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New ways to treat varicose veins - includes related article on laser treatment

Better Homes & Gardens June, 1996 by Patricia Hittner

New ways to treat varicose veins - includes related article on laser treatment

Better Homes & Gardens, June, 1996 by Patricia Hittner

They're unsightly, uncomfortable, and for millions of people, they're almost unavoidable. And the longer you have them, the worse they can become.
"It's a chronic, nagging problem that doesn't go away," says D. Eugene Strandness, Jr., M.D., a vascular surgeon at the University of Washington Medical Center.

Varicose veins, the bulging vessels that are as much a badge of middle age as gray hair and bifocals, have long been an accepted fact of life. But take heart. Doctors today have a better understanding of leg veins and some new ways to fix this old and painful vexation.
"I feel much more confident with what I'm doing today than with what I did ten or fifteen years ago," says Dr. Strandness. "I have a much better appreciation of the anatomy and how to deal with it."
"People in the field have gotten a lot smarter,' agrees Robert B. Rutherford, M.D., a vascular surgeon at University Hospital in Denver and a leading authority on varicose veins. Instead of the one-size-fits-all approach to varicose vein surgery, doctors are now customizing treatments, zeroing in on abnormalities, and plotting their correction before making the first cut.

For years, surgical removal of the veins, or "stripping," was the primary treatment for varicose veins. This process, however, often left many patients with noticeable scars.

Today, doctors strip only the major vessels. Refinements in operating techniques allow surgeons to do the job with just a few small incisions. This results in minimal scarring and a much shorter recovery time. Smaller veins can be destroyed through injections known as sclerotherapy. Some doctors report comparable results with a new technology that blasts enlarged veins near the skin with pulsed fight. (See "Leaping Lasers" on page 62.)

Not all veins are alike. Vfte treatments improve, misconceptions linger, says Dr. Rutherford. People tend to lump all bothersome leg veins into one category.

Varicose veins are the bluish-gray bulges that protrude from beneath your skin. Smaller bluish-green veins, which usually crisscross the back of the knee, are known as reticular veins. Spider veins are the small reddish-purple lines, so named because their spindly branches resemble a spider.

This distinction is more than academic, says Dr. Rutherford. These veins spring from different causes and require different treatments.

Spider and reticular veins usually don't affect men. These vessels, it seems, are fueled by the female hormone estrogen. Spider veins often appear at puberty, pregnancy, or other times when hormones surge. Reticular veins develop gradually. They're most apparent in older adults and in people with fair skin.

Varicose veins strike both sexes but are much more common in women. They also run in families. Researchers believe most cases resist from a combination of heredity and acquired stresses, which cause vein walls to weaken and bulge.

Being overweight or spending a lot of time on your feet also increases your risk of getting varicose veins. So do certain athletic activities, such as mountain biking and stairstepping, because they increase pressure on your leg veins. Varicose veins typically become more noticeable in pregnant women. They may recede after delivery, but each baby increases the odds they'll remain enlarged.

The standard advice is for a woman to delay vein treatment until she has completed her family. But Dr. Rutherford insists this is wrong. Each pregnancy puts additional strain on the veins. If enough damage occurs, ropy veins may run the entire leg. They also become difficult to eradicate. "The earlier the treatment, the lesser the treatment and the better the results," he says.

First, find the right doctor. Many specialists treat leg veins, including vascular surgeons, general surgeons, plastic surgeons, dermatologists, and general practitioners. The field is open to any licensed medical doctor, so be sure to shop around and ask questions before signing a consent form.

Look for someone willing to spend time explaining your condition and outlining options. Don't be afraid to inquire how much of the practice is devoted to varicose veins, advises Dr. Rutherford. "A good physician is never threatened by questions," he says.

If the problem is extensive, it's important to be evaluated by someone with a special interest in leg veins, such as a vascular surgeon.

Treatment options. Whichever specialist you see, most will likely recommend one or more of the following procedures. It's widely agreed a combination of treatments often brings about the best results.

* Surgery. Stripping is still the only way to remove the largest veins. In this out-patient procedure, a surgeon makes a small incision around the knee and pushes a flexible wire through the vein. The wire is then pulled out, through an incision near the groin, removing the vein.

The doctor may also tie off other veins connected to the major blood supply. These enlarged vessels, which the body doesn't need, wither and the. Blood then travels through the remaining healthy veins.

After five pregnancies, Lyn Muse, 43, of Dallas, had dozens of spider veins and developed a prominent varicose vein. Her legs hurt, and she also felt self-conscious wearing shorts or a swimsuit.

Surgery, plus a series of injections, resulted in remarkable improvement. "Going from legs that had all these little red marks to legs that are dear is wonderful," she says. "I tell my doctor that I'm his poster child."

However, surgery is not to be taken lightly. Serious complications are rare, but always a possibility. And there are no guarantees new veins won't crop up. These vessels are usually smaller than the original veins, and often respond wen to injections.

