Frequently Asked Questions
Q What is a vascular surgeon?
A A vascular surgeon must have advanced knowledge and experience with the management of vascular problems including:
- All elements of clinical evaluation; non-invasive testing including plethysmography, duplex ultrasonography, magnetic resonance imaging, CT scans, angiography, and other diagnostic tests utilized in the diagnosis of vascular disease.
- Comprehensive management of vascular disease to include screening and surveillance, medical management, drug therapy, risk factor management, wound management including amputations, and other adjunctive procedures.
- Indications and techniques relating to open and endovascular treatment of vascular disorders to include the entire spectrum of interventions used to treat vascular disorders including occlusive, aneurysmal, inflammatory disease, trauma, and neurovascular compressive syndromes involving the arteries and veins of the body (excluding the intracranial and coronary arteries). This includes the aorta and its branches, the arteries of the neck, pelvis and upper and lower extremities, and the venous system.
- The critical care of the vascular surgery patient.
Q What credentials, education, licensing should a vascular surgeon have?
A Medical school followed by residency in general surgery followed by vascular training. There are programs present now that accept medical students in preparation for a career in vascular surgery. I refer readers to the Society of Vascular Surgery website for a complete description: www.vascularweb.com.
Q What symptoms are related to a possible vascular problem?
A Vascular problems occur in arteries and veins. Simply stated, arteries carry blood with oxygen to every organ. The organ could be the kidney, the leg, any organ in the body. Oxygen is extracted from the artery by the organ and used by the organ. In vascular disease, the arteries can become narrowed because of plaque buildup, and this is called arteriosclerosis. The end organ does not get enough blood and suffers and could develop gangrene. Arterial vascular risk factors are cigarette smoking, cholesterol, diabetes, and hypertension. The veins return this nonoxygenated blood back to the heart. Veins can be as small as spider veins, and are as large as the inferior cava. At Mendes Vein Care, all vein problems are fully evaluated and treated.
Envision that there are valves in the vein. When we walk, the calf muscle squeezes and the underlying veins also squeeze and move the blood out of the leg and back towards the heart. There are valves in the vein so when the calf squeezes, the blood is pushed up towards the heart. When the calf relaxes, the valves open, and the blood should return back to the valve that should stay closed. When the valve does not work properly, the blood will drift back down the leg, to a “competent” or normal valve. In venous disease, when one stops walking, the valve stays opens because the valve is not competent, and the blood drifts back down the leg causing heaviness, burning and itching. The blood moves back down the leg.
Therefore, when patient come to see me, their symptoms are:
- Heaviness - the blood has moved back down the leg because the valve did not stay closed;
- Itchiness - there is too much blood in the leg and the overlying skin stretches;
- Burning - there is too much blood sitting in the leg;
- Hyperpigmentation - ankles get darker and the leg is like a vial of blood. If blood is left sitting for a period of time, the blood settles to the bottom of the vial. The breakdown of the blood is called hemosiderin, and it stains the overlying skin.
Q What is a spider vein?
A Consider it to be the small red looking vein that also has the appearance of a spider. It is not dangerous, and is treated by closing it with a medication that causes it to scar. Frequently they occur in patients that also have larger veins. When patients present to MVC with symptoms as noted above and has spider veins, a full evaluation consists of a full physical exam including a pulse check and possibly an ultrasound.
Q What are varicose veins?
A Varicose veins are enlarged tortuous veins that typically affect the legs. They are veins that become enlarged and twisted with pooling of blood when they fail to properly circulate the blood back toward the heart. The smaller spider veins are located in the skin, while varicose veins are larger bulging veins that are beneath the skin. Varicose veins are a very common problem. They occur in approximately one out of every five women and one out of every twenty men. More than 36 million people in the United States are afflicted with this condition.
These abnormal veins are frequently associated with symptoms. They can cause itching, burning, and aching pain. Many varicose vein sufferers complain of heavy or tired legs, especially at the end of the day. Others have no symptoms, but are so distressed by their unsightly appearance that they never wear shorts or swimming suits that would expose their varicose veins. In severe cases, varicose veins can rupture or form open sores called venous ulcers.
Q How do varicose veins occur?
