Varicose veins – Today's Parent, May 2008
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Varicose veins – Today's Parent, May 2008

Leg Work: Varicose veins creeping up on you?

Here are the latest treatment options.
 
By Alison Wood
 
After years of putting it off, its time to take my legs in hand. I’ve had a bluish-green network of varicose veins running behind my knees since my first child was born eight years ago. Two more children later, and my calves and thighs now resemble a multi-lane highway. 
        
“The good news is your varicose veins seem to be superficial, “ says Diana Phillips, a registered nurse at DLK on Avenue Dermatology & Cosmetic Laser Surgery Clinic in Toronto. Phillips taps the largest superficial veins in my legs to feel how the blood flows through them. This test , coupled with a visual examination, helps determine whether she can treat my problem at the clinic or needs to send me off to a vein specialist. 
        
I’m not alone. Women are almost twice as likely to get varicose veins as men. In fact, 25 percent of women in the US have them. 
        
Does that mean you’re doomed to keep your legs under cover? Of course not! Here’s the lowdown on the causes of varicose veins- and treatments. 
 
UNDER PRESSURE
If your legs look like your toddler has taken a blue marker to them, thank your parents- heredity is the main cause. But prolonged standing, obesity, aging and heat can make them feel and look worse.

So can pregnancy. As your fetus grows, you gain weight, putting pressure on the veins in you pelvis, explains Ferdinand Stasiak, medical director of the Vein & Laser Clinic in North Vancouver. Your body also tends to hold more water, adding to the pressure. And the same hormones that nourish the placenta cause your muscles to relax, which can lead to dilated veins.
                         
Confusing? Picture your veins as roads transporting blood to your heart through your body. If a vein gets blocked and the blood reverses, it pools like a traffic jam, causing veins to swell and bulge and, eventually, producing varicose and spider veins.
 
TELLTALE SIGNS
You have varicose veins for years without being bothered by them, explains Stasiak, until complications develop. Some people experience heavy, achy, tired legs and swollen ankles. Others complain of skin problems, ranging from dry itcy skin to rashes, ulcers or little buldges that can burst and bleed externally, if left untreated. A small number of people may even develop superficial blood clots or deep vein thrombosis (DVT) – a clot in a deep vein in the body – as blood stagnates in diseased veins.
 
ROADSIDE ASSISTANCE
Depending on the extent of the vein disease and expectations, different treatments are available. You may need more than one treatment to tackle the problem. Luckily I don’t have any symptoms except for visible veins, so sclerotherapy (see below) should give me the cosmetic results Im looking for. Read on to find a treatment that’s perfect for your pair.
 
Sclerotherapy This is the most common varicose vein treatment, and works best on spider and reticular veins- the flat, blue veins visible beneath the skin. A registered nurse or medical practioner injects a tiny needle filled with a chemical to irritate the vein, causing it to collapse and eventually be absorbed by the body. You may need several sessions to get the results you want. Side effects can include mild swelling and bruising.
 
A new treatment on the scene is ultrasound guided foam sclerotherapy, which uses a foam solution instead of liquid to irritate the vein wall. According to Stasiak, foam is more effective because of the tiny bubbles fill the vein better and remain there longer. Because the foam can obscure the position of the needle, though, there is a greater risk of hitting an artery or developing DVT. 
Cost $45.00(per session) for an isolated spider cluster to $350 for traditional scelerotherapy; $200 to $600 for ultrasound guided foam sclerotherapy. 
 
Since varicose vein treatment may require several treatments and can cause bruising, give yourself several months before you need to shimmy into shorts or a swimsuit.
 
Endovenous laser treatment (EVLT) This treats the longer and larger leg veins. Through a small incision, a surgeon threads a fine catheter into the vein, which lasers it closed. The surface veins connected to those being treated may also shrink; if they don’t they can be injected with sclerosant. EVLT is preformed under local anaesthesia and you usually go home the same day. Although there may be bruising, pain is minimal and recovery relatively quick, with low risk of bleeding or infection- making it an increasingly popular procedure. 
Cost about $2,500 per session.
 
Surgical ligation and stripping When the varicose vein is too large for sclerotherapy, or too ropy for a catheter to pass through, surgery may be the answer. Under local or general anaesthesia, problematic veins are tied shut and pulled from the leg. Most varicose veins removed by surgery are surface veins, which don’t affect blood circulation. Recovery can take several weeks and there is a possibility of infection, bleeding or DVT. This treatment is used less now than in the past. 
Cost covered by most provincial health plans.
 
Ambulatory phlebectomy This is often the best choice for branches of the main leg vein after the main vein has already been treated with foam sclerotherapy, EVLT or surgical ligation. Under local anaesthesia, veins are removed through a series of tiny incisions, which are less prone to infection or bleeding and leave only tiny, imperceptible scars. Cost $200 to $1000.

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