Beth Israel Deaconess Medical Center Harvard Medical School
		Leaders in Specialty Care Varicose Veins        Spider Veins
		Our staff have had great success in treating patients who have disorders of the venous system, including varicose veins and leg ulcers. Varicose veins are a very common problem in both men and women. The symptoms can range from just cosmetic issues to pain and numbness. There are two sets of veins that transport blood from the feet, up the legs and to the heart. 1) A deep system that runs with your arteries (you cannot see it). 2) A superficial system that runs mainly along the inside of your leg and thigh. The main vein of the superficial system, the greater saphenous vein, is the one used for heart bypass surgery. These two systems have multiple connections between them, and the saphenous vein has a number of side branches all over the leg. In general, the bulging veins that you find uncomfortable are those branches. These veins normally have valves that allow transfer of blood only away from the feet and legs, a so called trapping effect that is actually against gravity. However, in patients with varicose veins, the saphenous vein or deep system often has portions that are incompetent or allow reflux in which blood goes backwards down to the feet. This chronic build up in pressure leads to the bulging of the side branches. Some Useful Information About Varicose Veins 1) They are not dangerous. In general they can be cosmetically unappealing and cause some itching, numbness or pain but are not harmful. 2) Except under unusual circumstances, they are not a cause of blood clots that can move to the lungs (embolism). Although they can be associated with a condition of inflammation called superficial thrombophlebitis, it is rare for varicose veins to play a role in the serious condition of thrombosis of the deep system. It is still possible however to develop a deep venous thrombosis. 3) They do not always require surgery. There are several options, and treatment is mainly by patient preference except in certain circumstances. Treatment Options Although non-surgical options can never cure the condition, they can make a symptomatic difference. Since it is a condition of increased pressure (from the reflux), keeping your legs elevated above your heart will decrease the pressure. In addition, prescription stockings should be worn, also to control pressure buildup. Surgery Before surgery, in general, you will need to have an ultrasound scan of your veins. This will look for any blockage in the deep or superficial system and for reflux or incompetence. If there is reflux in the main superficial vein, just removing its bulging side branches is often only a short term solution because new side branches will bulge out. In this case, we need to remove the bulges, (called cluster excision) as well as the portion of the saphenous vein that is not working (called stripping). This will decrease the recurrence rate. To remove all the clusters of bulging veins, multiple small cosmetic incisions along the leg may be required. To remove the saphenous vein, if needed, there will be two incisions, one in the groin crease and one in the calf. This long vein is then removed underneath the skin via these incisions. Injection therapy and laser treatment for varicose veins are usually not effective therapies for the large bulging veins. In general, vein stripping is a very safe procedure. In a small number of patients, there can be wound infections and or some areas of numbness. Also, the bulges will be gone but you will have a number of small scars in their place. If you generally form large scars, this may be a concern. Anesthesia - Structured to fit patient preference but ranges from general anesthesia to spinal or local anesthesia. Routine You come in on the day of surgery and go home later that day. You will be wearing an ace bandage applied in the operating room, for two full days and you will need to take it easy. It is very important to elevate your legs as much as possible over the first five to seven days. On the third day after surgery, you can remove the bandages, shower, and may wear fitted stockings. There will be bruising that may take several weeks to go away. Spider Veins - More About Spider Veins This is really a separate condition. It is often seen in patients with varicose veins but the treatment is different. These are very small veins just below or in the skin. You can see them because they are so close to the surface. They also will cause you no harm, but often patients want them treated. A common treatment is to inject a solution directly into the vein that causes them to thrombose and lose their color. This is done in the office with a very small needle. Sometimes there is a brown discoloration and a small area of numbness around the injection. In addition, a further cluster may develop that will need injections. You do not need to miss work after the injections. New Treatments We now offer the less invasive Closure procedure which involves scarring of the saphenous vein with a heated catheter. This avoids the incisions normally done for the saphenous vein stripping but you may still need the small incisions for excision of the bulging clusters. The recovery is generally much quicker than the standard surgery. This procedure may be of benefit in you but is not helpful in all patients. For you to be a candidate your saphenous vein has to be a significant component of your varicose veins. It is important to understand that in only about 50% of patients, the catheter treatment without any incisions is all you need- this replaces the saphenous vein stripping. In the other 50% you will have the Closure as part of the treatment since you will need small incisions to remove the bulging clusters.
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