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Varicose Veins: Often More Than Just a Cosmetic Concern

November 9, 2011 1:00 PM with Dr. Benjamin Lind

While not all instances of varicose veins require treatment, sometimes they can lead to more serious health problems. Join Dr. Benjamin Lind as he answers your questions about the symptoms, complications, risk factors, causes and treatment options of varicose veins. Your participation and questions are welcomed.

Dr. Benjamin Lind (NorthShore) - 12:45 PM:
Good afternoon everyone, and thank you for stopping by. I'm a vascular surgeon and wound care specialist, and will be answering questions regarding varicose veins and venous disease.

Romi Anderfuren (Moderator) - 12:52 PM:
Welcome! Today’s chat: Varicose Veins: Often More Than Just a Cosmetic Concern will begin shortly. Please start submitting your questions and Dr. Benjamin Lind will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Vascular Surgery section to obtain more information.

  Linda (Chicago) - 1:00 PM:
I am required to stand a lot at my job. Am I at a great risk for getting varicose veins? What steps can I take to avoid them?
Dr. Benjamin Lind (NorthShore)
It is difficult to predict who will develop varicose veins. Two factors associated with developing them are a history of deep vein thrombosis, and a family history of varicose veins. Multiple pregnancies may also contribute. Many people who stand for long periods of time find compression stockings are helpful. They reduce swelling in the legs, and encourage the normal return of venous blood towards the heart. It isn't clear, though, if they can prevent varicose vein formation in people who don't have varicose veins.

  Jess (Evanston) - 1:05 PM:
What is the difference between varicose and spider veins?
Dr. Benjamin Lind (NorthShore)
A varicose vein is a swollen, enlarged vein. A spider vein is a smaller, milder form - usually an enlarged capillary. Both are caused by increased pressure in the venous system.

  Stacy (Evanston) - 1:07 PM:
I just recently received treatment for my varicose veins. Is it possible for them to return?
Dr. Benjamin Lind (NorthShore)
Yes. The venous system is highly complex and variable. There may be multiple areas of venous disease, and superficial veins that were previously unaffected can become affected over time. If the varicose veins were due solely to a refluxing great saphenous vein, ablation of the great saphenous vein should be very effective.

  Molly (Evanston) - 1:10 PM:
What treatment options are available for varicose veins? Are any of these treatments non-invasive?
Dr. Benjamin Lind (NorthShore)
There are many treatment options availabe, and the choice depends on the underlying problem. Many people have reflux in the great saphenous vein, which runs along the inner thigh, down the leg. Ablation of this vein decreases the flow into the varicose veins. The varicose veins are still present, but symptoms are often greatly relieved. The ablation procedure is minimally invasive and involves sealing the vein with a very fine catheter, inserted through a needle hole. The procedure is done in the office and takes about an hour. Afterwards, if the varicose veins are still bothersome, they can be removed via small incisions in the leg. This is called a phlebectomy, and can also often be done in the office. Some people also have varicose veins treated by sclerotherapy, though sclerotherapy is more commonly used for smaller spider veins.

  Sally (Skokie) - 1:15 PM:
I have pain in my legs when walking. I noticed that some of my veins appear enlarged. What symptoms exist? How do I know if I need treatment?
Dr. Benjamin Lind (NorthShore)
Leg pain when walking is a common complaint, with many possible underlying causes. Pain due to venous disease is often worse when standing and walking, and may be described as a heavy feeling or dull ache in the legs that gets worse as the day goes on. The pain is usually relieved with elevation, and feels better after sleeping in bed. People also describe an itching sensation in the veins as they get larger. Other causes of leg pain when walking include arterial disease, ie peripheral arterial disease, as well as musculoskeletal problems such as arthritis. A doctor's evaluation may be required to help discern the cause.

  Ramona (Moody, AL) - 1:23 PM:
Does itching @ the site typically go along with varicose veins?
Dr. Benjamin Lind (NorthShore)
Yes, itching is a common complaint of people with varicose veins. The itching may be related to stretching of the vein.

  Nancy (18330) - 1:26 PM:
What are the risks for surgery on large varicose veins and can they be corrected without surgery?
Dr. Benjamin Lind (NorthShore)
To remove a large varicose vein with surgery, an incision is made and the vein is taken out. It is normal to have bruising where the vein was removed, and sometimes the bruising can be significant. Continued bleeding is a risk, especially if you are on blood thinners. There can also be problems with the incision sites, such as wound breakdown and infection. These risks are low but do exist. If the varicose veins arise from an incompetent saphenous vein, saphenous vein ablation may provide significant relief and no further surgery is required. Before surgery, patients are encouraged to wear compression stockings. Some people find the symptom relief is good enough that no further treatment is necessary.

