycledpaperusingsoybasedinks
advancing vein care
SAMPLE