You're (not) so vein:You're (not) so vein:Causes, prevention and Causes, prevention and treatment of varicose veins treatment of varicose veins

Women's Connection Luncheon

Dr. Jack Shellito, MD, RPVI

July 10, 2012

Acropolis in Greece

5th Century B.C.

Anatomic Drawings of Leonardo Da Vinci

What are Spider Veins and What are Spider Veins and Varicose Veins?Varicose Veins?

Spider Veins Spider Veins and Varicose Veinsand Varicose Veins

Telangiectasias (“Spider Veins”) Venulectasias Reticular Veins Varicose Veins

Telangiectasias <1mm Diameter (“Spider Veins”)

Reticular Veins1-3 mm (“Blue Veins”

“Venulectasias”)

Varicose Veins-Subcutaneous Dilated Veins >3mm Diameter

What Causes Varicose and What Causes Varicose and Spider Veins?Spider Veins?

Normal Vein Valve Function

Incompetent Vein Valves With Varicose Veins

How Common are How Common are Abnormal Leg Veins?Abnormal Leg Veins?

Venous Disease Venous Disease —— Scope of the Problem Scope of the Problem

Vein Problems seen in 50-55% of females 40-45% of males

Varicose veins present in 1 out of 2 people age 50 and older

What Are The Risk Factors For What Are The Risk Factors For Varicose and Spider Veins?Varicose and Spider Veins?

Risk Factors for Developing Risk Factors for Developing Varicose or Spider VeinsVaricose or Spider Veins Family members with vein problems Increasing age Hormonal changes

Puberty BCP’s Hormonal Replacement

Pregnancy Obesity Leg injury Prolonged standing (weakens valves) Sun exposure (spider veins)

Why do Varicose and Spider Why do Varicose and Spider Veins Usually Appear Veins Usually Appear in the Legs?in the Legs?

Gravitational Pressure Can Overwhelm Vein’s One-Way Valves

Are Varicose and Spider Are Varicose and Spider Veins Painful or Veins Painful or Dangerous?Dangerous?

Spider and Varicose VeinsSpider and Varicose Veins

Spider vv usually do not need medical treatment. But varicose vv usually enlarge and worsen over time.

Severe varicose veins can cause health problems including:

Blood clots Sores or skin ulcers Ongoing swelling and skin

irritation/rashes

Eczematous Skin Changes

Pigmentation

Pigmentation

Active Venous Ulcer

What are the SymptomsWhat are the Symptoms of Varicose Veins? of Varicose Veins?

Common Symptoms ofCommon Symptoms of Varicose Veins Varicose Veins Aching pain Easily tired legs Leg heaviness/fatigue Leg swelling Darkening of the skin Numbness in legs Itching Irritated rash in legs Night cramps Restless legs Bleeding/skin breakdown

How Can I Prevent How Can I Prevent Varicose and Spider Veins?Varicose and Spider Veins?

Prevention/Symptom Relief Prevention/Symptom Relief of Venous Diseaseof Venous Disease

Wear sunscreen (prevents spider veins) Exercise to improve leg strength,

circulation, and vein strength Control weight to reduce the pressure on

your legs Elevate your legs when resting as much

as possible

Prevention/Symptom Relief Prevention/Symptom Relief of Venous Disease (cont.)of Venous Disease (cont.)

Do not stand/sit for prolonged periods of time. Stand up and move around every 30 minutes

Wear elastic support stockings Eat a low salt diet to reduce swelling Eat a high fiber diet to reduce

constipation

Should I See a Doctor Should I See a Doctor About My Varicose Veins?About My Varicose Veins?

See a Physician See a Physician About Your Varicose Veins If:About Your Varicose Veins If:

The veins become swollen, red, tender, or warm to the touch

There are sores/rashes on the leg or near the ankle with the varicose veins

You have bothersome symptoms as described above

How Are Varicose How Are Varicose and Spider Veins Treated?and Spider Veins Treated?

Closure of Varicose Veins Closure of Varicose Veins With Laser Fiber Inside Vein With Laser Fiber Inside Vein (Endovenous)(Endovenous)

Endovenous Laser Closure Endovenous Laser Closure of Varicose Veinsof Varicose Veins Treatment for larger varicose veins of legs

(saphenous veins) Successful in 98% of patients Performed in-office Well tolerated with local anesthesia Fewer complications with avoidance of general

anesthesia Has replaced old procedure of ligation and

stripping of varicose veins

Laser Endovenous Ablation

Endovenous Laser ProcedureEndovenous Laser Procedure

Endovenous Laser Treatment-Endovenous Laser Treatment-VideoVideo

Dress leg with compression bandage Walk for 20 minutes Compression stocking for 2–4 weeks Resume normal activities Anti-inflammatories for 2–4 weeks Over-the-counter pain medications

(Ibuprofen)

Postoperative Postoperative Endovenous Laser TreatmentEndovenous Laser Treatment

Pre-Treatment 1 Wk Post-EVLT

Great Saphenous VeinGreat Saphenous Vein

Pre-Treatment One Week Post Treatment

Pre-Treatment 1 Wk Post-EVLT

Small Saphenous VeinSmall Saphenous Vein

Pre-Treatment One Week Post Treatment

Lower treatment costs compared to surgery Minimal scarring Minimal down time Faster return to normal activity Excellent symptom relief Vein closure maintained with long term

follow-up

Advantages of Endovenous Laser Advantages of Endovenous Laser Treatment of Varicose VeinsTreatment of Varicose Veins

Sclerotherapy for Spider Sclerotherapy for Spider VeinsVeins

Injection SclerotherapyInjection Sclerotherapy for Spider Veins for Spider Veins

Office procedure, no anesthesia Physician injects solution (Polidocanol) into

vein that causes vein walls to swell, stick together, and seal shut

Same vein may need to be treated more than once

Most patients can expect 50-75% improvement

Out-of-Pocket expense

Topical Laser TherapyTopical Laser Therapy for Spider Veins for Spider Veins

Topical Laser SclerotherapyTopical Laser Sclerotherapy for Spider Veins for Spider Veins

Topical laser beam sends burst of light through skin into vein to make vein slowly fade and disappear

No needles, but heat from laser on skin can be painful

2-5 treatments/site generally needed Not effective for veins > ¼ inch diameter Out-of-Pocket expense

Combined Topical Laser and Cooling UnitCombined Topical Laser and Cooling Unit

Before After

Topical Laser SclerotherapyTopical Laser Sclerotherapy

Venous disease is an epidemic in the U.S. Most is inherited (don’t say your parents never

gave you anything) Treat smaller (spider) veins with topical laser

or sclerotherapy (out-of-pocket expense) Treat larger (varicose) veins with endovenous

laser (usually covered by insurance for patients with symptoms)

You’re (Not So) Vein You’re (Not So) Vein —— ConclusionsConclusions

Thank You For Your

Kind Attention!

Questions?