A Veins normally have a series of valves that help the blood flow upwards from the legs and back to the heart. If these valves are absent or incompetent, venous blood tends to pool in the legs. Over a period of time the affected veins elongate and dilate. The ultimate result is the condition we describe as varicose veins. It is easy to understand that symptoms are aggravated by prolonged standing or sitting. The combined effects of gravity and faulty valves cause increasing pressure in the leg veins. This condition is commonly referred to as venous insufficiency, and is the primary cause of varicose veins.
Q What are the causes and complications of varicose veins?
A Heredity is the primary cause; however, certain hormones (estrogen & progesterone) are definitely a factor. It accounts for the strong predominance of women with this condition. Pregnancy can aggravate the problem because of hormonal changes, increased blood volume, and compression of pelvic veins. Often varicosities which occur during pregnancy will disappear after delivery. More often than not, however, the veins persist and enlarge over time.
There are several other causes of venous insufficiency and the resulting varicose veins. A history of phlebitis or thrombophlebitis, which is an inflammation and/or thrombosis of the veins, eventually leads to venous insufficiency. Local traumatic injury, causing fragile surface veins to break, can also cause varicosities to develop. Additionally, obesity and certain occupations requiring long periods of sitting or standing can be aggravating factors.
There are several complications of untreated varicose veins. Varicose veins may become inflamed resulting in a painful condition called superficial thrombophlebitis. Another common complication is profuse bleeding, which may occur either spontaneously or after mild trauma to the varicosity. A late complication is brownish pigmentation of the skin in the lower calf, sometimes leading to skin breakdown and ulcer formation. These venous stasis ulcers can be very difficult to heal and occasionally require skin grafting.
Q What treatment options are available for varicose veins?
A Most of the symptoms of varicose veins can be relieved with graduated compression support stockings. If properly fitted, these stockings compress the varicose veins and reduce the effects of blood pooling in the lower leg; therefore limiting the occurrence of long-term complications.
The second treatment choice is vein stripping. This is a surgical procedure performed in the operating room, as a same-day procedure. The operation consists of making small incisions over the varicose veins and removing or "stripping" the veins. Return to normal activity and work ranges from several days to several weeks.
Radiofrequency or laser ablation of the saphenous vein is rapidly replacing vein stripping as the treatment of choice for venous insufficiency with symptomatic varicosities. This outpatient procedure can be done without a surgical incision. Utilizing a small needle puncture in the skin a catheter is inserted into the saphenous vein at the level of the knee. The catheter employs heat to ablate the vein from the groin to the knee region. The procedure is performed in an office-based operating room and can be done with local anesthetic and/or a general anesthetic. There is minimal post-procedure pain or bruising and you are encouraged to walk around immediately after the procedure. Saphenous vein ablation is usually performed in conjunction with follow-up sclerotherapy for the treatment of residual varicose veins.
Q What is sclerotherapy?
A Sclerotherapy is a popular minimally invasive way to treat varicose veins. The procedure consists of using micro-needles to inject the affected veins with an irritating salt solution. The vein becomes inflamed after being exposed to this solution. Over a period of several weeks to several months the vein goes through a process called sclerosis, where the walls collapse and are eventually reabsorbed. At the completion of the process the vein is no longer a blood carrying vessel and cannot be seen or felt. Other normal veins will take over the function of these sclerosed veins.
Following injections, compressive dressings are applied for large varicose veins and are usually worn for one week. When spider veins are injected, smaller dressings are applied and can be removed the following day. Patients are encouraged to walk at least 15 minutes immediately following the procedure and 15 minutes daily while the compressive dressings are worn. Normal activity can be resumed immediately after the treatment session.
The number of sessions after the initial consultation varies from one to three depending upon the number and severity of the varicose veins. Each treatment session takes approximately one-half hour. It is performed as an outpatient procedure in the Vein Clinic and requires no anesthesia.
Q Are there any side effects of sclerotherapy?
A There are few side effects related to sclerotherapy. Following removal of the dressing, some bruising at the injection sites may be noted. It is also not unusual to have small harmless blood clots trapped within the injected veins. The body reabsorbs this clot as the vein is reabsorbed. In larger varicose veins this trapped blood can be felt as a hard lump beneath the skin. These lumps eventually soften and disappear over several months. Brownish pigment in the skin is occasionally present at the site of an injected varicosity. This, too, eventually fades and disappears, but in the case of darker areas of pigmentation, this process can take as much as a year. Unlike surgery, sclerotherapy does not leave scars and can be used effectively on all size veins, from tiny spider veins to very large, bulging varicose veins in the calf and thigh.