Frequently Asked Questions

While tiny spider veins (telangiectasia) may be a cosmetic problem if they are not associated with pain, varicose veins are NOT just a cosmetic problem.

Although some patients with varicose veins may not experience pain, varicose veins will worsen with time. Patients with varicose veins eventually will develop complications which may include tired, heavy legs; swelling of the ankles; infection (cellulitis); clotting (thrombophlebitis); skin changes (stasis dermatitis); venous stasis ulcerations or poorly-healing wounds; pain; or itching.  Early detection and treatment of varicose veins may prevent many of these complications.

Look for a vein center where the physicians, nurses, and vascular technologists are trained and qualified to care for vein disorders.

Find a physician that is Board Certified in Surgery.  While physicians of many specialties may treat venous diseases, those trained in surgery have advantages over those without surgical training.

Look for a Diplomate of the American Board of Phlebology.  Since the evaluation and management of venous diseases have undergone a revolution over the past decade, surgical training and board certification in surgery alone are not guarantees of current expertise in management of venous diseases.  In 2008, the American Board of Phlebology offered its first certification examination in Phlebology. In order to achieve diplomate status, the candidates must prove substantial experience in treatment of venous diseases and they must pass a rigorous examination in the specialty of Phlebology.

Find a specialist that is full time dedicated to the treatment of venous disease.

Venous insufficiency is a chronic, progressive problem which will get worse over time and which will result in new, enlarging varicose veins and/or vein symptoms.  Even with very effective treatment of venous insufficiency, the effect of gravity will cause future enlargement of previously normal veins resulting in valve failure.

A careful clinical history and exam followed by venous color duplex ultrasound will help to sort out the location of problem veins so appropriate therapy can be chosen.

Treat the major problems as they occur which nearly always can be done with minimally-invasive procedures. Then, maintain a normal body weight, remain physically active with moderate exercise, avoid prolonged sitting or standing when feasible, perform calf muscle pump exercises often when sitting or standing, elevate the legs higher than the heart periodically, and wear elastic compression support hose as routinely as practical.

The veins which we remove or ablate (seal shut) for treatment of venous insufficiency already function incorrectly and allow blood to run away from the heart toward the feet.  Other veins already are carrying the blood back to the heart.  Treating the malfunctioning veins actually improves venous flow back to the heart.

By the time a saphenous vein is diseased enough to require treatment, it no longer is acceptable for use for a heart bypass procedure.  Cardiac surgeons use the radial artery from the forearm or the internal mammary artery (from inside the chest) for the heart bypass.

Vein stripping rarely is the appropriate technique for management of venous insufficiency. A detailed clinical evaluation and venous color duplex ultrasound exam are necessary to make individual recommendations, but endovenous thermal ablation with radiofrequency (VNUS ClosureFast or Venefit) or with LASER are more effective, safer, result in much less time off work, cause much less discomfort, and are much less costly than vein stripping.

In very special circumstances when a portion of the saphenous vein is immediately under the skin, we occasionally perform a special minimally-invasive procedure in the office with local anesthesia called perforate-invagination stripping.

See us for a detailed clinical exam and venous color duplex ultrasound exam.  Most ankle ulcers are due to venous insufficiency which is quite treatable.

High pressure in the veins of the ankles due to venous insufficiency, blockage of veins draining the legs, and/or obesity may cause swelling of the ankle, skin discoloration at the ankles, pain, or leg ulcers.

ALL patients with leg ulcers associated with swelling or discolored skin should be evaluated for venous insufficiency with a venous color duplex ultrasound exam to detect venous insufficiency.  An ultrasound exam which tests only for thrombus (DVT) as is commonly done outside vein centers does not evaluate for venous insufficiency.

Even patients who have only tiny spider veins (telangiectasia) should undergo venous color duplex ultrasound to identify underlying problems in the veins beneath the surface.  Spider veins may be a symptom of a larger problem that is not visible to the eye.  A thorough understanding of the venous anatomy (which varies considerably from person to person) and the location of valve failure or vein obstruction is necessary to develop a custom plan of treatment for each patient.

Follow-up of patients is highly individualized depending on the severity and type of venous disease.  Since venous problems are progressive, and since early treatment reduces long-term complications, periodic follow-up to evaluate and treat new problems is important.  Most vein patients should be re-evaluated at least annually.

Compression hose rarely are contraindicated.  With few exceptions, use of elastic compression stocking is a good idea for anyone with varicose veins or venous insufficiency.

A very small number of patients who have severe arterial blood flow problems or severe neuropathy with poor sensation in the feet may need to avoid compression hose, but most of those patients can still wear lighter compression hose with open toes without problems.

Proper fitting and proper wearing of the hose is important to prevent problems with the hose.  Generally, the hose should be removed for at least a few hours daily such as during sleep hours.