Having your veins surgically removed can be expensive. Unless they cause medical complications, you'll probably have to pick up the whole tab. Most health plans don't cover cosmetic procedures. Surgery can cost from $500 to $2,500. Anesthesia and the hospital charities are usually extra.

Patients who aren't good candidates for surgery can wear elastic stockings during the day to help relieve pain. Doctors often advise pregnant women with enlarged veins to wear support stockings.

* Sclerotherapy. Spider and reticular veins, as well as smaller varicose veins, can be eliminated through sclerotherapy. A doctor uses a fine needle to inject a chemical solution that irritates the vein, causing it to collapse and virtually disappear. These injections are done in a doctor's office, usually without anesthesia. Most patients report little or no pain from the needle, although they may feel a slight burning sensation as the solution is injected.

Lyn Muse says she was squeamish about being stack with needles, but then watched in awe as each network of veins was destroyed. "The discomfort was minor," she says.

One session of sclerotherapy typically costs between $100 and $250. Several treatments are often needed. Your insurance plan probably won't cover injections unless your veins cause pain or other problems. Lyn paid for multiple visits herself, but says she considers it a bargain. "I'd recommend anyone do it," she says.

Dianne York strongly agrees. A professional model based in Los Angeles, she needed blemish-free legs. Through the years, her spider veins worsened to the point where makeup artists had to touch up her legs before each photo shoot.
"It's kind of like plaque forming on your teeth," says Dianne, who underwent sclerotherapy and a new light-based therapy to remove longstanding spider veins. "You either remove it or let it build up."

Sclerotherapy is considered safe and effective, but it's not perfect. Complications include extremely rare ahergic reactions, as well as discoloration of the treated area. Even after successfull treatment, new unwanted veins may appear.

Debra Fox, 42, of Cockeysville, Maryland, was one of the unlucky ones. Sclerotherapy erased her spider veins, but left behind something she didn't have before-bruiselike patches beneath her skin. "It made my legs look worse than ever."

* PhotoDerm VL. This new treatment uses a machine, similar to a laser, that delivers pulsed light to the affected site. But it's able to reach deeper veins. not penetrated by laser light. Current lasers have only a limited role in obliterating leg veins.

PhotoDerm is not effective for the largest varicose veins, yet it risk sclerotherapy in clearing smaller vessels, says Jerome Garden, M.D., a dermatologist at Northwestern Memorial Hospital in Chicago. PhotoDerm eliminates the need for injections. The fight also hits vessels too small for a needle to easily pass through. Side effects include temporary swelling and skin discoloration.

PhotoDerm's biggest drawback is its limited availability. Many physicians aren't yet familiar with the device. Or, they may not want to buy an expensive machine when they can use sclerotherapy, says G. Ken Hempel, M.D., a vascular surgeon at Baylor University Medical Center. PhotoDerm costs about $250 per treatment. It can take two or three sessions to erase unsightly veins.

RELATED ARTICLE: leaping lasers

Many distressing beauty flaws can now be zapped with lasers. This space-age technology can dramatically improve wrinkles, acne scars, and age spots, as well as firm up sagging jowls and baggy eyelids.

Patient demand is soaring. The frenzy is fueled, in part, by the media. Each new application is widely disseminated, generating countless calls to laser surgeons.

Is the excitement justified? Lasers do offers distinct advantages, says David B. Apfelberg, M.D., director of the Atherton Plastic Surgery Center in Atherton, California. Doing a facelift with a laser, instead of a scalpel, he says, results in less bruising and bleeding. This shortens recovery time, not a trivial matter for people with high-powered careers. Also, he insists, for certain problems, the laser is superior to conventional procedures.

For example, a procedure called laser resurfacing can level acne scars and smooth furrowed skin. It gives the patient a more natural-looking appearance than chemical peels and dermabrasion, according to Dr. Apfelberg.

But, David W. Low, M.D., a plastic surgeon at the Center for Human Appearance in Philadelphia, says it's too soon to abandon these old standbys. Lasers may well prove to be the treatment of choice for scarred and wrinkled skin, but more research is still needed. some laser procedures are so cutting edge it's too soon to tell if unforeseen complications will appear years down the road. "We may not be aware of some of the long-term adverse effects," admits Dr. Low.

No one argues that special expertise is needed to use a laser. An inexperienced doctor could burn and scar a patient. And there's nothing stopping any doctor, regardless of his or her training, from wielding a laser.

If you're considering laser surgery, ask friends and other physicians for recommendations. Look for a doctor who owns the equipment or uses it regularly. Someone who occasionally rents a laser probably isn't doing enough procedures to become proficient, says Dr. Apfelberg.

even if your doctor owns the equipment, you still need to be careful. A heavy investment in laser machines might prompt a physician to recommend hightech treatment when a simpler, less expensive approach might suffice, says Dr. Low.
"If all you have is a hammer, everything is a nail to you," he says.

COPYRIGHT 1996 Meredith Corporation