How to treat varicose veins

The Woman of Wellness program held in July at Fallbrook Library featured Dr. Stefan Moldovan talking about varicose veins. A vascular surgeon, Moldovan informed the room full of ladies, and a few men, about the symptoms and causes of this common condition.

Forty million people in the U.S. have varicose veins; 25 percent of women have it while the number of men with it is 15 percent and growing. Not everyone who has it has the symptoms, which include burning, hard or leathery skin, venous ulcers, swelling, heaviness, pain, discomfort and a heaviness in the legs.

Moldovan said that varicose veins are swollen, blue, bulging, twisted superficial veins of the legs. Superficial veins, he explained, are those closest to the surface of the skin. Deep veins are located within the muscle compartments of the legs while perforator veins connect the superficial veins to the deep veins.

He said that those who are at risk for this condition are over 55 years old, have an immediate family history of varicose veins, are women who have had multiple pregnancies, people who are overweight, and people who stand for long periods of time. Genetic factors are most important, he added.

Moldovan then detailed the anatomy of the condition. Healthy veins, he said, contain valves that open and close to assist the return of blood back to the heart. Venous reflux disease develops when the valves that keep blood flowing out of the legs and back to the heart become damaged or diseased and the blood doe not flow correctly, causing the veins to bulge with a reflux of blood.

To confirm the disease, a vascular doctor obtains the patient's medical history and performs a physical exam. In most cases, Moldovan said, an ultrasound will be performed to detect the presence of reflux in the veins. The ultrasound is performed in the doctor's office by a registered vascular technologist (RVT) in an accredited vascular lab and interpreted by a board certified vascular surgeon.

If the patient had tried compression stockings, elevation of the legs and a regular routine of exercise and the symptoms have not resolved, one of the following procedures can be performed. Radiofrequency ablation uses radiofrequency energy to heat, collapse and seal off the targeted blood vessels. Clarivein uses an infusion catheter system with a unique rotating tip that allows for 360 degree coverage of the blood vessel, scratching the inside of the vein with solution which makes it clot. Sclerotherapy involves an injection of a solution (generally a salt solution) directly into the vein. In laser ablation, the abnormal veins are heated by a laser and the body then absorbs the debris.

Moldovan said that stripping veins is a procedure that is no longer used.

Today, treatment can be done under local anesthesia on an outpatient basis. He advised that all sources of reflux need to be treated.

The most frequently used procedure is radiofrequency ablation, which takes the affected vein out of the blood system and redirects blood to other, healthy veins. He said this is a better, less painful option.

The patient lays down, and her leg is prepared from groin to ankle; a wire catheter is threaded up the vein and connected to a regulator of radio frequency or laser energy. The vein clots and shrinks in two minutes. The leg is then wrapped in an elastic wrap and the patient can walk out.

Afterwards, the patient should walk for 20 to 30 minutes to keep the blood flow going and prevent a deep vein thrombosis (DVT) from developing. An ultrasound is performed the following day and again a week later to check the veins. An anti-coagulation medication may also be prescribed. Exercise, good nutrition and a healthy lifestyle are also recommended post recovery.

According to Moldovan, radiotherapy and clarivein both produce post procedure bruising and have the best success rate with a fast recovery and less pain than surgery or laser therapy. Radiotherapy and laser therapy both minimize the chance of DVT. Laser therapy is the most painful of all the treatments, he said.

As for cost, he said that the procedures are covered by most insurance companies but some require more documentation than others. The procedures are necessary for medical reasons, he added, and are "not vanity".

Thirteen people had a sonogram done on their legs after the doctor's presentation.

Woman of Wellness is provided by the Fallbrook Healthcare District at the library on the first Thursday of the month.