VARICOSE VEINS / VENOUS INSUFFICIENCY

What are varicose veins?

Arteries carry blood away from the heart. Veins use an intricate system of one-way valves to carry blood back up to the heart. There is a deep system and a superficial system of veins that are connected with one another by perforating veins. Sometimes, valves do not function and they “leak”, allowing veins close to the skin surface to overfill and distend, becoming visible. These swollen, superficial veins are varicose veins. As pressure increases, such as standing for long periods of time, these veins may ache, throb, itch, become discolored or form skin ulcers.

How are they diagnosed?

An ultrasound is performed to evaluate the integrity of the deep system of veins, and to determine which valves in the superficial and/or perforating system are leaking. We will then determine if your medical condition would improve from surgical repair or injections of your varicose veins.

Ultrasound Scheduling and Follow up

What treatments are available?

There are different levels of intervention, such as sclerotherapy or surgery. Conservative management is recommended for all patients: leg elevation is an important part of treating vein related problems. The more time spent with your legs elevated at least 90°, the fewer symptoms you will have. Most patients require compression stockings to the knee level. These minimize symptoms and if worn after surgical intervention, minimize recurrence. These can be supplied to you from our office.

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Sclerotherapy:

Sclerotherapy is a vein injection to close off a vein. It is beneficial to patients who have an isolated problem with one or two small veins, without a significant incompetence of the underlying system of veins. The injection is given directly into the vein to stimulate scar tissue formation that leads to disappearance of the varicosity. The injected site may be sore for a few days. The injection site will be wrapped with an ace bandage and it should be removed after 24 hours. It is normal for the area to be sore and to have some discoloration; this gradually disappears over the next couple of weeks. You should plan on no heavy activity the night after an injection, and do not fly for 10 days after an injection.

Surgery:

Depending on your anatomy, the surgical procedures are chosen to get the best results with the least pain and the fastest return to full activities. We no longer perform vein stripping, as we find that the Closure Technique is a better procedure. A formal stripping physically removes the vein from your body. The closure technique gains access to the vein by means of a catheter and uses heat to collapse the vein by scarring it from within. The chart below compares and contrasts the two different approaches. For more details, please refer to the VNUS website, VNUS.com

	Old technique: Formal Stripping	New Technique: VNUS Closure
Approach/Scars	Groin and ankle or knee surgical incision Phlebectomy (local removal of vein) sites on leg	None at groin/ankle phlebectomy sites on leg
Recovery	normal activity: 7-14 days strenuous activity: 3-4 weeks Pain: first 3-4 days (prescription given at hospital for pain meds) Return to work: 3 weeks	normal activity 1-2 days strenuous activity: 2 week Pain: little to none (OTC meds adequate) Return to work: within 1 week.
Recurrence	Comparable success	Comparable success
Pain	Some: first 4 days; pain prescription given at hospital	None to some: first 1-2 days; rare to use medication for pain
Missed Work	Range 2-4 weeks	Range ½ -2 weeks
Follow up	72 hours for bandage removal & 1 month	72 hours, with ultrasound & 1 month
Limitations	Walking: as tolerated No flying 1 month; scars without sun exposure 6 months	Walking: encouraged within first day of surgery No flying 1 month: limit sun exposure to scars

Surgery is what type of commitment?

· Surgery is done as an outpatient. The day of your surgery is roughly a 6 hour process. You must check in 2 hours before your surgery time. The procedure itself takes about 1 hour. You will be observed for approximately 3 hours after your procedure before you are discharged.

· You will need someone to drive you home.

What happens at the hospital?

· You will meet with an anesthesiologist at the hospital to determine what kind of anesthesia you need (general, spinal, epidural, etc).

· Your leg will be marked for the Closure procedure.

What should I expect after I go home?

· While recovering, you want to minimize the amount of fluid that accumulates in your leg. You will need your leg elevated at all times. Walking is permitted, as long as you elevate your leg when sitting and avoid standing still for any length of time.

· You will have a bandage wrapped from your ankle to your thigh. This will be removed at your follow up appointment.

VASCULAR SPECIALISTS of SAN FRANCISCO
Dr. John Long, Dr. Marc Levine, Dr. Daniel Nathanson
3838 California St., Suite 612
San Francisco, CA 94118
415-221-7056       fax 415-221-7058