Leg work

Varicose veins creeping up on you? Here are the latest treatment options.

After years of putting it off, it’s time to take my legs in hand. I’ve had a bluish-green network of varicose veins running behind my knees since my first child was born eight years ago. Two more children later, and my calves and thighs now resemble a multi-lane highway.

“The good news is your varicose and spider veins seem to be super-ficial,” says Diana Phillips, a registered nurse at DLK on Avenue Dermatology & Cosmetic Laser Surgery Clinic in Toronto. Phillips taps the larger superficial veins in my legs to feel how the blood flows through them. This test, coupled with a visual examination, helps determine whether she can treat my problem at the clinic or needs to send me off to a vein specialist.

I’m not alone. Women are almost twice as likely to get varicose veins as men. In fact, 25 percent of women in the US have them.

Does that mean you’re doomed to keep your legs under cover? Of course not! Here’s the lowdown on the causes of varicose veins — and treatments.

Under pressure

If your legs look like your toddler has taken a blue marker to them, thank your parents — heredity is the main cause. But prolonged standing, obesity, aging and heat can make them feel and look worse.

So can pregnancy. As your fetus grows, you gain weight, putting pressure on the veins in your pelvis, explains Ferdinand Stasiak, medical director of The Vein & Laser Clinic in North Vancouver. Your body also tends to hold more water, adding to the pressure. And the same hormones that nourish the placenta cause your muscles to relax, which can lead to dilated veins.

Confusing? Picture your veins as roads transporting blood to your heart through your body. If a vein gets blocked and the blood reverses, it pools like a traffic jam, causing veins to swell and bulge and, eventually, producing varicose and spider veins.

Telltale signs

You can have varicose veins for years without being bothered by them, explains Stasiak, until complications develop. Some people experience heavy, achy, tired legs and swollen ankles. Others complain of skin problems, ranging from dry, itchy skin to rashes, ulcers or little bulges that can burst and bleed externally, if left untreated. A small number of people may even develop superficial blood clots or deep vein thrombosis (DVT) — a clot in a deep vein in the body — as blood stagnates in diseased veins.

Roadside assistance

Depending on the extent of vein disease and expectations, different treatments are available. You may need more than one treatment to tackle the problem. Luckily I don’t have any symptoms except for visible veins, so sclerotherapy (see below) should give me the cosmetic results I’m looking for. Read on to find a treatment that’s perfect for your pair.

Sclerotherapy

This is the most common varicose vein treatment, and works best on spider and reticular veins — the flat, blue veins visible beneath the skin. A registered nurse or medical practitioner injects a tiny needle filled with a chemical to irritate the vein, causing it to collapse and eventually be absorbed by the body. You may need several sessions to get the results you want. Side effects can include mild swelling and bruising.

A new treatment on the scene is ultrasound guided foam sclerotherapy, which uses a foam solution instead of liquid to irritate the vein wall. According to Stasiak, foam is more effective because the tiny bubbles fill the vein better and remain there longer. Because the foam can obscure the position of the needle, though, there is greater risk of hitting an artery or developing DVT.

Cost
$45 (per session) for an isolated spider cluster to $350 for traditional sclerotherapy; $200 to $600 for ultrasound guided foam sclerotherapy

Endovenous laser treatment (EVLT)

This treats the longer and larger leg veins. Through a small incision, a surgeon threads a fine catheter into the vein, which lasers it closed. The surface veins connected to those being treated may also shrink; if they don’t, they can later be injected with sclerosant. EVLT is performed under local anaesthesia and you usually go home the same day. Although there may be bruising, pain is minimal and recovery relatively quick, with low risk of bleeding or infection — making it an increasingly popular procedure.

Cost
about $2,500 per session

Surgical ligation and stripping

When the varicose vein is too large for sclerotherapy, or too ropy for a catheter to pass through, surgery may be the answer. Under local or general anaesthesia, problematic veins are tied shut and pulled from the leg. Most varicose veins removed by surgery are surface veins, which don’t affect blood circulation. Recovery can take several weeks and there is possibility of infection, bleeding or DVT. This treatment is used less now than in the past.

Cost
covered by most provincial health plans

Ambulatory phlebectomy

This is often the best choice for branches of the main leg vein after the main vein has already been treated with foam sclerotherapy, EVLT or surgical ligation. Under local anaesthesia, veins are removed through a series of tiny incisions, which are less prone to infection or bleeding and leave only tiny, imperceptible scars.

Cost $200 to $1,000

Lasers

While lasers can be effective for the tiny broken blood vessels on the face, results are less predictable on the body. They are best used on small spider veins after the reticular veins have been eliminated with sclerotherapy. You may need more than one session to achieve results, and there is a risk of superficial burns or pigmentation changes from the heat.

Cost $200 to $500 per session

Vein management

These tips won’t eliminate pre-existing varicose veins, but will help prevent new ones from forming:

• Wear support stockings, especially when flying; avoid alcohol while in the air, since it can lead to clotting
• Keep legs elevated when sitting and avoid crossing your legs
• When standing, lift heels frequently (do calf raises) to boost circulation
• Avoid high-heeled shoes, which impair blood flow in the legs
• Exercise regularly

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