Summertime in San Antonio is unreasonably hot—I am from El Paso, and I’m starting to think it’s cooler there. Staying cool means shorts and T-shirts. I can diagnose a lot of medical problems just by looking at you—I see lots of belly button hernias, skin cancers and varicose veins in those shorts and T-shirts. In the last few years, treatment of varicose veins has dramatically improved.
What is Venous Disease?
Venous disease ranges from telangiectasias—small spider veins just underneath the skin surface—to varicose veins—the winding ropes of veins I see in all you shorts-lovers. Chronic vein insufficiency are those changes—swelling, skin changes or ulcerations of the skin—that are usually associated with reflux in the veins. Venous reflux means that the blood flow, which is normally going back to the heart, is reversed and is going backwards. This is usually diagnosed by Duplex ultrasound of the legs. Symptoms of venous disease range from painless spider veins to heaviness, pain and swelling in the legs. It is estimated that 6-7 million people in the United States have venous insufficiency. Compare that to the 8 million people that have peripheral arterial disease—it’s almost as common.
Treatment Options for Varicose Veins
The three options for treatment of venous disease are surgical excision, sclerotherapy and thermal ablation. In my training I learned to do stab phlebectomies and vein strippings. These procedures basically consistent of pulling the refluxing vein out of your leg. The recovery was painful and required you to be off work, laid up at home with your legs wrapped up in Ace bandages. Sclerotherapy, which involves injecting a chemical into the vein, is suitable for spider veins and smaller varicose veins. It is not appropriate for the larger veins in the leg that have reflux, such as the saphenous vein. Thermal ablation is a technique whereby a catheter is fed into the large refluxing vein, say the saphenous, and heat is passed through the catheter into the vein to collapse and close it. This allows blood to flow through the healthy, non-refluxing veins. This alleviates much of the itching, pain and swelling. Amongst all the treatments the success rate ranges from about 75-85%; recovery is much faster with the non-surgery methods, and the rate of complications is lower as well.
Varicose Vein Treatments are Often Covered by Insurance
These treatments for venous insufficiency are often covered by insurance, but many times the sclerotherapy for spider veins is considered cosmetic. Most insurances, however, will require you to try conservative treatments for the symptoms for a minimum of three months before covering surgery or thermal ablation. Conservative treatment includes weight loss, elevation of the legs and compression stockings. If leg heaviness, swelling or itching, or pain is becoming bothersome, talk to your doctor about a referral to a doctor who provides these services—we are available on the South Side and throughout San Antonio.
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