Varicose veins are gnarled, enlarged veins. They can be painful and unpleasant to look at. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet.
Dr. Allen Chan is here to discuss the treatment options for those sometimes painful, unsightly varicose veins.
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There is Help for Varicose Veins
Featured Speaker:
He received his medical degree from UC San Francisco, did a general surgery residency at Harvard Medical School, and did a vascular surgery fellowship at the University of Washington, Seattle.
Learn more about Dr. Chan
Allen K. Chan, MD
Dr. Chan is board certified in general surgery and vascular surgery. He is a member of the medical staff at Temecula Valley Hospital.He received his medical degree from UC San Francisco, did a general surgery residency at Harvard Medical School, and did a vascular surgery fellowship at the University of Washington, Seattle.
Learn more about Dr. Chan
Transcription:
There is Help for Varicose Veins
Melanie Cole (Host): Varicose veins may cause no issue at all or they may be quite painful. My guest today is Dr. Allen Chan. He is a general and vascular surgeon and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Chan. Tell us, what are varicose veins?
Dr. Allen Chan (Guest): Thank you very much for having me on the show. Varicose veins are fairly common. They are veins that have become abnormal and usually somewhat bulging or dilated. It appears on the leg. Sometimes, they are quite small and we call them “spider veins”. Then, if they become larger than three or four millimeters, they become very visible and they protrude. Most people will call those “varicose veins”. They are quite common. They occur in as frequently as 40% of women in our country and as high as 25% of men in our country.
Melanie: Are there certain risk factors for varicose veins? Is there a hereditary factor or pregnancy--anything like that that contributes?
Dr. Chan: Yes. That’s a great question. I get asked that all the time. The main reason why people get varicose veins is hereditary – genetic reasons. If your mother or father had them, you’re at a high risk of having them. That’s the most common reason. The second most common reason would be any history of having a blunt trauma to your leg. I have patients that had blunt trauma to their leg from accidents or one had a horse fall on their leg at some time and later, on they developed varicose veins in the area of the trauma. That can be quite symptomatic. Other factors such as having multiple pregnancies or obesity. I think those factors are more exacerbating factors, meaning if you have the gene to have varicose veins, having multiple pregnancies or having obesity can make the veins become worse but I don’t think they are actually the cause of having varicose veins.
Melanie: Are varicose veins an issue? Are they a problem? Do they affect blood flow to your legs?
Dr. Chan: Another great question. If the varicose veins are just merely very small spider veins, they are in the size of less than one millimeter to a couple of millimeters, usually those veins don’t really cause any medical issues, meaning they don’t cause any pain or swelling or heaviness or fatigue. They have no symptoms relating to it. In a case like that, I would say that’s more of a cosmetic concern. I do see patients who come to my office for purely a cosmetic type of spider vein. Those can be treated. However, the majority of my patients that come to see me have larger varicose veins ranging from the size of, say, 3-4 millimeters up to centimeters or even more and are a very severe, protruding type of vein in their legs and in every single case like that, the patient will report that they have typically aching or throbbing pain. They have swelling in their legs. Their legs feel heavy and tired. They may complain of numbness or tingling, a burning sensation or itchiness of the skin or restlessness. The most severe case would be, they come in and they actually have an ulcer or wound on their ankle that hasn’t healed for months and months and months. The symptoms of varicose veins can range from having no symptoms, which then would be a cosmetic type of situation, all the way to having a wound that doesn’t heal. Of course, that could be a very serious problem.
Melanie: Before we get into treatment, Dr. Chan, is there any prevention? Does exercise, making sure to warm up and cool down, do any of these things help to prevent them?
Dr. Chan: That’s an interesting question. As far as I know, I haven’t seen any evidenced-based studies that will tell you that exercising or any other types of activities can help with varicose veins since it is a genetic problem. The only thing that I can recommend that is not invasive would be wearing compression stockings and also elevating ones leg for symptomatic relief. Compression stockings can be found all over the place. They actually will give relief of symptoms to most patients although they will not change the progression or the direction of where the disease is going to go.
Melanie: Let’s speak about treatments. When do they require intervention? What are treatments for varicose veins like?
