Aging Well

Vanquishing

Painful VARICOSE VEINS

Together, our veins and arteries make up an intricate, coordinated system that takes blood to and from the heart and lungs. In order to function properly, the valves in our leg veins must work against gravity, moving blood upward to the heart and lungs and keeping blood from traveling down toward the feet.

When leg veins suffer damage or change due to age or genetic predisposition, those valves can fail to work correctly, leading to a condition known as venous insufficiency. In such cases, blood pools in the legs, leading to bulging, painful varicose veins.

“Gravity is the reason people develop symptoms from varicose veins,” explains Tara Balint, MD, a vascular surgeon at Sentara RMH Medical Center. “When we sit or stand for too long, gravity pulls blood flow toward the feet when the leg veins dilate.”

More common in women than in men, varicose veins are often hereditary. However, they also can be caused by pregnancy, weight gain, aging, and frequently standing or sitting for extended periods.

“People with varicose veins can experience burning, itching, skin discoloration and leg swelling,” says Lewis Owens, MD, a vascular surgeon with Sentara Martha Jefferson Hospital. “With those types of symptoms, we’ll often come up with a treatment plan to help alleviate the condition.”

Traffic Jam Leads to Long-Term Vein Issues

Vein issues began for Sharon Archer, of Massanutten, Va., back in 2009. During a drive from California to their home in Nevada, Sharon and her husband, Steve, ended up in an eight-hour traffic jam.

“The day after we got back, my ankle and leg were so swollen,” recalls Sharon, 69. “We went to the hospital, and it turned out I had a massive blood clot in my left leg that was completely blocking blood vessels.”

Deep vein thrombosis (DVT) occurs when a blood clot forms in a deep vein, commonly in the lower leg, thigh or pelvis. The most serious complication of DVT can occur when part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage known as a pulmonary embolism.

Thankfully, Sharon’s clot dissolved with medication—but the blockage had caused scarring and damage to the veins in her leg, so they could no longer pump blood efficiently. The pooling blood had led to varicose veins and swelling in her ankles.

Diagnosing Vein Conditions

Dr. Balint advises patients to see a vascular specialist if they have pain and swelling that is uncomfortable and disruptive, or if they would like to remove varicose veins for cosmetic reasons. In most cases, varicose veins do not pose a serious health threat.

After a physical examination of the affected veins, a specialist can order a venous insufficiency ultrasound exam to determine the extent of the vein damage.

“The exam, which takes about an hour on each leg, looks at vein valves and blood flow, as well as how long the valves in the veins stay open,” Dr. Balint says. “Ultimately, the test tells us what kind of treatment plan we should pursue.”

Vascular doctors rate vein damage in a classification system called a CEAP (clinical, etiological, anatomical and pathophysiological) score, which ranges on the low end from spider veins, which are broken capillaries on the surface, to severe cases of bleeding skin ulcers caused by chronic venous insufficiency.

Treating Varicose Veins

Home treatments for varicose veins include leg elevation and compression to relieve pressure on the veins, Dr. Balint explains: • Elevation: In this technique, the person lies down on a bed or couch so that the toes are above the nose. However, this is a temporary solution to relieve pain, since blood can begin to pool again upon when the person returns to a standing position. • Compression: Compression stockings for vein issues—which aren’t the same as diabetic compression stockings—exert more compression on the foot, and the compression gradually decreases up the calf.

Usually, insurance companies will ask patients to wear compression stockings for a couple of months to see how well they control the problem, according to Dr. Balint. If they don’t provide adequate relief, doctors will look for other causes for the leg pain, such as nerves, muscles, bones and joints.

If a vein procedure turns out to be the best course of action, doctors can use minimally invasive techniques, including endovenous ablation and sclerotherapy, or surgical options: • Endovenous ablation: A minimally invasive procedure that uses heat to close veins.

“We put a catheter inside the veins, and it releases thermal energy that closes veins from the inside,” explains Dr. Owens. “When the veins close, less blood pools, and blood flow improves.”

• Sclerotherapy: Instead of heat, this minimally invasive technique relies on chemicals to close veins.

“We can use a medicine that glues the veins shut, or a foam-type medicine that irritates the inner lining of the veins and causes them to close,” Dr. Owens says. • Surgical solutions: When minimally invasive techniques aren’t effective, doctors can turn to surgical solutions, including vein stripping and phlebectomy. During vein stripping, the surgeon removes the longest vein in the leg, which runs from the foot up the thigh, through small incisions. During a phlebectomy, the surgeon removes veins near the skin’s surface through small incisions.

Fortunately, for Sharon, a patient of Dr. Balint, the minimally invasive endovenous ablation and sclerotherapy treatments dealt with her varicose veins successfully.

“Almost all of them are gone now,” Sharon notes. “I have one more treatment to go, but I am already back in sandals and am not in pain. My results have been fantastic.”

More Serious Varicose Veins

The most severe cases of venous insufficiency can lead to bleeding skin ulcers. When blood pools in the veins of the lower leg, fluid can leak out.

Symptoms include: • Dark red, purple, brown, hardened skin • Itching and tingling • Shallow sores with surrounding skin that may be shiny, tight, and warm or hot • Leg pain

Treatment for venous ulcers includes cleaning and applying a dressing to the wound regularly. Patients will need to wear compression socks to improve circulation and speed up healing. Doctors also may prescribe an antibacterial topical ointment and an oral antibiotic to prevent infection.

For more information on varicose veins and other vascular concerns, please contact Sentara Martha Jefferson Vascular & Vein Center in Charlottesville at 434-654-1700, or Sentara Vascular Surgery Specialists in Harrisonburg at 540-689-5800.

Varicose Vein Prevention

• Exercise: Walking 20-30 minutes every day is a great way to prevent varicose veins, since walking engages all vein systems in the leg: deep, superficial and connecting.

Walking is an excellent way to improve your blood flow. Wearing compression socks while walking is even more effective.

• Limit sitting and standing:

Get up every hour and take a short walk. • Toe ups and calf stretches: From a

standing or sitting position, lift your heels to flex your calves. Then lower your feet, plant your heels and raise your toes. • Watch your weight: Although weight

gain doesn’t cause varicose veins, it can make the condition worse.