Frequently Asked Questions
General Venous Disease Questions:
What are varicose veins?
Varicose veins are dilated or large, ropy, blue, enlarged veins most often found in the legs. They occur when the valves in the veins become weak or diseased and no longer provide adequate support. The loss of structural integrity causes blood to pool in the legs, ankles and feet. Visually varicose veins are the most obvious sign of vein disease, but you do not have to have visible veins to have vein disease.
What are spider veins?
Spider veins are veins that are close to the skin's surface and may look thin and wispy like spider webs or thick and squiggly like branches. Similar to varicose veins but smaller and thinner. We tend to think of spider veins as a cosmetic problem, even medical professionals and even vascular surgeons do. Many times there is increased pressure in the venous system and thus underlying medical cause that has created the spider veins. If you have spider veins along with any other symptom of vein disease (heaviness, stinging, burning, throbbing, swollen ankles, itchy burning legs, aching, numbness, etc.) then you may have an underlying condition. An evaluation by The Vein Center of Arizona and a high-quality venous ultrasound test can establish if spider veins are cosmetic in nature or a result of venous insufficiency. This test also can assist in getting your insurance to pay for treatment.
What causes varicose veins?
The normal function of leg veins – both the deep veins in the leg and the superficial veins – is to carry blood back to the heart. During walking, for instance, the calf muscle acts as a pump, contracting veins and forcing blood back to the heart. To prevent blood from flowing in the wrong direction, veins have numerous valves. If the valves fail (a cause of venous reflux), blood flows back into superficial veins and back down the leg. This results in veins enlarging and becoming varicose. The process is like blowing air into a balloon without letting the air flow out again- the balloon swells. To succeed, treatment must stop this reverse flow at the highest site or sites of valve failure. In the legs, veins close to the surface of the skin drain into larger veins, such as the saphenous vein, which runs up to the groin. Damaged valves in the saphenous vein are often the cause of reversed blood flow back down into the surface veins.
Who is at risk for varicose veins?
Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, and past vein diseases such as thrombophlebitis (i.e. inflammation of a vein as a blood clot forms.) Women suffer from varicose veins more than men, and the incidence increases to 50% of people over age 50.
Treatment and Insurance Questions:
What is the short-term treatment for varicose veins?
ESES (pronounced SS) is an easy way to remember the conservative approach. It stands for Exercise, Stockings, Elevation and Still. Exercising, wearing compression hose, elevating and resting the legs will not make the varicose veins go away or necessarily prevent them from worsening because the underlying disease (venous reflux) has not been addressed. However, it may provide some symptomatic relief. Weight reduction is also helpful. If there are inflamed areas or an infection, topical antibiotics may be prescribed. If ulcers develop, medication and dressings should be changed regularly. There are also potentially longer-term treatment alternatives for visible varicose veins, such as sclerotherapy and phlebectomy.
What is sclerotherapy?
A chemical injection, such as a saline or detergent solution, is injected into a vein causing it to “spasm” or close up. Other veins then take over its work. This may bring only temporary success and varicose veins frequently recur. This treatment is most effective on smaller surface veins, less than 1-2mm in diameter.
What is vein stripping?
Vein stripping is an older procedure for treating varicose veins that involves inserting a wire into the affected vein and then pulling it out of the body. This is no longer recommended for patients; standards-setting medical organizations such as American Venous Forum now recommend more modern techniques such as laser and radiofrequency ablation, which are offered by Center for Vein Restoration. Vein stripping requires a long recovery time (2-3 weeks off work) and can cause pain, bruising and other problems, such as increased risk of DVT.
Will my Insurance cover varicose vein treatment?
Insurance coverage for the treatment of venous insufficiency varies depending on both your insurance provider and your specific policy. In general, most insurance providers separate vein treatments into two categories—those that are deemed “medically necessary” versus those that are “cosmetic” in nature. As the presence and extent of venous insufficiency is best determined via ultrasound, we encourage anyone thinking about seeking vein treatment—cosmetic or otherwise—to better understand the complete status of their veins through one of our comprehensive ultrasound screenings as, more often than not, venous insufficiency is not readily visible. Most insurance providers cover this initial, comprehensive screening. Typically, larger veins that are symptomatic (i.e. those that are causing discomfort such as pain, aching, burning, itching, swelling, fatigue, heaviness as well as other symptoms that may be specified by your insurance provider) are usually considered “medically necessary” and are therefore covered by your insurance.
Should I apply creams or lotions to my leg before treatment?
You will be instructed not to apply any type of moisturizer, sunblock or oil to your legs on the day of your procedure and advised to shower the morning before your treatment too. This is to ensure that your legs are clean, lotions on the skin have the potential to carry germs and bacteria that may promote infection. We want the area being treated to be sterile so having a shower the day of your surgery and not using any lotions afterward will help ensure this. We also advise that you refrain from shaving your legs the day of your procedure; this is to reduce any razor burn irritation when the sterilizing wash is applied to your legs before surgery.
What should I wear on my Treatment Day?
We advise either coming in loose clothing or bringing a spare set that you can easily change into to go home in. After you have had your EVLA treatment you will be bandaged up in an assortment of both bandages and compression stockings and your legs may swell slightly too. This results in your legs being a little wider than they were when you first came in, so those skinny jeans are not going to go back on easily!