Frequently Asked Questions
What are veins?
Veins are blood vessels that carry blood from the legs and body back to the heart.
What are varicose veins?
Varicose veins are veins that have become dilated (larger in diameter) due to pressure from blood which is not moving well through the vein. As the disease worsens, the veins become tortuous (twisted, snake-like). At this point the veins are not functioning properly. At times, this results in blood moving backward in the veins, causing them to become even larger. Other veins, which are connected to the varicose veins, can then be affected.
What causes varicose veins?
The most important cause is heredity. Other factors, which can make them worse, are pregnancy, advancing age and standing for prolonged periods of time. The hormone, oestrogen, can increase the number and size of veins. Oestrogen occurs naturally in women, particularly in their reproductive years. It is present in most birth control pills and hormone replacement therapy.
What are spider veins?
Spider veins develop from tiny veins that are present on every person's legs. When larger veins do not function properly (the beginning of varicose veins) the spider veins become enlarged and more visible. The spider veins are usually the result of the malfunctioning larger veins surrounding them.
Can I prevent varicose veins?
We cannot change heredity which is the most important factor. However mantaing a healthy body weight and being active helps. Using appropriate graduated compression stockings can slow the progression of the disease. (See "Where to Buy".)
What can be done to treat varicose veins?
A variety of treatments are available to treat varicose and spider veins
Sclerotherapy:
Sclerotherapy was first developed in Europe in the early 1900's and has been in North America at least since the 1960's. This involves injecting salt like solutions into the veins with a needle . The injected medication irritates the walls of the veins which in turn causes a localized inflamation. The inflamation causes the vein to collapse. The collapsed vein is then slowly reabsorbed by the body. Sclerotherapy is most commonly used for small and medium sized varicose veins and for treating spider veins.
Abulatory Phlebectomy:
Ambulatory Phlebectomy -AP- was first performed in Switzerland in 1956 and has been used in Canada since the 1970's. It is being used increasingly to complement traditional vein surgery and sclerotherapy. Ambulatory Phlebectomy involves the removal of a larger varicose vein through a tiny puncture in the skin. Thr procedure is done using local anaesthetic similar to what is used for stitches in the Emergency room. The procedure results is minimal to no scarring. Ambulatory phlebectomy allows the physician to permanently remove the larger vein which would otherwise be difficult and time consuming to treat with sclerotherapy alone.
Surgery:
This method is occasionally required before sclerotherapy can be started. This involves either removing a segment of vein or tying a knot at the top of the vein (ligating). This allows us to then treat the remaining veins by injection.
What can happen if my varicose veins are not treated?
Changes in the colour of the skin over varicose and spider veins occurs in a large number of patients. This is called staining. Staining may already be present before any treatment begins. It is the result of many years of pressure in the vein. This pressure causes blood to leak out of the vein and deposit in the skin over the vein. The blood breaks down leaving iron in the skin. The iron causes a yellow-brown discolouration of the skin or a stain. The physician will tell you during your initial assessment if you have staining present over your veins. It is very important to realize that the staining already present before you start your treatments will be permanent. Some of it may gradually fade over 6 months to 2 years, however, some will be permanent. There are some bleaching creams that can be used to treat stain after the rest of the treatment is complete
Are there any other complications other than staining that can occur if my veins are not treated?
Other more serious complications that can happen if your varicose veins are not treated include skin rashes (dermatitis), bleeding, ulcers [open sores], and blood clots. The clots are of two types:
Superficial thrombophebitis - phlebitis- occurs in the superficial veins between the skin and muscle. This presents as red, tender and painful hard lumps over the visible veins that the patient can see and feel. It can be very uncomfortable but, in itself, is not dangerous.
Deep Venous Thrombosis [DVT] This occurs in the large deep veins inside the muscles. It can be very dangerous. It usually causes much of the leg to swell and needs urgent care
What happens to the blood in the veins that are treated?
The blood in the varicose veins, once they are treated, reroutes to the veins deep in the leg (we cannot see these veins). In fact, the veins on the surface of the leg, that can become varicose, only carry 10 % of the blood back from our legs. The other 90 % is carried in the deep vein system of the leg. This system can easily carry more than 100 % of the blood if needed.
What actually is involved in sclerotherapy?
The varicose veins are treated every 1 to 2 weeks. There are a number of injections each visit. We always start from the thighs and work down to the feet. It is usually impossible to just treat one patch of spider veins on the lower leg without first treating the larger veins on the thigh. These larger ones feed the spider veins.
How long does each session take?
Each appointment will involve an assessment by the doctor. Within a few minutes the injections will be performed by the doctor or a specially trained registered nurse. The process takes approximately 10 minutes.
What medications are injected?
Treatment starts with a sugar (dextrose) and salt (saline) solution. These components are naturally found in our blood, but are used in a slightly stronger concentration. If this does not treat the vein, we will then gradually use stronger medications until the vein is treated. For those of you claiming the cost of the medications from a drug insurance plan you will be supplied with the medication names and their DIN - drug identification number-
Can I have sclerotherapy while I am pregnant?
