While not typically a fatal condition, varicose veins can be intensely painful and develop into several advanced medical conditions if not properly treated. Venous disease can progress and develop into conditions such as lower leg stasis dermatitis (an inflammation of the skin) or venous ulcers (brownish red swollen areas or sores) usually occurring around the ankle area. In extreme cases, venous diseases can lead to secondary infections or other complications. Varicose veins can also decrease blood flow back to the heart by 15 to 20 percent. It’s also estimated that 50 percent of restless leg cases may be attributed to venous diseases.
Along with these medical issues and conditions, varicose veins also cause some individuals to limit their own lifestyles. Whether due to pain or complications – or possibly appearance – some patients report changing personal routines, activities or clothing choices due to varicose veins, negatively impacting the individual’s self-confidence and their ability to participate in activities they love.
To understand how varicose veins can impact quality of life, let’s take a little refresher on the role the veins play in our body. Veins are a key component of the circulatory system. Veins push the blood against gravity back to the heart, returning the blood that has circulated through the body’s organs and extremities to the heart and then to the lungs where it is re-oxygenated.
Most varicose veins occur in the legs. “The veins of the leg are like major rivers and tributaries,” shares Dr. Bohn. The veins in the leg fall in two broad categories:
- Deep veins, the “major rivers” deep in the leg, carry around 80 percent of the blood in the legs back to the heart. These veins do not develop into varicose veins.
- Superficial veins, the “tributaries” closer to the surface, carry the remaining 20 percent of the blood back to the heart. Superficial veins can develop into varicose veins.
The valves in veins allow blood to flow in only one direction – back to the heart, flowing against gravity. This is achieved by the valves in the vein opening, allowing the blood to flow up and through, and then closing after each push. In the case of varicose veins, the valves don’t function effectively. Instead of snapping shut after each push of blood, the valves hang open causing blood to pool between valves and into the lower part of the legs.
The walls of superficial veins are thin so, when too much pressure occurs, veins can swell just like a river overflowing its banks. “If the Mississippi River burst through its banks, it would cause flooding in smaller tributaries,” states Dr. Bohn. “The veins of the leg are no different. When circulation is ineffective in the superficial saphenous deep veins, it can cause pooling in these veins and their tributaries, which can develop into varicose veins.”
New steps for treating painful legs
In 2003, the US Food & Drug Administration (FDA) approved Endovenous Laser Ablation (EVLA) for treatment of varicose veins.
Historically, vein stripping was the procedure of choice to treat varicose veins. With vein stripping, the diseased veins are surgically removed. Usually, the procedure was performed in a hospital setting with the patient under full anesthesia and facing weeks of recovery.
Unfortunately, in the long term, vein stripping has proven to be only about 50 percent effective as a treatment option. If even a tiny part of the vein is left during the surgery, the veins can grow back over time, causing the painful condition to return to the patient’s legs.
On the other hand, EVLA uses a laser to seal the vein shut from the inside, removing the chance for the diseased veins to regrow. The patient can be awake during the procedure, which can be performed in the office at IVS. Most patients are able to drive themselves to and from their own procedure. Best of all, this new procedure has shown to be highly effective in successfully treating varicose veins, with a reported 85 to 90 percent success rate.
The doctor begins the EVLA procedure by using an ultrasound to identify the spot in which the disease and pooling is the greatest. The area is numbed, a tiny incision is made and an IV is started. Next, a catheter is inserted into the vein. The laser fiber is placed into this catheter. When the laser is started, the laser fiber heats the inside of the vein and closes it as the fiber is removed from the vein.
If a patient had vein stripping performed in the past, Dr. Bohn can use a sonogram during an office visit to determine if EVLA is an option for future treatments.
While the idea of choosing to close off a vein might make you nervous about blood flow, don’t be. With more than 400 veins in the body, odds are that if you have a diseased vein the other veins have already taken over blood on its behalf. Sealing the diseased vein shouldn’t have a significant impact on the overall blood flow in the body.
Your blood lines impact your vein health
While there are steps you can (and should) take to keep your veins healthy, Dr. Bohn indicated genetics has a lot to do with whether or not someone will develop spider or varicose veins. “Exercise and weight management are important steps to take in keeping your veins healthy. However, if your mom had varicose veins, odds are you will have them too,” shares the Doctor.
Vein treatment by the numbers
15: The age at which varicose veins can begin to develop
20: The percent of the body’s blood pumped back to the heart by the “superficial” leg veins
26: The youngest patient Dr. Bohn has treated
50: The percent of restless leg syndrome cases believed to be due to venous disease
80: The percent of the body’s blood pumped back to the heart by the “deep” leg veins
90: The oldest patient Dr. Bohn has treated
400: The approximate number of veins in the human body
Dr. Bohn performs about 30 procedures a month in her practice with many of them being EVLA treatments. She enjoys seeing the changes these treatments have made in the lives of her patients. “A patient who had heavy legs and pain read an article about EVLA and came to visit me. We determined he was a candidate and performed his procedure. He couldn’t wait to tell me during follow up visits how light and mobile his legs felt,” Dr. Bohn said.
“Another patient was frustrated because her leg pain kept her from sleeping. She said she had been taking sleeping pills for years. However, at her follow-up visits, she was thrilled to let me know she no longer needed the medication to sleep,” beamed Dr. Bohn.
With one physician and three medical assistants on staff, the Bloomington IVS practice provides patients a personal, supportive environment during their treatments and appointments. Typically, only one patient is in the treatment area at a time, so patients get the full attention of the staff during their visits and privacy. All staff have a background in emergency medicine as well as specific training for their specialties.