Treatment for Varicose Veins

To learn more about varicose veins, please watch this slide presentation:
Superficial Venous Insufficiency of the Lower Extremeties

Varicose Veins in Calf

Varicose veins, often mischaracterized as a cosmetic problem are actually a sign of an underlying disorder of the circulatory system called venous insufficiency. This condition is an enormous problem in the USA as it afflicts five times as many as arterial disease. By age sixty, 70% of women and 40% of men will suffer from this condition. Left untreated, it can lead to a chronic, debilitating, and sometimes limb-threatening condition.

A new, minimally invasive, office based treatment called the Venefit™ Procedure offers patients excellent relief from varicose vein disease. Unlike painful vein stripping, this treatment gets you back on your feet the very same day.

Normal Vein: Open and Closed. Dilated Vein: Leaky

To understand the treatment of varicose veins, it is important to understand their cause, venous insufficiency. Our circulatory system has four components; the heart, arteries, tissue capillaries, and veins. The heart pumps blood through the arteries to the tissues. Blood filters through tiny capillaries where oxygen and nutrients are delivered. Blood then circulates back to the heart and lungs through the veins. Whereas the heart pressurizes the blood for the trip to the tissues, this pressure is lost to the resistance of the capillary bed, so the pressure directing blood back to the heart in the veins is low. In the head, arms, and chest, gravity helps pull blood into the heart. However gravity works against the return of blood from the lower half of the body. The return of blood from the legs is directed by a series of one-way valves. When we walk, the veins are compressed as our muscles pump. Blood within the veins moves when they are compressed, and when the valves are working properly blood flows up towards the heart. When these valves leak, gravity wins the battle and pulls blood down. These leaky or insufficient valves are the underlying mechanism of varicose vein disease.

Veins: Front of the Leg and Back of the Leg

Much like driving where one goes from driveway to side street to major road to interstate, the return of blood through the veins proceeds through ever-larger branches. In the legs, the tiny veins in the skin (driveways) empty into larger branches below the skin (side streets), and then into the Greater Saphenous Vein, or GSV (highway). The GSV runs from the ankle to the groin where it joins the large femoral vein, returning blood to the larger veins in the pelvis.

Now what would happen if the valves in the GSV were to leak and allow gravity to pull blood down into the leg instead of returning to the heart?

    Ultasound Clip of Reflux

This reverse flow through the GSV forces veins to progressively enlarge to varicosities. Over time this unhealthy circulatory pattern leads to tissue damage, including swelling, dermatitis, and ulceration. As the blood is not flowing, the varicosities may clot, causing phlebitis, or they may rupture and bleed. Additional risks of untreated venous insufficiency include deep venous thrombosis and pulmonary embolism, a potentially fatal event. Patients with venous insufficiency may complain of aching, fatigue, itching or restless legs. Symptoms worsen at the end of the day. Relief is obtained with leg elevation, support stockings and pain medication. Because symptom onset is gradual, this disease may take decades to become apparent. All too often patients and physicians alike defer seeking care.

Click here to view a movie about venous insufficiency.

"Spider Veins" or telangiectasias are an early sign of venous insufficiency that appear when tiny skin veins, previously invisible, become engorged and enlarge. We evaluate many patients who present for treatment of spider veins, who have had these treated, only to see reappearance after 6-12 months. A careful ultrasound evaluation will usually show a deeper source of reflux in the GSV.

The primary contributing factor to vein disease is heredity. Vein insufficiency afflicts women with twice the frequency as men, and as many as 70% of women have some vein insufficiency by age 60. Hormonal factors play a significant role in aggravation of this disease. Puberty, menopause, birth control pills, estrogen/progesterone pills, can aggravate vein disease. Pregnancy can greatly exacerbate existing vein disease as the increased blood volume overwhelms the insufficient veins. Other predisposing factors include standing occupations, sudden weight loss or weight gain, leg injuries and aging. Pain, heaviness, aching, stinging, burning, itching, and restless legs are common symptoms of vein insufficiency, or reflux. These symptoms often worsen with long periods of standing and can lead to leg swelling, throbbing and leg cramps. Severely compromised vessels can cause phlebitis, dermatitis, or even ulceration of the skin.

Varicose Vein Treatment: VNUS Closure Device

Contributing factors to vein disease

Women often notice varicosities with pregnancy. During pregnancy, blood volume increases by as much as 50%. The leg veins are overloaded by increased blood volume, and manifest as varicose veins. After delivery, when blood volume returns to normal, the veins remain enlarged because the valve mechanisms have been rendered insufficient by the stretch endured during pregnancy. Some women note that the varicosities worsen with each pregnancy.

Varicose Veins: Before and After Treatment


A new outpatient treatment called the Venefit Procedure uses radiofrequency energy to close the leaky GSV, and eliminate a major cause of varicose veins. With the Venefit Procedure, a tiny catheter placed into the GSV delivers a form of light energy to the vein wall. This energy causes collagen in the vein to change shape, closing the vein. This elegant procedure is completed in about an hour with minimal or no discomfort and a return to work or normal activity the same day. Venefit is covered by most all insurances and is performed in an office setting. Clinical studies have shown outstanding safety, efficacy, and patient satisfaction. Patients are delighted with symptom relief and cosmetic improvement, 98% of whom would recommend Closure for a friend.

Patients who undergo the Venefit procedure for varicose veins typically resume normal activities within a day.


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