Varicose Veins: More Than Just a Cosmetic Problem

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Varicose Veins More Than Just a Cosmetic Problem

• Jeffrey Stein, MD
• Charlotte Radiology Vein and Vascular Center
• Vascular and Interventional Radiology
• Charlotte Radiology
• February 8, 2012

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What are Varicose Veins?

• abnormally enlarged superficial veins
• tortuous, twisted, widened or lengthened
• bulging under skin surface
• due to a defect in the valves within the veins
  themselves (venous valve insufficiency)
• blood pools in sections of the vein causing the
  vein to bulge and swell

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What are Varicose Veins?

• Normal vein
• cusps of valves close prevent backward flow
  of blood
• Varicose vein cusps cannot close because vein
  abnormally widened and blood can flow in the
  wrong direction

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Introduction

• may be no symptoms
• for some a problem in terms of appearance
• may result in mild discomfort
• may cause severe pain
• may result in additional medical problems

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Introduction

• Images of varicosities

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Introduction

• Telangiectasia, more commonly known as spider
  veins

• Spider veins on the leg usually appear in one of
  three patterns
• simple linear
• arborizing, which appear branch-like
• spider, which appear as a cartwheel shape with a
  dark center point.

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Incidence and prevalence

• 15 of males over 18
• 30 of women over 18
• increases with age, being present in more than
  half the population by age 65
• 20 Million adults with varicose veins or chronic
  venous insufficiency (CVI)

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Risk Factors

• Genetics / Hereditary - those with a family
  history are at greater risk
• family history of varicose veins 15 of patients
• Increasing Age
• Gender - women are at greater risk than men
• related to female sex hormones estrogen and
  progesterone which relax blood vessels, allowing
  the vein valves to separate
• pregnancy

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Risk Factors

• Obesity- excess weight increases pressure on the
  saphenous vein valves, causing them to weaken
• Pregnancy
• varicose veins may surface for the first time
  during pregnancy
• progesterone smooth muscle relaxation
• later in pregnancy the uterus exerts greater
  pressure on the pelvic and leg veins and may
  cause or worsen varicose veins

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Risk Factors

• Standing and sitting- those who have jobs that
  require them to stand or sit for long periods
  also are at increased risk
• prolonged standing can weaken the walls of veins
• prolonged sitting can aggravate inflamed veins

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Symptoms

• pain
• leg heaviness
• aching or tension
• tenderness along the course of a vein
• burning sensations
• pruritus / itching

• exercise intolerance
• restless legs
• paresthesias
• night cramps
• edema
• skin changes

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Complications

• Thrombophlebitis

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Complications

• Stasis Dermatitis/
• Varicose eczema

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Complications

• Stasis Dermatitis/
• Varicose eczema
• Lipodermatosclerosis

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Management of Varicose Veins and Venous Reflux

• Conservative treatment (will not solve the
  problem but will help with symptoms)

• elevation
• avoid prolonged sitting/standing
• no leg crossing
• exercise
• weight reduction
• compression stocking therapy

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Management

• Compression Stocking Therapy

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Management

• Treatment options

• Surgical stripping old way of removing the vein.
  Typically required a hospital stay and weeks of
  recovery time.
• Injection sclerotherapy often treats the surface
  veins, but does not treat the underlying problem.
• Endovenous laser treatments much less invasive
  way of eliminating the vein. The procedure
  seals off the vein while leaving it inside of
  your leg.

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Management

• Benefits of laser treatments vs. traditional
  stripping
• Minimally invasive, in-office treatment
  alternative to surgical stripping of the great
  saphenous vein
• No sedation
• Most procedures take less than 30 minutes
• Patients are able to walk immediately after the
  procedure and most individuals are able to return
  to work the next day

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Ultrasound Evaluation Before

• During a consultation, you will meet with the
  doctor and have an ultrasound to determine which
  veins are not functioning properly. Your doctor
  will then discuss your treatment plan and review
  your insurance requirements. Most procedures are
  covered by insurance.

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Varicose Veins More Than Just a Cosmetic Problem

• If you are interested in a consult, please give
  us a call. We accept all major insurances.
• Southpark 4525 Cameron Valley Parkway
• Charlotte, NC 28211
• 704.333.3794 ext. 2220
• Concord 212 LePhillip Court NE
• Concord, NC 28205
• 704.786.0052
• www.crveins.com