Dr. Chan: Usually, I break that down into two categories. One would be the patient that comes in that has very small spider veins and has no symptoms and the patient desires treatment. Treating small spider veins is fairly straight forward. We use two modalities in my office. One is called “injection sclerotherapy” where we take a very fine needle and we inject a type of medication right into the spider veins to cause them to collapse. It’s an office procedure that takes maybe 15 or 20 minutes per session and, typically, a patient requires a couple of sessions or maybe even three sessions to get satisfactory results. The other way to treat spider veins is using a laser. We have a laser in the office that shoots a laser beam onto the skin and it focuses into the small spider veins and causes them to collapse. That also works very well. We will use a combination of both – an injection therapy and laser therapy for the small spider veins on the surface of the leg. For the patients that come in with large varicose veins and lots of symptoms, such as pain and swelling, those patients usually have an underlying vein inside their leg that is the cause of their problem – it’s the source of where their abnormal blood flow comes from. Those patients will begin the treatment by receiving an ultrasound to find the particular vein in their leg that is the source of what we call “reflux”. We would treat that vein using what’s called “endovenous ablation”. It’s a simple procedure done in the office where we introduce a fine laser fiber into that vein under ultrasound guidance. Then, we activate the laser and the vein will be closed as the laser fiber is pulled out of the patient. That procedure works very, very well. It eliminates the source of the reflux and the patient will feel relief of the symptoms fairly quickly within a week or so. Then, if they still have residual large varicose veins in their legs, then we can take care of those with other methods such as what is called “excision” of varicose veins which is just making tiny incisions on the skin to remove them or sometimes we may be able to treat it with injection therapy. There are many different modalities to treat varicose veins, depending on their sizes and the origin of the reflux.
Melanie: If you remove those veins or they disappear over time, do we need those veins? Is it okay to get rid of them? Does the body or the legs develop collateral circulation?
Dr. Chan: Great question. Think of the varicose veins and the abnormal veins that we either remove or we close – they are harming your circulation. They are actually moving blood in the wrong direction. They are allowing blood to flow down the leg instead of moving the blood up the leg back to the heart where a normal vein should be doing. Closing the abnormal veins and removing them actually improves the circulation. Yes.
Melanie: Wow. That is really interesting to know. What should, Dr. Chan, people with varicose veins be thinking about when they’re seeking care?
Dr. Chan: It’s important to think that the veins that you see on the surface of your leg may only be a sign of something going on inside the leg. They should seek to make sure that they get a complete workup, including an ultrasound, to look into the veins inside their legs to make sure the source of their problem is taken care of rather than just focusing on the surface of their leg. Making sure that you choose a specialist that can provide a comprehensive multi-modality approach to treatment of varicose veins.
Melanie: Why should patients come to Temecula Valley Hospital for their care?
Dr. Chan: Temecula Valley Hospital has a very good reputation in providing a multi-disciplinary approach to many types of diseases, including varicose veins. They have operating rooms that are equipped with some of the best equipment. I am very confident that varicose veins can be treated in an exceptional fashion at Temecula Valley Hospital.
Melanie: Thank you so much, Dr. Chan. It is great information. Thank you for being with us. You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can visit TemeculaValleyHospital.com. That’s TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
There is Help for Varicose Veins
Melanie Cole (Host): Varicose veins may cause no issue at all or they may be quite painful. My guest today is Dr. Allen Chan. He is a general and vascular surgeon and a member of the medical staff at Temecula Valley Hospital. Welcome to the show, Dr. Chan. Tell us, what are varicose veins?
Dr. Allen Chan (Guest): Thank you very much for having me on the show. Varicose veins are fairly common. They are veins that have become abnormal and usually somewhat bulging or dilated. It appears on the leg. Sometimes, they are quite small and we call them “spider veins”. Then, if they become larger than three or four millimeters, they become very visible and they protrude. Most people will call those “varicose veins”. They are quite common. They occur in as frequently as 40% of women in our country and as high as 25% of men in our country.
Melanie: Are there certain risk factors for varicose veins? Is there a hereditary factor or pregnancy--anything like that that contributes?
Dr. Chan: Yes. That’s a great question. I get asked that all the time. The main reason why people get varicose veins is hereditary – genetic reasons. If your mother or father had them, you’re at a high risk of having them. That’s the most common reason. The second most common reason would be any history of having a blunt trauma to your leg. I have patients that had blunt trauma to their leg from accidents or one had a horse fall on their leg at some time and later, on they developed varicose veins in the area of the trauma. That can be quite symptomatic. Other factors such as having multiple pregnancies or obesity. I think those factors are more exacerbating factors, meaning if you have the gene to have varicose veins, having multiple pregnancies or having obesity can make the veins become worse but I don’t think they are actually the cause of having varicose veins.
Melanie: Are varicose veins an issue? Are they a problem? Do they affect blood flow to your legs?
