Varicose Veins: More Than Just a Cosmetic Problem

1. Varicose Veins: More Than Just a Cosmetic Problem Jeffrey Stein, MD Charlotte Radiology Vein and Vascular Center Vascular and Interventional Radiology Charlotte Radiology February 8, 2012

2. What are Varicose Veins? • abnormally enlarged superficial veins • tortuous, twisted, widened or lengthened • bulging under skin surface • due to a defect in the valves within the veins themselves (venous valve insufficiency) • blood pools in sections of the vein causing the vein to bulge and swell

3. What are Varicose Veins? • Normal vein: cusps of valves close & prevent backward flow of blood • Varicose vein: cusps cannot close because vein abnormally widened and blood can flow in the wrong direction

4. Introduction • may be no symptoms • for some a problem in terms of appearance • may result in mild discomfort • may cause severe pain • may result in additional medical problems

5. Introduction • Images of varicosities:

6. Introduction • Telangiectasia, more commonly known as spider veins: • Spider veins on the leg usually appear in one of three patterns: • simple linear • arborizing, which appear branch-like • spider, which appear as a cartwheel shape with a dark center point.

7. Incidence and prevalence • 15% of males over 18 • 30% of women over 18 • increases with age, being present in more than half the population by age 65 • 20 Million adults with varicose veins or chronic venous insufficiency (CVI)

8. Risk Factors • Genetics / Hereditary - those with a family history are at greater risk • family history of varicose veins 15 % of patients • Increasing Age • Gender - women are at greater risk than men • related to female sex hormones estrogen and progesterone which relax blood vessels, allowing the vein valves to separate • pregnancy

9. Risk Factors • Obesity- excess weight increases pressure on the saphenous vein valves, causing them to weaken • Pregnancy • varicose veins may surface for the first time during pregnancy • progesterone smooth muscle relaxation • later in pregnancy the uterus exerts greater pressure on the pelvic and leg veins and may cause or worsen varicose veins

10. Risk Factors • Standing and sitting- those who have jobs that require them to stand or sit for long periods also are at increased risk • prolonged standing can weaken the walls of veins • prolonged sitting can aggravate inflamed veins

11. Symptoms • pain • leg heaviness • aching or tension • tenderness along the course of a vein • burning sensations • pruritus / itching • exercise intolerance • restless legs • paresthesias • night cramps • edema • skin changes

12. Thrombophlebitis Complications

13. Complications Stasis Dermatitis/ Varicose eczema

14. Complications Stasis Dermatitis/ Varicose eczema & Lipodermatosclerosis

15. Management of Varicose Veins and Venous Reflux Conservative treatment (will not solve the problem but will help with symptoms): • elevation • avoid prolonged sitting/standing • no leg crossing • exercise • weight reduction • compression stocking therapy

16. Management • Compression Stocking Therapy

17. Management Treatment options: • Surgical stripping: old way of removing the vein. Typically required a hospital stay and weeks of recovery time. • Injection sclerotherapy: often treats the surface veins, but does not treat the underlying problem. • Endovenous laser treatments: much less invasive way of “eliminating” the vein. The procedure seals off the vein while leaving it inside of your leg.

18. Management Benefits of laser treatments vs. traditional stripping: • Minimally invasive, in-office treatment alternative to surgical stripping of the great saphenous vein • No sedation • Most procedures take less than 30 minutes • Patients are able to walk immediately after the procedure and most individuals are able to return to work the next day

19. Ultrasound Evaluation: Before • During a consultation, you will meet with the doctor and have an ultrasound to determine which veins are not functioning properly. Your doctor will then discuss your treatment plan and review your insurance requirements. Most procedures are covered by insurance.

20. Varicose Veins: More Than Just a Cosmetic Problem If you are interested in a consult, please give us a call. We accept all major insurances. Southpark: 4525 Cameron Valley Parkway Charlotte, NC 28211 704.333.3794 ext. 2220 Concord: 212 LePhillip Court NE Concord, NC 28205 704.786.0052 www.crveins.com