The venous system of the leg consists of three
categories of veins; superficial, perforating and deep. Each
of these three categories of veins is lined with valves. Valves
are small cups that allow blood to flow in one direction
(uni-directional). Venous flow begins in the distal, superficial veins, into the perforating veins and finally to
the deep veins and off to the heart. The muscles of the legs aid
in compressing the veins of the leg, pushing the blood through the veins
to the heart. Defects in the valves allow blood to flow in a reverse
manner creating back pressure on the wall of the vein. If this
back pressure is sufficient to damage the wall of the vein, the vein
will change in shape to become tortuous and dilated creating what we
know as a varicose vein. Telangectasia are very similar to varicose veins and
are the small visible superficial veins often referred to as spider veins.
Varicose veins are very common with estimates ranging as high
as 15 to 20% of the general population. In patients over the age of 50
years, varicose veins are estimated to be present in as high as 50% of the
general population. This age relationship tends to be
due to the atrophy of the muscle as we age resulting in loss of muscle tone and
less support for the vein. The superficial veins of the leg are
particularly predisposed to increased pressure due to lack of support on all
sides of their walls.
The
causes of varicose veins and telangectasia are many,
but the single most common contributing factor is genetic.
Most of the contributing factors implicated in causing varicose veins do
so by creating a back pressure on the flow of blood from the legs into
the pelvis. These include obesity, prolonged periods of standing,
pregnancy or abdominal tumors.
Varicose veins and telangectasia account for more than 90% of
overall venous disease. The importance of treating varicose veins lies in
the fact
that patients with varicosities are more predisposed to the
formation of emboli (blood clots) within the varicosity. Emboli can have
significant sequella including pulmonary embolus (blood clot to the lung) or
myocardial infarction (heart attack). Another common problem associated
with chronic venous disease of the legs is edema (swelling). Chronic edema
of the legs due to venous insufficiency may lead to
venous stasis dermatitis, cellulitis,
venous ulcers and the
inability to stand or walk.
Treatment of varicose veins and telangectasia
At the onset of varicose veins or telangectasia, support by leg
compression is essential to control the progression of the damage to the
vessel wall. In early cases, support may be a simple as
OTC support hose. As the damage to the vessel increases, support will require
prescription support hose. Prescription support hose are made on a
case by case basis and require that the patient be measured for an exact
fit.
Homeopathic medicine discusses nutritional support for healthy
veins and varicose veins.
Horse chestnut (Aesculus hippocastanum) has been used for years as a
natural product known to promote the health of the vein wall.
Other homeopathic remedies for varicose veins include white oak
bark.
Sclerotherapy is a popular method used to treat
telangectasia and small varicose veins. Sclerotherapy is performed
in the office without the use of anesthesia. The chemicals used to
perform sclerotherapy vary, but the most popular is 23% saline, or salt
water. The concentrated salt solution scleroses the vein by
dehydrating the cells of the vein wall. Compression is
applied to the leg for several days following sclerotherapy to
promote the ability of the sclerosing agent to complete its' job.
Although sclerotherapy is a permanent change to the vein, sclerotherapy
needs to be performed every 3-5 years due to new telangectasia that form
over time.
Several types of lasers are also to treat
telangectasia. The draw back to the lasers are that they treat a
very focused area compared to the injection methods of
sclerotherapy. The laser's most appropriate use seems to be for
touch-up sclero following an incomplete or partially successful
injection.
A new procedure developed by VNUS Medical Technologies,
Sunnyvale, CA. was approved by the FDA in the spring of 1999. The
technique uses ultrasound to view the saphenous vein to guide the
insertion of a small catheter from the knee to the groin.
Radio-frequency energy is then used to destroy the lining of the vein.
As the catheter is slowly removed, the destruction of the vein is
performed to the insertion point above the knee. This technique can be
completed in an office setting and patients can bear weight immediately
follow surgery. Use of support hose is recommended for a period of
10-14 days following the procedure.
In advanced cases of varicose veins, venous stripping may
still be the treatment of choice for some vein specialists. Venous
stripping is a surgical procedure, performed under general anesthesia.
But with the popularity and success of radiofrequency ablation, vein
stripping rarely recommended.