Dr. Chan: Another great question. If the varicose veins are just merely very small spider veins, they are in the size of less than one millimeter to a couple of millimeters, usually those veins don’t really cause any medical issues, meaning they don’t cause any pain or swelling or heaviness or fatigue. They have no symptoms relating to it. In a case like that, I would say that’s more of a cosmetic concern. I do see patients who come to my office for purely a cosmetic type of spider vein. Those can be treated. However, the majority of my patients that come to see me have larger varicose veins ranging from the size of, say, 3-4 millimeters up to centimeters or even more and are a very severe, protruding type of vein in their legs and in every single case like that, the patient will report that they have typically aching or throbbing pain. They have swelling in their legs. Their legs feel heavy and tired. They may complain of numbness or tingling, a burning sensation or itchiness of the skin or restlessness. The most severe case would be, they come in and they actually have an ulcer or wound on their ankle that hasn’t healed for months and months and months. The symptoms of varicose veins can range from having no symptoms, which then would be a cosmetic type of situation, all the way to having a wound that doesn’t heal. Of course, that could be a very serious problem.
Melanie: Before we get into treatment, Dr. Chan, is there any prevention? Does exercise, making sure to warm up and cool down, do any of these things help to prevent them?
Dr. Chan: That’s an interesting question. As far as I know, I haven’t seen any evidenced-based studies that will tell you that exercising or any other types of activities can help with varicose veins since it is a genetic problem. The only thing that I can recommend that is not invasive would be wearing compression stockings and also elevating ones leg for symptomatic relief. Compression stockings can be found all over the place. They actually will give relief of symptoms to most patients although they will not change the progression or the direction of where the disease is going to go.
Melanie: Let’s speak about treatments. When do they require intervention? What are treatments for varicose veins like?
Dr. Chan: Usually, I break that down into two categories. One would be the patient that comes in that has very small spider veins and has no symptoms and the patient desires treatment. Treating small spider veins is fairly straight forward. We use two modalities in my office. One is called “injection sclerotherapy” where we take a very fine needle and we inject a type of medication right into the spider veins to cause them to collapse. It’s an office procedure that takes maybe 15 or 20 minutes per session and, typically, a patient requires a couple of sessions or maybe even three sessions to get satisfactory results. The other way to treat spider veins is using a laser. We have a laser in the office that shoots a laser beam onto the skin and it focuses into the small spider veins and causes them to collapse. That also works very well. We will use a combination of both – an injection therapy and laser therapy for the small spider veins on the surface of the leg. For the patients that come in with large varicose veins and lots of symptoms, such as pain and swelling, those patients usually have an underlying vein inside their leg that is the cause of their problem – it’s the source of where their abnormal blood flow comes from. Those patients will begin the treatment by receiving an ultrasound to find the particular vein in their leg that is the source of what we call “reflux”. We would treat that vein using what’s called “endovenous ablation”. It’s a simple procedure done in the office where we introduce a fine laser fiber into that vein under ultrasound guidance. Then, we activate the laser and the vein will be closed as the laser fiber is pulled out of the patient. That procedure works very, very well. It eliminates the source of the reflux and the patient will feel relief of the symptoms fairly quickly within a week or so. Then, if they still have residual large varicose veins in their legs, then we can take care of those with other methods such as what is called “excision” of varicose veins which is just making tiny incisions on the skin to remove them or sometimes we may be able to treat it with injection therapy. There are many different modalities to treat varicose veins, depending on their sizes and the origin of the reflux.
Melanie: If you remove those veins or they disappear over time, do we need those veins? Is it okay to get rid of them? Does the body or the legs develop collateral circulation?
Dr. Chan: Great question. Think of the varicose veins and the abnormal veins that we either remove or we close – they are harming your circulation. They are actually moving blood in the wrong direction. They are allowing blood to flow down the leg instead of moving the blood up the leg back to the heart where a normal vein should be doing. Closing the abnormal veins and removing them actually improves the circulation. Yes.
Melanie: Wow. That is really interesting to know. What should, Dr. Chan, people with varicose veins be thinking about when they’re seeking care?
Dr. Chan: It’s important to think that the veins that you see on the surface of your leg may only be a sign of something going on inside the leg. They should seek to make sure that they get a complete workup, including an ultrasound, to look into the veins inside their legs to make sure the source of their problem is taken care of rather than just focusing on the surface of their leg. Making sure that you choose a specialist that can provide a comprehensive multi-modality approach to treatment of varicose veins.
Melanie: Why should patients come to Temecula Valley Hospital for their care?
Dr. Chan: Temecula Valley Hospital has a very good reputation in providing a multi-disciplinary approach to many types of diseases, including varicose veins. They have operating rooms that are equipped with some of the best equipment. I am very confident that varicose veins can be treated in an exceptional fashion at Temecula Valley Hospital.
Melanie: Thank you so much, Dr. Chan. It is great information. Thank you for being with us. You’re listening to TVH Doc Talk with Temecula Valley Hospital. For more information, you can visit TemeculaValleyHospital.com. That’s TemeculaValleyHospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.