Q: When I was 42 years old (I am now 77), I had my right leg vein stripped. I regretted it, as it did not help. In fact, the veins seemed to get worse. My legs have been troublesome for many years. I have seen three different doctors (all in the same group). The first one told me that my only option was to wear compression stockings. I went again a few years later, and this doctor recommended a procedure called vein closure. At that time I said no.
A few year later, I noticed strange red scratches on my leg that looked like they were about to bleed. They would eventually fade away, but they left a mark where they had been. Also, I have a strange red mark on one ankle the size of a dime. Thinking this was related to my vein issues, I went back to the same medical group. Again, the doctor recommended vein closure and something called Clarivein. I have an appointment in a month -- as long as my insurance OKs it -- but I am not sure if I should go forward with this. Can you shed any light on this for me?
A: The many years of struggle with varicose veins Dorothy has described are probably very familiar to many of you. Her letter also touched on many other aspects of dealing with this problem. I will do my best to clear up some of the confusion.
Let's start by describing the problem. Varicose veins are otherwise enlarged or engorged veins. They can also appear twisted and bulging. They most commonly happen to affect our legs. This is due to old-fashioned gravity as the work of blood traveling from the legs and feet upwards is much more than from our heads, neck or hands. Spider veins are a lesser form of veins and can show on other parts of the body including the face.
We all have two types of blood vessels. Arteries carry blood full of oxygen from the heart and lungs to the rest of our body. Veins, on the other hand, collect used blood and bring it to get oxygen from the heart and lungs.
There are two systems for veins -- superficial and deep. Superficial veins collect blood from the skin and nearby tissues. This blood then travels by connectors to the deep veins and then higher up to the heart.
Normally, the way we help blood travel against gravity is by three things. First, the walls of veins are made from elastic tissue that stretches like rubber. Veins also have valves, which only allow flow from the superficial to the deep direction. Finally, our leg muscles serve as a mechanical pump to massage blood up the body to the heart. The more we stay active and walk, the stronger our muscles and the veins get better help.
Aging is the most common reason to have problems with varicose veins, although not the only one. With age, our veins' elasticity decreases. Valves stop working well. Muscles get weaker. Maternal hormones in pregnancy also contribute to varicose veins, as do birth control pills. Obese people and those who work long hours standing also are prone to this condition. Finally, a family history of varicose veins is important, as the condition is hereditary.
Most of the time, people do not have major symptoms with varicose veins. A very small group of people with serious circulatory problems will have pain, throbbing and even burning sensations. Rarely, as a complication of a bulging vein, one may develop a skin breakdown or an ulcer. These are often difficult to treat. Another complication that can happen is a clot, either in the superficial vein system or, more seriously, in the deep vein system. Although superficial clots are treated essentially the same way as bulging veins, deep clots require the patient to take a blood thinner for at least six months -- sometimes for life, if they reoccur.
The first step in dealing with a bulging vein or any other strange-looking discoloration on your body is to show it to a doctor. Your primary care physician can answer easily what the discolorations are. If a clot is suspected, an ultrasound may be done.
Treatment of varicose veins is always conservative at first. A doctor might prescribe keeping the legs up, losing weight, or walking more. He or she also might suggest tight compression stockings, which can be bought in any pharmacy. They should fit snugly, but one needs to be able to put them on relatively easily. If these measures do not work, more sophisticated measures are offered.
Sclerotherapy means injecting veins with a special agent causing them to atrophy and collapse. The Clarivein Dorothy was told about is just a newer version of sclerotherapy. Lasers and ultrasound are also modalities used by vascular specialists in tougher cases. These interventions essentially permanently close bulging veins. Since deep veins still work and other veins are carrying blood, closing the few worst "offenders" is safe.
One has to understand, however, that this condition is chronic and affects the whole person -- not just one or two veins. Varicose veins will reappear over time in most people. For some people, the complete removal of the vein or part of it, known as stripping, may be the best choice. This is done as an outpatient procedure without the need to stay overnight.
One important aspect Dorothy mentioned in her letter is that most insurance companies will not pay for varicose vein surgery unless a person has serious symptoms.
How to decide about the vein problem? First, a varicose vein may have nothing to do with the strange lesions on your legs. Make sure that a doctor you trust sees these before attributing everything to the bulging veins. Second, make sure you have exhausted conservative modalities such as making lifestyle changes. Go with surgery only as a last resort and remember that veins may re-bulge in other locations of your body. Since you have worked with one medical group for years and are still not certain about their diagnosis, consider getting a second opinion.