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What is Venous Disease and how is it treated?

Symptomatic varicose veins are one of the most common problems we see in our office. Patients who have varicose veins typically lose their elasticity of their veins and therefore their veins dilate, when the veins dilate, the valves that typically function to return blood back to the heart don’t touch each other and therefore with gravity blood tends to pool in the lower extremities and cause these veins to dilate, and at that point they can become symptomatic, red, or inflamed, or painful. Usually patients come in the office with swelling, aching, throbbing, burning, itching legs, their skin changes would include; redness of the skin, darkening of the skin, and some patients have ulcers, or open wounds around the ankles. Other symptoms can include restless legs and night cramps and many people will frequently complain of fatigue towards the latter part of the day, especially if they stand quite a bit throughout the day. One of the more common causes of developing varicose veins is having a family history of varicose veins, other causes would include; people who have become pregnant, people who are on their feet for prolonged periods of time, having a history of prior blood clots, and people who are overweight. The diagnosis of varicose veins is primarily centered around performing a focused ultrasound in the office to determine whether they have blood clots in their legs or whether their symptoms are primarily related to what we call reflux disease which is essentially backwards flow of blood in their veins. Initially we treat patients medically and that would consist of leg elevation, exercise, weight loss, and the use of graduated prescription compression stockings for a period of 3 to 6 months. On occasion we will add diuretic therapy and sometimes horse chestnut seed extract. A common treatment option would be to perform invasive ablation procedures, that can be accomplished with either a laser catheter or a radiofrequency ablation catheter which we have here, we typically would gain access into the diseased vein and pass these heat source catheters to ablate the vein, in essence shutting them down so there is no further pooling of blood in the vein causing symptoms. Other options that can be offered include sclerosing agents or sclerotherapy, where we actually inject an agent into the veins to cause them to close down, and another option would be what we call Microphlebectomy which is where we make tiny little incisions and remove the bulging veins.

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