February 2019

Vein Health and Treatment

Lisa W. Darby, MD

Dr. Darby is a Vascular Surgery specialist in Greenville, South Carolina. She attended and graduated from University Of South Carolina School Of Medicine and has more than 16 years of diverse experience, especially in Vascular Surgery. She is affiliated with many hospitals including GHS Greer Memorial Hospital, GHS Laurens County Memorial Hospital, Oconee Medical Center, GHS Patewood Memorial Hospital, Saint Francis-Downtown. She answered some common questions about vein health, what treatment entails and how medical compression helps with venous issues.

1. How do you know your veins need treatment? What symptoms may you experience?
Whether you have spider veins or varicose veins, there are many reasons to consider treatment. Spider veins may be unsightly and discolored. Some people are embarrassed to show their legs or wear shorts because of their cosmetic appearance. But, spider veins are not just a cosmetic issue. More than 87 percent of patients experience pain, stinging and burning. Spider veins also may spontaneously bleed or rupture if they are close to the surface and enlarged.

Varicose veins can produce more serious symptoms. Most patients experience heaviness and swelling of their legs, usually after standing or sitting for prolonged periods. The veins also may be tender and sore and cause nighttime cramping. If the vein becomes red and inflamed, it may cause a superficial thrombophlebitis. More serious issues from untreated varicose veins are permanent skin discoloration and a wound or ulcer that may not heal.

2. Where should you go for vein treatment?
There are many practitioners and providers that treat venous issues, such as spider veins and varicose veins. If you experience any of the above symptoms, go see a qualified vascular physician who is trained in the practice of venous and lymphatic medicine and how to appropriately treat these issues – such as a phlebologist, vascular internist or vascular surgeon.

3. Who needs a procedure/intervention and what does that process entail?
For varicose veins and associated problems, a physician will order an ultrasound to evaluate the venous system and the problems areas. This ultrasound will help determine which treatment will be the most beneficial. The ultrasound evaluates the deep system and ensures it is functioning appropriately with no evidence of deep venous thrombosis. The ultrasound also will examine the great and small saphenous veins and document how much reflux, or abnormal flow, is present. The physician will recommend medical compression stockings to help control symptoms until they can perform further intervention. Many insurance companies require compression stockings for six weeks to three months before they will approve coverage of a procedure to fix varicose veins.

4. How does medical compression help veins?
Medical compression stockings will greatly help reduce symptoms including achy legs, heaviness, swelling, etc., before and after a venous procedure. Some patients are not aware of how comfortable and fashionable compression stockings are. They come in wide variety of sizes and options, including fun colors and patterns, knee-highs and even leggings.

5. Are vein treatments invasive?
Many years ago, vein treatments involved mostly stripping, but this is rarely done now. All treatments for varicose veins are minimally invasive with minimal recovery and downtime. There are several options for treatments, depending on what the physician decides is best for their patient.

The gold standard of treatment is the laser procedure, endovenous laser treatment (EVLT), or radiofrequency ablation (RF). These procedures use a heat source to create a thermal injury to the inside of the abnormal vein causing it to shrink and “scar down.” Eventually, as the vein is turned into scar tissue, the body absorbs what is left and it goes away. The majority of these are “office procedures” and are quite painless, as everything is done with small wires and catheters. There are no large incisions or scars, and usually no sutures are needed. Most patients take a day or two off of work and are given an anti–inflammatory for pain control. We advise patients to wear thigh-high medical compression stockings for three weeks following the procedure to help keep the vein closed and ensure the body can scar it down effectively, and to help with post-op soreness and bruising.

Other options for treatment are injection sclerotherapy treatments, which involve injection of a liquid sclerosant directly into the vein that will cause chemical damage inside the vein so it will scar down and eventually go away. Patients can return to work immediately following this procedure. We advise that patients wear compression stockings following injections for two to three weeks following the procedure to help minimize discoloration, bruising, pain and soreness.

6. What are the benefits of vein closure?
There are many benefits to venous closure. First and most important is to alleviate symptoms such as pain, swelling, aching, heaviness and leg cramps. Many times, these symptoms have become lifestyle-limiting, interfering with work or daily activities. Varicose veins will usually disappear with time following procedures. Areas that may have bled, or had the potential to bleed, will decrease in size and likely no longer be a problem. Brown discoloration will likely improve following treatment. Patients that have been suffering from non-healing venous wounds will likely notice improvement and resolution of the wound. Enlarged refluxing varicose veins and saphenous veins are also at risk for superficial thrombophlebitis if left untreated. Venous closure procedures help decrease this risk.

7. When do you recommend your patients wear compression?
I am an advocate for the use of medical compression stockings. As a physician who treats venous disease, and who has also suffered from varicose veins and leg pain, I truly believe in their benefits for many reasons. Compression stockings are beneficial in reducing symptoms associated with varicose veins, such as swelling, aching and heaviness, until further intervention can be performed. They are used in post-procedure care to help with bruising and discoloration and help with quicker recovery. I continue to recommend compression following procedures, especially in patients with family history of varicose veins, recurrent varicose veins despite previous procedures, and in patients who stand and sit for prolonged periods. Compression can help decrease pain and swelling, as well as decrease the risk of DVT, when traveling for a prolonged amount of time in the car or air. I also recommend compression stockings for patients that may be unable to have treatment in the near future, for either financial or situational issues, to help control symptoms and prevent further progression of venous insufficiency, until intervention can be performed (read the American Venous Forum guidelines about medical compression).

8. What do you like about Juzo products?
I love Juzo products for many reasons – they come in a variety of colors, styles and textures, and are not only comfortable, but also fashionable. I have been wearing Juzo compression stockings for about nine years – during pregnancy, following EVLT, post-sclerotherapy treatments, and now for routine leg care. They are soft, comfortable and easy to put on. I love the variety of colors they come in and enjoy the legging option as well. They truly help with pain and aching of my legs when standing during multiple sclera, EVLT or Venaseal procedures. My Juzo stockings also help with recovery of my legs following tennis matches and running.