NO. You should not have any injections while you are pregnant. A significant, but unpredicable, number of your varicose veins will disappear after the birth of your baby.
How many sessions will I need?
This is variable. It depends not only on the number and type of varicose veins, but also how your veins react to the medication. Because we increase the strength of the medication in a step-like fashion, it may take a few weeks with the large veins to find the medication that is going to work for you. Please bear with us during this time period. (This is usually not a problem with the small and spider veins.)
What are the side effects and complications of sclerotherapy?
You will have:
Bruises: These will last 2 - 3 weeks and may vary in size. Please be aware of this in planning your treatments around special events.
Red spots: These tiny spots occur where the needle enters the skin, lasting 1 - 3 weeks.
You may have:
Swelling around the injection site: This will resolve in a day or two. Small areas of inflammation along the vein that is injected: If this occurs, apply warm wet cloths to the area 4 times a day. This will usually resolve quite quickly. Areas of retained blood along the vein that is injected: As the vein starts to close a small amount of blood may become trapped in a segment of the vein. The physician easily treats this by releasing the retained blood.
Staining of the skin: Rarely, tiny amounts of blood leak out of the vein. This results in a darker colour over the vein. Usually, this fades gradually over 6 months to 2 years but may be permanent. This happens in 1 - 3 percent of patients. Small spider veins may rarely form after injecting very large veins. These veins are not a problem and usually disappear in a few weeks without treatment. If they do persist, they can easily be injected at a later time once the large vein is closed.
Itching along the line of the treated vein: This is related to the irritation of the vein and lasts only a few days.
Very rare complications:
Allergies to the solution: Although you tell us about your allergies, you may discover an allergy to the medications.
Deep vein thrombosis: This is a blood clot in the large deep veins of the legs. This is extremely rare. I have never seen or heard of a case from sclerotherapy, but it has been reported in the medical literature. This blood clot may then move to the lung, causing a pulmonary embolus which can be life threatening.
Ulcers: If the stronger medications are injected into an artery or the medication leaks into the surrounding tissue, an ulcer may form. The ulcer will heal but will likely leave a permanent scar.
Is there anything I need to do before treatments?
Do not apply any moisturizing lotions or creams to your legs the day of your treatments. They can prevent the tapes from adhering properly. Avoid hair removal from your legs on the day of your treatment.
What needs to be done after a treatment?
Remove the cotton balls 1 - 2 hours after the treatment. Do not rip them off, as you may cause irritation to the skin. If possible, do not keep the tapes on overnight.
If a tensor has been applied to your leg, keep it on for 48 hours after the treatment, except while sleeping.
If compression stockings have been prescribed, wear them regularly.
Do not expose your legs to the sun for 48 hours.
Exercise and walk regularly. There is no need to rest after treatment.
After your treatments are all completed, we recommend a check up every 6 months.
Is this treatment covered by OHIP?
OHIP continues to cover an initial assessment and treatment of any varicose veins that are larger than 5 millimeters in diameter and causing symptoms. Treatment not paid for by OHIP is payable by cheque, money order, or cash on a per session basis.
Can I be guaranteed that all my veins will be gone after the treatment is complete?
Unfortunately, there are no 100 % guarantees in medicine. Genetics play a very large role in the formation of veins, so new veins which require further treatment could occur over the years. We may not be able to get rid of every single vein, especially spider veins, but we will do our very best to provide you with a result that you will be please with.
Can I sun tan before or during treatment?
My theoretical answer must be that I believe sun tanning is not good for you at any time. With the decrease in the ozone layer, the skin is being exposed to an increase in ultra violet light. This has lead to a very marked increase in skin cancers, and particularly, malignant melanomas. However, I realize that some of you still want the tanned look. The sun does interfere with sclerotherapy by:
making it much more difficult to see the course of the veins, which makes injections more difficult to give accurately
causing increased pigment, melanin, to form along the injected veins. This can lead to areas of much darker skin to form along the vein, which has an unsightly appearance
In summary, you should not actively sun tan during sclerotherapy. You should wear sunscreen if you are going to be exposed to a lot of sunlight during treatment.
Is it safe to travel by air?
It is known that there is a heightened risk of Deep Venous Thrombosis (DVT or blood clot) in the legs during prolonged air flights. (This is equally true for those making long car or bus trips.) This can lead to pulmonary embolism or blood clot to the lungs, and can be very serious. These risks are small, but real.
Are there any vitamins or other supplements that I can take?
There has been a lot of advertising recently in the lay press for a product called Venastat. This is an extract of horse chestnut and has long been advocated for vein treatment. There is little to support this in the conventional medical literature. One article in the prestigious British Journal - The Lancet - suggested it helped decrease swelling in patients with varicose veins, but the set up of the study was criticized by others. However, the alternative medical community does support its use. I will reserve judgment at this time and simply say, if you do want to take vitamins or supplements to help your vein problems, something containing horse chestnut is probably the best choice. However, I believe you will get better results following the Tips to Improve Your Legs.
|
