Transcription:

Bill Klaproth (Host): Oh those unsightly varicose veins. What do you do about them? Here to talk with us about varicose veins causes, diagnosis, and treatment is Dr. Mark Rheudasil, Medical Director at Emory Vein Center at Emory Healthcare. Dr. Rheudasil, thank you so much for your time today. So varicose veins, what causes them?

Dr. Mark Rheudasil, MD (Guest): Most often varicose veins are a result of some valves in the veins themselves that don't work properly. Veins should normally be a one-way street that carry blood out of your legs and return it to the heart. These valves are what allow blood to only go one direction and prevent it from essentially falling back into the leg when you're upright. When these valves don't work correctly, then some of the blood that should be normally emptied out of the leg literally falls back down into the leg under pressure, and it causes the veins to begin to dilate and eventually for the leg to swell or develop varicose veins.

Bill: Do varicose veins then present a health risk?

Dr. Rheudasil: Generally not. Most of the time they are treated because they cause symptoms, either heaviness, aching, pressure, burning, itching, heat, or on rare occasions they can bleed or clot. And then small varicose veins can be treated for cosmetic purposes. Rarely they, if untreated, will lead to some complications that will require treatment or be a health risk, but that's fairly unusual.

Bill: So the biggest problem then it sounds like is most people just don't like the look of them. I know that especially women hate the varicose veins, and sometimes they can get really dark and big.

Dr. Rheudasil: Sure, the cosmetics of it are certainly a factor in the equation for almost every patient, but a great many patients come in because they do in fact have aching, heavy, tired legs, and as the veins get larger, their legs just start bothering them more. I say that they start barking at them more, and they just become more and more of an aggravation, and it's that sort of constant heaviness and pressure that brings a lot of patients in.

Bill: So then at what point should someone seek treatment? Should they wait until their legs, as you say, start barking at them? Or once they notice them, or they become defined, is that when they should seek treatment?

Dr. Rheudasil: It's an individual decision for the patient. I can see five patients which appear to have almost the same veins, and they'll all have different symptoms. And so we really tell patients that whenever the veins really start to bother them, that's when they should come in for an evaluation, and that can be because of symptoms, and aggravation, and pain, or it can be the cosmetics of it. But just whenever they have become irritating enough or bothersome enough to the patient that they would like to have treatment, that's really when they should be evaluated. If they're completely asymptomatic, not causing any problems, and a patient frankly is not bothered by their veins, then they really probably don't need treatment and don't necessarily need an evaluation.

Bill: Dr. Rheudasil, why do some people get them and others don't? Is this a lifestyle equation or hereditary?

Dr. Rheudasil: It can be both. Hereditary is probably the most common risk factor, having had family members with veins. But other risk factors include being a female, work, or habits that have you on your feet, or standing, or even sitting for prolonged periods of time. Being overweight, pregnancy is often a sentinel event that makes veins worse because of the extra pressure that it puts on the veins. Just simply being older, we have more varicose veins. So all of those are risk factors.

Bill: Dr. Rheudasil, for someone whose legs are barking, how do you diagnose them? And then what are the treatment options?

Dr. Rheudasil: So the veins are fairly- most veins on the surface are fairly obvious, but as patients get more symptoms, and as patients get larger veins, it is more- it becomes more likely that they do have underlying vein abnormalities, what I refer to essentially as feed veins, and that's the veins in which the valves don't work properly, as we discussed a few minutes ago. The way we evaluate that or test for that is fairly simple. It is painless ultrasound testing in which we can take a look at the veins under the surface and measure how they function, whether they're flowing the correct direction, and if there is reversal of flow, for instance. We can measure the size of the veins, and many of those measurements can tell us if there's enough abnormality to warrant treatment of the inside veins in addition to the surface veins. As far as treatment goes, in a very general sense, the way you treat bad veins is to get rid of them. The majority of the treatments performed today simply involve closing the abnormal veins by one mechanism or another. Veins on the surface most often are closed with small injections of a dilute chemical that irritates the lining of the vein and causes it to spasm, and scar down, and close. That's called sclerotherapy. Inside veins are larger veins and are closed in a variety of different techniques. Most often nowadays using heat, we call that a thermal ablation, meaning heat to close off a vein pathway. There are some newer techniques that include some of those chemical agents made into a foam, and even essentially a medical grade superglue that has now been approved to treat and close veins. Occasionally big veins will also still do limited surgical procedures on, many of those I do in the office just under local anesthesia, but we call that a phlebectomy or a vein removal, and that can be performed at the same time as some of the other ablation procedures. So the lion's share of vein treatment is done in the office, I would say well over 95%, and typically procedures that are done under local or no anesthesia, and usually are thirty-minute procedures or less.

Bill: And how often do they have to see you then?

Dr. Rheudasil: Well it depends a little bit on the extent of their varicose veins. If a patient comes in with quite severe veins on both legs, then I may see them a couple of times in the first month or so to get the inside veins treated, which is what we typically do first. If they have abnormal pressure in some of those feeding veins on the inside, then we typically close those feeding veins and then treat the surface veins if they need to be treated, and the surface veins sclerotherapy type treatment in our practice is done about every other month. So the advantage of vein treatment these days, and one of the nice things about vein treatment these days is that they're small procedures without much discomfort and with little or no downtime. I suppose the one drawback from that is that they are small procedures and it often becomes a little more of a process that may be as many as two to six visits over six or more months depending on the extent of the varicosity.

Bill: And you can get most of the discoloration and bulging in the more severe cases down?

Dr. Rheudasil: Sure. Bulging veins are in many cases actually easier to treat and get rid of than some of the smallest veins are. As I said, I do think I have- my practice has evolved a bit more over the years to removing the largest of the veins with some of those phlebectomy techniques, but absolutely we can get rid of the big bulging veins, and we would make every effort to do that for every patient.

Bill: And lastly, Dr. Rheudasil, when it comes to insurance, can you talk about coverage for treatment?

Dr. Rheudasil: Sure, most of our patients are able to get their treatment covered. Almost all patients that have significant symptoms will have coverage by insurance, so whether that be pain, swelling, clotting, bleeding, whatever. It's really only the smallest of spider veins that we're doing purely for cosmetic purposes that would not be submitted to insurance or would not be covered.

Bill: Alright, Dr. Rheudasil, thank you so much for your time today, we appreciate it. For more information please visit  emoryhealthcare.org/veincenter. That's  emoryhealthcare.org/veincenter. You're listening to Advancing Your Health with Emory Healthcare. I'm Bill Klaproth, thanks for listening.