Varicose Veins: More Than a Cosmetic Problem

What are Varicose Veins?
According to the federal Centers for Disease Control and Prevention, more than 40 million Americans have varicose veins. Although common, the condition is paradoxically underdiagnosed and undertreated. Jason M. Andrus, M.D., who is also a board-certified interventional radiologist at St. Clair., says that a complex of factors contributes to this.

Most believe that varicose and spider veins are a cosmetic problem, but in actuality, they are a symptom of an underlying disease known as chronic venous insufficiency, or CVI. “Chronic venous insufficiency is misunderstood. It is a disease process,” Dr. Andrus emphasizes. “It is not a normal part of aging, nor is it benign. It can lead to severe swelling, skin ulcers and infections and can make walking difficult. I often find that people are willing to tolerate it and live with it because they believe it is inevitable. Spider veins can be the tip of the iceberg and should not be ignored or dismissed.”

Understanding The Risk Factors
There are multiple risk factors for chronic venous insufficiency. Heredity, age, gender and pregnancy are all common factors. Obesity is not an etiologic factor, according to Dr. Andrus, although it exacerbates the condition. Pregnancy is a risk factor because of progesterone, he says; it’s a hormonal problem, not the weight of the fetus pressing on the veins of the lower extremities. Family history may be the strongest factor; as many as 70 percent of people with varicose veins have a parent who had them, Dr. Andrus says.

There is also a cultural component, Dr. Andrus adds. “Since most people view this as cosmetic rather than medical, they don’t complain about it to their doctors and they don’t begin treatment early enough. Men, especially, dismiss it, viewing it as a female problem. It’s true that women are diagnosed with chronic venous insufficiency three times more often than men, but I believe this is largely due to it being underdiagnosed in men. Many people fail to realize that their symptoms, such as heaviness in the legs, itching, cramping, swelling, restless legs and pain are actually due to varicose veins. You have to battle that disease process early, before complications like skin ulcers develop. If your legs are keeping you from walking, standing or doing normal daily activities, you need to see your physician. Once my patients have had vein ablation done, they can hardly believe the difference.”

Preventative Measures & Treatment
“Walking is an effective way to keep the leg veins healthy,” Dr. Andrus says. “When you walk, you work the ‘calf muscle unit,’ compressing and squeezing the veins that go through those muscles. This sends blood back to the right side of the heart.” Compression stockings can keep pooling of blood and subsequent swelling to a minimum, but to be truly effective, one has to wear the thigh-high hose rather than socks. Compression hose have a downside, as they can be hot, uncomfortable and difficult to put on. More importantly, warns Dr. Andrus, compression stockings can keep people from dealing with the disease. “Compression hose have their benefits, but they help you manage the symptoms and that may lead you to delay seeking treatment.”

In addition to vein ablation, the St. Clair Hospital Vein Care Center offers two additional procedures, micro-phlebectomy and sclerotherapy. Micro-phlebectomy is a procedure in which a 1-2 millimeter incision is made in the leg and a tiny hook device is utilized to tease out small varicosities and reticular veins, veins that form a lattice-like structure. Sclerotherapy is a similar treatment for spider veins, although it can result in pigmentation changes in the skin.

“We’re getting very good outcomes treating venous insufficiency at the vein clinic, but this is a lifelong disease,” says Dr. Andrus. “For this reason, it’s essential for patients to take preventive measures after treatment, including walking.” Many patients find that they lose weight, without dieting, after undergoing vein ablation and other procedures to treat venous insufficiency. “Varicose veins keep people from walking,” Dr. Andrus explains. “The pain and swelling keep you sedentary and once those problems are resolved after treatment, you naturally begin walking more and burning calories. The ability to walk is critical to health and well-being, to aging well, and to overall quality of life, so having vein ablation is likely to positively impact your general health.”

This story is an edited version of a full report published in our Winter 2016 edition of HouseCall. If you want to read the full write-up – which includes more information about varicose veins – you can visit the St.Clair website and download a copy of our Winter 2016 HouseCall here.