Maggie McKay (Host): Varicose veins. Nobody wants them, but there are ways to get rid of them. Dr. Scott James, Board Certified Vascular Surgeon, joins us to discuss minimally invasive vein care. Welcome to Answers in Vascular, a podcast by the Vascular Care Group. I'm your host, Maggie McKay. Thank you so much for joining us today, Dr. James.

Scott James, DO, RPVI: Thank you, Maggie. Glad to be here.

Host: What are reticular veins, spider veins, and varicose veins?

Scott James, DO, RPVI: That's a great question. They are a spectrum of veins that occur that are abnormal, usually on the legs. Oftentimes they'll start out as spider veins, which are very small veins and then progress to reticular veins, which are slightly bigger. And then the varicose veins are the much bigger bulges that you see on your legs that are, by definition, usually greater than three millimeters.

Host: Why do varicose veins even happen? How do they occur?

Scott James, DO, RPVI: Yeah, mostly because there are little valves in the veins. And what happens is sometimes those valves stop working correctly. So the blood is supposed to travel from your feet and toes back up to your heart. But with gravity, if those valves aren't functioning, the pressure can increase and cause spider veins, reticular veins, and varicose veins to form in the legs.

Host: How do we prevent varicose veins?

Scott James, DO, RPVI: So, some things we can't prevent because of gravity. We're on our feet most of the day, and people who have jobs that are standing for long periods of time are actually at higher risk of developing varicose veins and abnormal veins just because the muscle pump isn't functioning correctly to push the blood back up to the heart.

And when you're standing, that can push the blood flow just simply through gravity. So it isn't something that we can just say that it's a cure for it, but sometimes lifestyle changes in terms of elevating the legs as much as possible and things like wearing compression stockings to help compress the legs during the day when you're on your feet for prolonged periods of time to prevent the pressure from increasing in the veins and causing varicose veins.

Host: Dr. James, are varicose veins and spider veins dangerous?

Scott James, DO, RPVI: In and of themselves, the varicose veins and spider veins aren't dangerous. What we oftentimes will treat is the pain and inflammation that occur with these things. Most of the time, spider veins and reticular veins are more problematic from a cosmetic standpoint, but sometimes, if these veins become very thin walled or very close to the skin, they can cause superficial bleeding.

Now with varicose veins, our biggest concern is formation of clot in the veins, and that clot can sometimes travel to the deeper veins and in the worst case scenario, could travel to the lungs. The other thing that we get concerned about is varicose veins can sometimes lead to swelling in the legs, and that swelling can get to the point where it becomes so bad that you develop blisters or open wounds on the legs and that becomes a bit more dangerous for patients.

Host: Oh my goodness, I had no idea about that part. How do we treat spider veins and varicose veins?

Scott James, DO, RPVI: So there's a whole host of different ways that we can treat them. If we're talking about spider veins and reticular veins, the best course of action is what we call sclerotherapy. And that's injecting a medication into the vein that causes a chemical reaction and scarring on the inside of the vein so that the veins will close on themselves.

For varicose veins, we need to find the source of the underlying pathology or the abnormality that is underneath these varicose veins and that's often from what we call reflux. And reflux is blood flow that's going in the wrong direction. It's going from the pelvis or the upper leg down into the legs.

So for varicose veins, we need to treat the underlying pathology so that if we were to progress to removing the varicose veins, that we have the least risk of those recurring or returning later. And then once we treat the underlying source of the veins, some people need to come back to remove the veins with little tiny incisions that are just made through a tiny needle stick.

Gone are the days when you had to have your veins stripped like you've probably heard about in the past which was obviously very painful. Everything we do now is minimally invasive, and we do right here in the office in short treatment sessions.

Host: Dr. James, what's the recovery like after a vein procedure?

Scott James, DO, RPVI: Recovery is actually very quick. If we do any type of sclerotherapy, which is chemical injection, we put a compression stocking on your leg after the procedure, and you're up doing all of your normal activity the same day. If we do an ablation, which is treating some of the larger superficial veins, a stocking is utilized and we often tell patients to take it easy the day of their procedure, but you're up and ambulating, which means up and walking and doing all of your normal activities, including exercise the day after the procedure.

We may limit you. We tell patients not to travel on airplanes for long plane rides or long car rides or heavy, strenuous activity like squats, things like that, but we do encourage patients to be up and walking and doing their normal exercise and activity, the day following the procedure.

Host: That sounds ideal. I mean, I would think it would be so much longer, at least a week, but no, not now.

Scott James, DO, RPVI: No, not at all. In fact, the studies show that keeping patients immobilized actually increases the risk of a blood clot in the deeper veins. So we encourage these patients to be up and walking and doing all of their normal activities to decrease the risk of any blood clots.

Host: How do I choose a vein treatment center?

Scott James, DO, RPVI: So we would recommend going to a vein treatment center that is run by a Board Certified vascular surgeon who can offer the entire plethora of vein treatments. Anything from treating, uh, deep vein thrombosis, to deep vein treatments as well as varicose veins, and spider veins as well as the reticular veins.

 We have specialists in all of our offices at the Vascular Care Group, and we have ultrasound capabilities to diagnose the source of the varicose veins, which is of utmost importance in formulating a treatment plan because every patient has a different underlying pathology that needs addressing and we customize a treatment plan for each patient individually.

Host: So in closing, Dr. James, how would you advise people who are nervous about getting any of these procedures done? What would you say?

Scott James, DO, RPVI: I would say definitely come in for a consultation. Anytime any patient has any type of procedure, we always recommend at least coming in and discussing it with a professional. Like I said, a lot of the things that we do are very minimally invasive, done right here in the office, under local anesthesia, with very minimal discomfort, and if there's ever any consideration as to whether or not you should have a procedure, talking to one of the professionals who can offer these procedures would be the first step.

And even if you don't decide to have a treatment, at least you come in and get a full evaluation, as well as an ultrasound to determine where these veins come from and what the long term sequelae are of any varicose vein, whether it's a large varicosity, a spider vein, or a reticular vein.

Host: I know so many people suffer from these, and so it's so great to get this information from you. Thank you so much for sharing your expertise today.

Scott James, DO, RPVI: Absolutely. My pleasure. Thank you, Maggie.

Host: Again, that's Dr. Scott James. To find out more, visit thevascularcaregroup.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Answers in Vascular, a podcast by the Vascular Care Group.