Vein Disease Q & A

Q: Will my health insurance pay for treatment?
Every condition is considered on a case-by-case basis. Varicose veins constitute venous insufficiency, and it is almost always reimbursable by health plans, including Medicare, when medical necessity is demonstrated. An ultrasound tech will need to complete a thorough evaluation using a duplex vascular ultrasound to determine if abnormal blood flow is present in the veins.  In addition, if the condition includes pain or skin changes, then insurance companies are more likely to cover treatment.  If varicose veins are just unsightly without any other physical symptoms, then the condition may be considered a cosmetic issue and treatment is not covered by health insurance. At the conclusion of your initial appointment, a physician will discuss your treatment options with you. Generally, insurance companies do not reimburse for cosmetic spider veins. We are your insurance advocate.  Our staff is highly experienced with insurance requirements.  We will work with your insurance company to maximize your insurance benefits and minimize your out-of-pocket costs, so that you can get the best treatment.  Our practice is in-network with most major insurance plans.

Q: How do I begin treatment?
A: During your initial consultation,a duplex venous ultrasound will be performed to examine your leg anatomy and check the flow characteristics of the veins beneath your skin. Useful information is gathered that your physician can use to adequately diagnose your specific vein problem and to plan and guide treatment. During this visit, any questions you might have will be answered, as well as a discussion on treatment options and anticipated results. At this point, an estimate of the number of treatments, affiliated costs, and payment will be covered which will vary depending upon the size and extent of your problem. You should then be able to schedule an appointment for treatment.

Q: What are Varicose Veins?
A: Varicose Veins are veins that become abnormally swollen and large, usually due to defective valves in the vein. Varicose veins are sometimes bluish in color, protrude from the surface of the skin, and frequently have a winding or worm-like appearance.

Q: Are varicose veins caused by crossing your legs?
A: Scientifically, this has never been proven. However, it has been proven that leg crossing and sitting causes extra venous compression which decreases the upward flow of blood through the veins, causing it to pool in the veins below, increasing the venous pressure, and theoretically forming varicose and spider veins.

Q: What causes varicose veins?
A: Varicose veins were once part of the superficial venous system which normally returns only 5-10% of the blood flow from the legs back to the heart. Varicose veins begin when tiny one-way valves inside veins wear out over time. When these valves fail, blood falls down the veins with gravity causing excessive pressure to build up inside the veins. The veins swell and become tortuous. Once a vein is damaged by this process it can never again function as a healthy vein.

Q: Are there any health risks to not treating varicose veins?
A: Untreated varicose veins may create complications such as leg swelling, hyperpigmentation, and leg ulcers. It is best to consult with a Doctor as soon as you notice varicose veins for an evaluation. 

Q: How will my blood circulate if I eliminate my varicose veins?
A: Varicose veins are a burden on your circulation. Because the blood inside them is refluxing (going backwards), correcting the flow can only improve your circulation. In treating varicose veins, we eliminate only the bad veins and safeguard the healthy veins for normal circulation. We also preserve healthy veins for possible future use as a bypass graft source. Ultrasound helps to ensure that treatment is highly selective.

Q: What will happen if my varicose veins are NOT treated?
A: Over time varicose veins always enlarge and become more symptomatic, forcing many people to alter their daily activities to try to decrease the pain. In severe cases, varicose veins can cause skin damage and persistent pain. These complications can be prevented by treating the varicose veins early.

Q: Is the treatment of varicose veins just for women?
A: Absolutely not. In our practice, one out of five patients with varicose veins are men. However, rarely do we see men with spider veins.

Q: What is the difference between spider veins and varicose veins?
A: Varicose veins are the large, ropey blue veins that extend across the thigh or the calf. They are related to poor valve function in the major superficial veins themselves. They cause symptoms of aching, pain, and burning and can progress to a chronically swollen disfigured leg. These veins are a true medical problem and not cosmetic. Treatment is generally covered by insurance. Spider veins are significantly different. They are the clusters of tiny red and/or blue vessels that are actually present in the skin. Most insurance carriers consider spider veins a cosmetic problem and are not a covered service.