  Paul (Evanston, IL) - 1:33 PM:
What is sclerotherapy? Is it safe?
Dr. Benjamin Lind (NorthShore)
Sclerotherapy involves injecting a small vein with a sclerosing agent. The sclerosant creates inflammation along the inner wall of the vein. This results in fibrosis and closure of the vein. There are many potential side effects. The most common are allergic reactions. Also, the sclerosant may leak outside of the vein being treated and create inflammation of the skin instead. This can result in blistering as well as adverse cosmetic outcome.

  Sandy (Evanston, IL) - 1:37 PM:
Are varicose veins dangerous to one's health? I believe I started to get them and am wondering if any treatment is necessary or if it's only done for cosmetic reasons.
Dr. Benjamin Lind (NorthShore)
They are not usually dangerous to one's health. However, some people with advanced disease find the pain and discomfort great enough that they seek treatment. In advanced cases, varicose veins are associated with significant venous insufficiency and patient develop venous stasis ulcerations, which can be difficult to heal.

  Allison (Evanston, IL) - 1:40 PM:
Can I expect to be in pain after my surgery? How long will it take before I can resume daily activities--exercise, walking, showering, etc.?
Dr. Benjamin Lind (NorthShore)
It depends on the type of procedure you have, and your own personal threshold and tolerance for pain. After a saphenous ablation, it is normal to have tenderness along the length of the vein, and this can last up to a week. Some people aren't bothered at all, and others are. Regardless, you can take medication to decrease the pain. Walking is encouraged after the procedure. You can shower two days after the procedure. You should avoid soaking in a bathtub or whirlpool until incisions are healed. I would also avoid strenuous activities, like long distance bike rides or long runs, for a few days after the procedure.

  Kathy (Chicago, IL) - 1:45 PM:
I've had varicose veins for years and they have never bothered me. Do they worsen over time? What should I be aware of that would require treatment or surgery?
Dr. Benjamin Lind (NorthShore)
It is hard to predict if they will worsen or not. If they don't bother you, there's a low risk that they will need treatment. If they become large and painful you may want to have them evaluated. Likewise, if you develop leg ulcers, you should have them evaluated. I would also have them evaluated if they become red and inflammed, which may be a sign of clot formation.

  Susan (Evanston, llinois) - 1:49 PM:
Can you have a varicose vein on the top medial part of the foot?
Dr. Benjamin Lind (NorthShore)
Yes, any part of the leg can be affected.

Romi Anderfuren (Moderator) - 1:50 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes. Please submit your final questions.

  Toni (Glenview, IL) - 1:52 PM:
I'd like to be able to self treat my the varicose veins in my legs. Are there any medications that can be used for treatment? How about other homeopathic remedies or recommendations?
Dr. Benjamin Lind (NorthShore)
Probably the most effective non-surgical treatment available is a good fitting compression stocking. I recommend seeing a professional fitter with a good inventory of stockings who can measure and fit them properly. This is the first line treatment that I recommend to my patients. Multiple medicines have been tested, and some are available in Europe. I'm not aware of any that are available here in the US, though.

  Cate (Highland Park, IL) - 1:55 PM:
There seem to be many different treatment options. What are the differences between surgical excision, ligation and sclerotherapy? Are certain options better than others?
Dr. Benjamin Lind (NorthShore)
You're right, there are many treatment options. The best option is the one that successfully treats the underlying problem while addressing the symptoms you are having. If a patient has varicose veins arising from an incompetent saphenous vein, and the problem is leg discomfort, then saphenous vein ablation may be an excellent choice. But if the problem is more cosmetic, then excision may be needed. Sclerotherapy is generally less effected on larger varicose veins, but may help with smaller spider veins.

  Nicole (Glenview, IL) - 1:58 PM:
I didn't seem to have any problems with varicose veins during my first pregnancy, but am starting to notice them now. (I am about 23 weeks pregnant). Will I still have them after giving birth? How can I reduce/treat them now?
Dr. Benjamin Lind (NorthShore)
It is common that varicose veins become more noticeable with pregnancy, and that they may get worse after pregnancy. They may well stay after childbirth. A good pair of compressions stockings may help relieve the symptoms, if they are bothering you. Many women wait until they are done having children before pursuing further intervention, because they may be exacerbated by future pregnancies.

  Kate (Chicago, IL) - 2:00 PM:
I just had surgery about 5 weeks ago and I still feel lumps under the skin where veins were removed. Is this normal? How long will it take for the bruising to go away?
Dr. Benjamin Lind (NorthShore)
It can be normal to have small bruises under the skin, where the veins were removed. These can take a few months to go away. You should let your doctor know of any concerns.

Romi Anderfuren (Moderator) - 2:03 PM:
Thank you again for participating in our chat today. For more information please visit our Vascular Surgery section .

Dr. Benjamin Lind (NorthShore) - 2:05 PM:
Thanks everyone for all of your excellent questions.

This chat has ended.

Thank you very much for your participation.