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All About Varicose Veins

As if being ugly weren't bad enough, those big blue bulges can really hurt. We're talking about varicose veins, the bane of more than 25 million Americans, the majority of whom are women. Until recently, some of the options for getting rid of varicose veins seemed worse than the condition itself. But a new technique called "closure" makes banishing the blue meanies a lot easier.

Where Do Varicose Veins Come From?

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What goes down must come up, in our circulatory systems anyway. Varicose veins can occur anywhere in the body, but they're most common in the legs. Normally, blood that has traveled all the way down to the feet returns toward the heart, in defiance of gravity, with the aid of a system of valves in the veins. But if a valve is defective or a portion of the vein wall is weak, de-oxygenated blood accumulates in that area, creating the familiar blue bulge.

"Most people don't realize that varicose veins are formed because of a defect in the way the vein is made initially, during our development, so that it is too stretchable," explains Dr. Robert Weiss, Assistant Professor of Dermatology at Johns Hopkins University School of Medicine. "Once it stretches beyond where the valves can meet, the blood is free to flow backwards in the wrong direction."

But you don't have to see the tell-tale bulge to suspect you have a varicose vein. Symptoms sometimes include minor swelling, a feeling of heaviness in the legs, or a dull aching in the affected area. In some cases, the pain can become intense as the distended vein pushes against surrounding nerves.

No one is sure what causes the initial malformation, but vulnerable veins may be partially hereditary. Hormones also seem to contribute to the problem, which may account for the fact that women are nearly twice as likely as men to develop varicose veins. An injury, or added pressure due to pregnancy or obesity can also make a good vein turn ugly.

While varicose veins are mostly just unsightly and uncomfortable, they can occasionally cause more serious problems. When a swollen vein doesn't allow adequate drainage of fluid from the surrounding tissue, an ulcer can form on the nearby skin. Within the vein itself, painful inflammation called phlebitis can develop, and in some cases, dangerous blood clots can form, called thromboses. The American Academy for Dermatologic Surgery estimates that nearly 100,000 Americans are completely disabled by varicose veins.

Common Treatment Options for Varicose Veins

There is no fix for the fatally flawed vein, so current treatments are designed to destroy or remove the offender. Most have excellent success rates, but some are no walk in the park. With all of these methods, side effects can include bruising, swelling of the leg or foot, itching, and minor scarring.

Sclerotherapy

A "sclerosing" (hardening) solution such as saline is injected into the vein, causing it to collapse. The "dead" vein slowly becomes scar tissue that is eventually reabsorbed into the body. While the procedure can be performed in a doctor's office and the injection is relatively painless, in many cases, it must be performed several times before the vein or veins are eliminated. Treatments must be separated by at least 4 to 6 weeks, and following each session, the patient has to wear compression bandages or support hose for two days to three weeks.

Laser/Pulsed Light Therapy

Relatively new in the treatment of varicose veins, light energy can also wither a vein from the inside, leaving scar tissue that is eventually reabsorbed. Lasers can be adjusted to emit a single wavelength, or "color" from the light spectrum, and so can be targeted at areas that will absorb that color, leaving surrounding tissues unharmed. A beam of light that targets the bluish hemoglobin in oxygen-depleted blood heats the blood in the varicose vein, scalding the vein itself. Since lasers cannot penetrate the skin very deeply, this technique is only effective on veins close to the surface of the body.

Ambulatory Phlebectomy

Also most effective on veins near the skin surface, this procedure actually removes the varicose vein and can be performed in a doctor's office using only local anesthesia. The vein is viewed under a special light source that makes it stand out clearly, and the doctor makes a series of small needle punctures through which the vein can be grabbed and pulled out with a tiny hook.

Stripping/Ligation

To remove veins that are not near the skin surface, this procedure is generally performed by a vascular surgeon and usually requires general anesthesia. An incision is made to access the vein, and it is either removed or tied-off so that it will shrivel and eventually be reabsorbed. After recovery from the anesthesia, tenderness in the area from which the veins were removed can last for days or even weeks."

Finding Closure for Varicose Veins

In the Spring of 1999, Susan Carroll of Timonium, Maryland, was becoming frustrated by her varicose veins. "Cosmetically, it was not a pretty sight," she recalls. "I am active in sports and I was very aware that people were probably saying, 'why doesn't she do something about those horrible legs?' She had tried sclerotherapy several times, but her varicose veins kept coming back. She was hesitant about undergoing the anesthesia and trauma of stripping. Then she learned about a new procedure called "closure" which had just been approved by the FDA.

Combining many of the benefits of existing procedures, closure involves making one small incision above the knee, through which a slender catheter is threaded down into the defective vein. Once in place, the catheter delivers radio-frequency energy. Dr. Weiss, one of the developers of the technique, explains, "This radio-frequency energy goes through the wall of the vein and it actually causes the collagen to vibrate and heat up, and when collagen heats up, it contracts, so you actually shrink the vein from the inside."

The procedure can be performed in a doctor's office using only local anesthesia, and can be used for both surface and deeper veins.

After undergoing the treatment in Dr. Weiss's office, Carroll reported, "It was very simple. It didn't even take an hour to do and the recovery period was nil. I was up and out of there immediately and I had very little pain. Very, very little."

On a follow-up visit, Carroll's treated vein showed no sign of blood flow, indicating the procedure had worked. "We've been doing this for about a year now," says Dr. Weiss, "and closure has worked in every single case. In worldwide studies, there's been a 95 percent success rate."

Dr. Weiss expects the closure technique to become the "gold standard" for treating varicose veins, but because it is still so new, many insurance companies have yet to approve it for coverage. Susan Carroll, however, needs no more convincing. "I'm just glad that something is out there like this," she says, "I would definitely recommend it to my friends.

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