Tag: varicose veins

Will My Sclerotherapy Procedure Be Painful?

Sclerotherapy uses ultrasound guidance to inject a medication into veins, causing scarring to occur and closing the vein permanently. This procedure is routinely used at IVC and patients want to know how this procedure compares to EndoVenous Thermal Ablation (EVTA) as far as pain caused during the procedure and recovery time after the procedure.

The sclerotherapy procedure often involves multiple injections along the course of the the problematic veins. Patients often ask if a local numbing agent could be used to anesthetize the area before the injection of the sclerosing agent. This technique is not used as this would require two needle sticks, one needle stick to inject a numbing agent and another needle stick to inject the sclerosing agent. In general most patients tolerate the sclerotherapy procedure well and do not need any anesthetic agent.

The post-procedure pain is usually localized to the area where the vein was injected. This pain is not nearly as intense as the pain following the EVTA but will be noticeable for longer. In fact it may take several weeks for the veins to be resolved by the body. During this time you may experience tenderness from these areas. A mild pain reliever like ibuprofen helps but really the biggest factor is giving the body time to resolve the treated veins.

Why do I see so many different doctors during the course of my treatment?

At IVC we currently have 7 different doctors that treat varicose veins. All of them are Interventional Radiologist. They are radiologist in the classic sense that read X-rays and MRI’s, but they have also done additional training to do minimally invasive procedures that use various imaging techniques to accomplish it. Our doctors perform a wide variety of procedures in all areas of the body. IVC is not the only location they do procedures in, they also work in two different hospitals. Just about every day they are working in a different location. A doctor may only rotate to IVC 2-3 times a month.

 

Because of this the majority of our patients will choose a day that works for them to have their procedure on and simply have whatever doctor is working that day perform their procedure. Hence most patients will end up seeing several different doctors to perform their procedures. This generally works out for most patients because there is very little difference in technical expertise from one doctor to the next.

 

Some patients prefer to have one doctor perform all their treatments while at IVC. This is a perfectly acceptable way to proceed through the treatment process, the only challenge is matching the patients schedule up with the preferred doctor. In most cases this will prolong the overall treatment process, but if the patients don’t mind then we can accommodate.

Is it safe to close down veins? Don’t you need those veins?

Often times when we are talking to patients about closing down their problematic varicose veins we will get asked “are you sure you can close down those veins?” or “doesn’t my body need those veins, are you going to make things worse?”

When treating varicose veins we explain to patients that we are treating superficial veins and these veins only return 10% of the blood from the legs. The remaining 90% is returned through the deep system. We are not treating or closing down any deep veins, in addition, there are so many remaining superficial veins that are still working properly that we close down the problematic ones and improve symptoms in you legs.

Another question asked often is “What is the limit to how many veins you can close down without causing a problem?” That is a difficult question to answer, but so far we have not reached an upper limit in treating varicose veins where we would feel that treating anymore veins may create problems instead of solving them.

Why can’t all my Varicose Veins be treated in one session?

Often patients want to know why all of their procedures for varicose veins cannot be done all in one setting. At IVC we understand that it would be more convenient for some patients to have all the procedures done at once, but there are a few reasons this is not done.

The primary reason that we don’t combine all the procedures in one day is because some of the problematic veins may resolve after treatment of larger veins. At IVC your treatment plan begins with the principal veins that are causing the majority of problems. For example sometimes when we see moderate to severe reflux in the Greater Saphenous Vein (GSV) and mild reflux in the Small Saphenous Vein (SSV) the Small Saphenous Vein may actually resolve and therefore no treatment is necessary after treatment of the Greater Saphenous Vein. This is also true for the visible bulging veins seen in the legs, as they are branches arising off of larger, more problematic veins. That is why these veins are often treated last, because resolution of the primary problem can reduce these remaining veins to the point that treatment is not needed.

Concern for lidocaine toxicity is another reason that we do not combine treatments. Lidocaine is the local anesthetic that we use to numb the extremity, and there is a limit to the amount a person can be givin in one setting. By treating a vein that may run the length of the leg we approach that limit and treating more may put the patient at unnecessary risk.

Through years of treating patients we have developed methods that we feel give patients the best results while minimize exposure to unnecessary risks.

What are Varicose Veins?

Varicose veins are enlarged veins that are swollen and raised above the surface of the skin. They can be dark purple or blue, and look twisted and bulging. Varicose veins are commonly found on the backs of the calves or on the inside of the leg. They develop when valves in the veins that allow blood to flow toward the heart stop working properly. As a result, blood pools in the veins and causes them to get larger. Veins have an estimated prevalence between 5% to 30% in the adult population, with a female to male predominance of 3 to 1. The technical name for varicose veins is Chronic Venous Insufficiency(CVI).

Although the most common manifestations of CVI are dilated veins, such as telangiectases, reticular veins, and varicose veins ,CVI also includes problematic veins that are not visible to the eye causing a condition that is called venous hypertension. Venous hypertension can cause various pathologies including pain with standing or sitting for prolonged periods of time, achiness, heaviness, swelling, cramps at night, edema, skin changes, and ulcerations.

Risk factors found to be associated with CVI include age, sex, a family history of varicose veins, obesity, pregnancy, phlebitis, and previous leg injury. There also may be environmental or behavioral factors associated with CVI such as prolonged standing and perhaps a sitting posture at work. Varicose veins have a significant impact on lifestyles, with millions of people seeking medical attention for their symptomatic and cosmetic problems annually.

Why veins in the feet are are not treated.

In the feet there is very little muscle and fat tissue surrounding the veins. The arteries, veins and nerves are all very close together in the feet. With all of these vessels being in very close proximity there is a high risk of causing problems to the artery or nerve when the vein is treated. If veins are treated in the feet, irritation and inflammation in the foot can cause spasm in the artery or nerve that can cause permanent problems. These problems can include necrosis or tissue death, chronic numbness and the possibility of foot drop or the inability to lift the toes up when walking.

How do you determine which veins to treat?

In addition to obtaining a detailed medical history and physical examination, we perform a comprehensive ultrasound evaluation that will help identify the sources of venous disease. The comprehensive ultrasound will be very detailed and will evaluate the deep system for any blood clots or other problems, and the superficial system for blood clots and venous disease.

The veins that can be treated have reflux or blood that is allowed to flow backwards. There are small one way valves in the venous system that stop the blood from flowing down the vein rather than up towards the heart. When these valves are not working you are diagnosed with varicose veins. Varicose veins or veins with reflux are ones that can be treated.

Am I a candidate for varicose vein treatment?

If you have pain, swelling, heaviness or achiness in your legs, ankles, or pelvis you may have varicose veins (venous insufficiency). Typically, those with varicose veins also suffer from pain and achiness while sitting, standing or walking for long periods of time. You may experience the achiness and pain in the evening or when you are laying down in bed for the night.

The pain and achiness may be something that you experience occasionally or on a daily basis. The use of Ibuprofen and Tylenol may give you some relief of the pain and achiness. Venous insufficiency is a disease and should be treated by professionals who specialize in comprehensive varicose vein management including diagnosis and treatment.