Renato B. Berroya, M.D., FACS, FACPh
The Vein Center at Port Washington
639 Port Washington Blvd
Port Washington, NY 11050
Phone: (516) 883-2212
Fax: (516) 767-7064
Email us at firstname.lastname@example.org
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Mon - Thurs: 9 AM - 5 PM*
Fri: 9 AM - 4 PM*
*Though the office is open, testing and procedure appointment times vary.
ALL ABOUT VARICOSE VEINS
By Renato B. Berroya, M.D., FACS, FACPh
Arteries are networks of tubes through which oxygen-rich blood from the heart flows toward the body parts like the legs. Veins are also networks of thin walled tubes through which oxygen-poor blood return back to the heart. This cycle is repeated every time the heart beats. In the legs, there are two separate networks of veins: a network under the skin (superficial veins), and a network between the muscles of the leg (deep veins). The veins connecting the superficial to the deep vein network are called perforating or communicating veins (there are about 150). The main superficial veins are called great saphenous vein and small saphenous vein. The main deep veins are called common femoral, femoral, and popliteal veins.
The blood flow from the heart to the leg is facilitated by the strong pumping actions of the heart (blood pressure). The blood flow from the legs to the heart against gravity is accomplished by the calf and thigh muscles squeeze on the deep veins pushing the blood up. But even more important is the job performed by the hundreds of vein valves. Valves (small flaps inside the veins) open to let the blood through, then close when the muscles relax, much like a one-way double door. The valves prevent the blood from flowing in reverse, back to the leg or away from the heart. The muscular squeeze to return venous blood to the heart is called venous pump. When you walk and the calf and thigh muscles squeeze, the venous pump works well. But in prolonged sitting, standing, those who are overweight or pregnant, the blood in the leg veins pool and the pressure within the veins increase. The thick walled deep vein and perforating veins are usually able to withstand the increased pressure. However, if you have the hereditary tendency of weak superficial vein walls and/or weak valves, the superficial veins will stretch, and prolonged stretching will dilate the thin walled superficial vein (varicose veins). When the vein is dilated and the wall widens, the two leaves of the valves will separate and is unable to hold the blood (valvular incompetence or venous insufficiency). The pressure built up within the superficial veins increase (venous hypertension), and the reverse or backflow of the venous blood worsens (reflux). The great and/or small saphenous are the first to be affected by this process, then its branches swell, appear bulging, twisted and blue in color that can be seen through the skin. This is followed by the terminal ends of the branches, which are called the reticular veins and the capillaries, which become spider veins. The blood flow in the perforator is also in reverse, from the deep venous system to the superficial system.
The venous hypertension, venous insufficiency, varicose veins and stagnation of oxygen-poor blood in the legs are the causes of the symptoms of heaviness, fatigue, aches, pressure pain, throbbing, itchiness, dryness and cramps. The vein walls get inflamed, (superficial phlebitis), which cause sudden pain, redness, or swelling of the affected area. If this situation is untreated, fluid will start to seep through the vein walls and get into the tissues of the leg causing swelling. At this point, the pressure exerted by the boggy tissues on the skin will cause skin redness, thickening, eczema, pigmentation, cellulitis, dermatitis, excoriation, ulcerations, or sores. Fluids will start dripping out of the skin. This stage of the condition is called chronic venous insufficiency. At this point, as long as the walls and valves of the deep veins are still healthy and working, the condition is still curable or treatable. But, if the deep veins begin to dilate or balloon and have reflux, the condition is no longer treatable. Blood clots develop in the deep veins (DVT or deep vein thrombosis).
Varicose veins caused by heredity, gender, height, occupation and aging is called primary varicose veins. Varicose veins caused by previous episode(s) of phlebitis are called secondary varicose veins. Phlebitis (inflammation of veins) may or may not have associated blood clot within the affected vein. Nevertheless, both phlebitis and blood clots within the vein will cause significant damage to the vein walls and valves, hence, secondary varicose veins may develop because of reflux resulting from previous history of phlebitis.
The treatment plan for varicose veins, venous hypertension, venous insufficiency, and chronic venous insufficiency is based upon a complete medical history, thorough physical examination, good ultrasound imaging testings, and knowing the needs and expectations of the patient.
The treatment plan that is described below applies only to those individuals with extensive damage to the valves and walls of their leg veins. The great majority of individuals will only require a portion of these treatments.
In individuals with severe venous insufficiency and large varicose veins, the treatment begins with getting rid of the damaged main superficial vein (great saphenous vein). The entire main vein from the ankle to the groin, or only part of it from the knee to the groin, will be treated. The other superficial vein (small saphenous vein) may need treatment as well. The treatment consists of closing these veins with Endovenous laser treatment (EVLT). When the main vein is closed, the blood flow is rerouted to the normal deep veins.
Then, the branches of the main superficial vein that has damaged walls and valves (varicose veins) will be treated by removing them through small incisions (phlebectomy) or vein injections (sclerotherapy), or a combination of both. If desired or necessary, the damaged terminal branches (reticular and spider veins) can be treated by sclerotherapy.
Committing to preventative self care measures to reduce or prevent future recurrence of your vein problem is extremely important. I recommend the following: