VEINS

Varicose veins are extremely widespread within our population, since it is estimated that they concern 30 to 50% of women and 20 to 30% of men. This condition will be increasingly frequent because of the ageing of the population and lifestyle changes.
 

CAUSES OF VARICOSE VEINS

Venous insufficiency is related to a weakness of the venous wall, probably hereditary. This weakness will worsen gradually by factors of risks: jobs involving prolonged standing positions, putting on weight, pregnancy, heat, etc…

The venous wall dilates, causing its valves to separate.  As a result, blood flow reverses. Instead of bringing blood back to the heart as a normal vein would, a weakened vein allows blood to become static in the lower extremity.  This backward flow will involve an increase in pressure in the vein (hypertension). Dilation becomes permanent: it is a varicose vein.  This phenomenon will extend gradually and, if allowed to continue, will affect an increasingly wide surface venous network.

SIGNS/SYMPTOMS OF VENOUS DISORDER

• Aesthetic problem, sometimes neglected at the beginning of the disease.
• Problem of discomfort that disturb daily activities (feelings of aching, tiredness) and at night (a percentage of restless legs syndrome RLS is due to venous insufficiency).
• Medical problem with early or late cutaneous and circulatory complications.

WHAT WE DO:

If you have varicose veins, we perform a Duplex (color flow) ultrasound examination to determine the source of the problem.  The advent of ultrasound imaging has taught that the entire Saphenous vein may not reflux, and rather that a non-Saphenous, Accessory Saphenous vein may be responsible for the distal venous hypertension. A vascular surgeon in Nice, France has refuted the principle of Saphenous ablation by taking away the varicose tributaries to the Saphenous vein thus decreasing its reflux flow and allowing the vein to decrease in diameter and regain competence. He observed that Saphenous vein reflux disappeared after correction of superficial vein reflux, with associated functional and aesthetic benefits.

Next, we inject a drug that sensitizes the inner vein walls causing the vein to collapse in on itself.  The patient’s body eventually absorbs the shrunken vein.

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If you have telangiectasias (aka spider veins), we look for the source and treat the underlying reticular veins.  If the source is not treated, the spider veins will soon return.  For select cases of telangiectasias of the face and legs, we use a laser that has a patented cryogen cooling system that anesthetizes the skin before, during, and after treatment.

Why our techniques are superior

For a very long time, the methods of treatment of the varicose veins evolved little. The aggressiveness of the surgical treatment (size of scars, duration to resume normal activities, etc) and the frequency of recurrence very often discouraged the patients. Later, electromagnetic energy (endovenous laser and radiofrequency) was used as a means of taking saphenous veins out of the circulation. Unfortunately, since energy can radiate outside the vein wall, cases of nerve damage were reported.  In addition, reports of recurrent varices in ~30% of these cases are making some physicians look to alternatives in treating varicose veins.

Our medical treatment of varicose veins involves innovative techniques and our objectives are to be preventative, less aggressive and more precise. This now makes it possible for the patients to be better treated, earlier, and with a better follow-up care.

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General Health Screens          Questions for your MD

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Pregnancy and Varicose Veins

Many young female patients come to me and ask why they have varicose veins when they thought it was suppose to be an “old person’s disease.” The first thing I ask them is how many times they were pregnant. I emphasize here that the number of pregnancies matters more than the number of births. The pathophysiology to developing varicose veins is two-fold.

First, every time a woman gets pregnant, her body releases a lot of progesterone (a common female hormone). Progesterone dilates the veins of a woman’s uterus to accept the incoming baby, but then progesterone dilates ALL veins. As a result, leg veins bulge out. The second reason is that as a woman’s uterus grows, it presses on a major vein called the inferior vena cava (IVC). Back pressure in the IVC causes back pressure in the veins that drain into it, including leg veins.

For many pregnant woman, the varicose veins improve after pregnancy. However, for those that do not, treatment is available. In the above section, I briefly describe what is involved in the safe removal of these problematic veins. As I point out to many symptomatic patients. Varicose veins are not simply a cosmetic issue.

Other vein problems after pregnancy: PELVIC VEINS

Pelvic obstruction may be a cause of vulvar varicosities. This can occur in the third trimester. Vulvar varicosities that remain after pregnancy may become quite painful, usually during menses or even intercourse. They are easily treated with sclerotherapy, usually with complete resolution.

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Athletes and Varicose Veins

I am always asked by my patients whether exercising will increase symptoms of varicose veins. The answer is not straight forward. While some European studies show that performance can be affected by varicose veins, others argue that the increase in muscle contractions can improve venous return to the heart.

 

I have told patients for the last eight years of having my own practice and performing over 1,000 procedures, the benefits of exercise should not be sacrificed just because they may worry about getting veins. There have been so many advances since the complicated days of vein stripping, that one does not have to choose between his/her cardiovascular health and the symptoms/appearance from varicose veins.

 

On the other hand, venous insufficiency may inhibit an athlete’s performance despite not having any visible varicose veins. Subjectively, patients tell me that they have “an aching heaviness” that causes them to slow down whatever activity they are engaged. Objectively, varicose veins are dilated, and can therefore cause more blood pooling. This, in turn, decreases cardiac return, and therefore, may inhibit athletic performance. Professional athletes know this, and increasingly, are wearing compression stockings (e.g. 2014 Boston marathon winner, Meb Kefleziighi, proudly wore his over the finish line).

 

Whether you are a professional or recreational athlete, it is worth looking into whether venous insufficiency is inhibiting your performance.

 

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Hand Vein and Arm Vein Therapy

Americans spend billions a year on creams and procedures for their face and neck. However, as everyone in Hollywood knows, your hands reveal your age. Dr. Cheng was the first medical doctors to treat unsightly hand veins in the southern California region. Hand vein sclerotherapy is a quick and simple way toward more beautiful hands, restoring a more youthful smoothness and appearance.

How Is It Done?

Sclerotherapy is a non-surgical injection with a drug solution, which causes a vessel to collapse. As a result, the treated vessel can no longer hold blood and shrinks, ultimately disappearing. Performed in-office, sclerotherapy is a relatively quick procedure and takes anywhere from 20 to 30 minutes. Hand vein treatment sessions do not require anesthesia and are very easily tolerated. A compression glove or wrap is used after treatment and a rapid return to regular activities is the norm. In rare instances, mild swelling of the hands may occur which typically lasts a few days. Most patients are able to drive themselves home immediately.

Don't I Need These Veins?

The anatomy of the arm and hand is very much like that of the leg and foot. There are many veins that are able to return blood to the heart. Superficial veins (the surface veins we can see under the skin) are not essential, since there is a rich network of deep veins that is more than adequate to drain the hand. When treating hand and arm veins, we are always careful to preserve at least one arm vein for future administration of intravenous medications.

Benefits of sclerotherapy for hand veins:

1. Smoother, more beautiful younger looking hands.

2. Treatment in less than an hour in office with no general anesthesia or hospitalization.

3. Return to normal activity immediately - with little or no pain.

4. No scars.

What Are The Downsides Or Risks?

In a nutshell, there is no significant risk associated with hand vein therapy. The suntan-like darkening occasionally seen after leg vein treatment is never seen in the hands. Mild hand swelling may be present for a few days and there may also be some tenderness in treated areas, but these resolve quickly.