Q: I’ve told my doctor about my veins many times, but he told me not to worry about them, that they were just ‘cosmetic.’ What do you think?
A: Large bulging varicose veins cause symptoms in the vast majority of people who have them. In most cases, these veins are not just ‘cosmetic’ but are considered to be a significant medical problem that can lead to problems if not treated. In years past when the surgery to remove varicose veins was so traumatic (e.g., vein stripping), many physicians discouraged their patients from having anything done. The new surgical and non-surgical techniques are so much easier and less painful; there is no reason to live with varicose veins anymore. Unfortunately, your physician may not be aware of all the newest techniques available for varicose vein treatment. (But YOU are!) 

Q: I’ve had vein stripping before and the veins came back. How is your treatment different?
A: The key to modern, effective treatment of varicose veins is using duplex ultrasound, done in the standing position, to completely map out the size and location of all diseased veins, many of which are underneath the skin and not visible. By utilizing ultrasound to ‘see’ these hidden diseased veins, we can eliminate the root cause of most recurrences. Unless you had a complete vein mapping ultrasound in the standing position prior to your surgery, chances are the surgeon left behind some diseased veins, and that is why your problem came back. In addition, vein stripping’s were done in the hospital under general anesthesia and required prolonged and painful recovery times away from work. Our micro surgical procedures are done under local anesthesia right in our office. You are up and around immediately after the procedure, and most patients can return to work the very next day. And because our incisions are so small, there are no scars!

Q: I plan on becoming pregnant soon. Should I treat my varicose veins before, or should I wait until after delivery?
A: We recommend you treat your varicose veins before pregnancy and start with a clean slate. Your pregnancy will be much more comfortable, and the likelihood of potential complications, like blood clots, is reduced. You may develop additional veins, but many may actually resolve after delivery and the problem will not be as severe.

Q: How does pregnancy tie into Varicose Veins?
A: It is common for women to develop varicose veins during their pregnancy. The main cause of this is due to the hormone changes in the woman’s body. There are increased levels of progesterone which cause the blood vessels to relax. This problem can be increased due to the fact that the enlarged womb may pressure on the major veins that pass through the pelvis which results on pressure in the veins of the legs. Varicose veins during pregnancy are more likely to affect women who have an inherited tendency of varicose veins in their family.

Q: Will varicose veins reappear after treatment?
A: It is not uncommon for additional varicose veins to occur over time after the initial treatment, but these can be effectively treated.

Q: What is sclerotherapy and does it hurt?
A: Sclerotherapy involves the use of a very small needle to inject a solution into the diseased veins. The solutions work by causing the veins to shrink, close off, and gradually disappear. The needles used are very small and feel like a mosquito bite. Most people find this relatively painless.

Q: Will these spider veins come back?
A: The veins treated with sclerotherapy are destroyed and will be reabsorbed by the body so they can’t come back. However, nothing can be done to prevent your body from forming new spider veins. But new spider veins can be treated just as effectively as the previous ones with sclerotherapy. We cannot cure venous disease – but we can control it and maintain a healthy leg. 

Q: How long will my treatment take?
A: Sclerotherapy treatment sessions usually last 25-30 minutes. Every patient is different, and the number of sessions needed varies depending on the severity of your condition. Most cases require three or more, however, this is only a guideline and your individual case may be different. Your legs may begin to show improvement in as little as a few weeks, but the best results are usually seen after several treatment sessions. After healing has occurred, spider vein “road maps” and bulging varicose veins will be gone, leaving you with healthy, great-looking legs.

Q: Are there any restrictions to my activity?
A: There are usually no restrictions on physical activity after sclerotherapy and in fact exercise is encouraged, although high impact aerobics should be eliminated for 1 week. We do discourage direct sun exposure to treated areas for a couple weeks after each treatment (sunscreens are adequate protection during this time).

Q: Why Do You Recommend Compression Stockings?
A: The properly fitted gradient compression stocking can temporarily reverse the effects of vein disease and lessen the discomfort as well as skin damage. Many insurance companies require a trial of stocking use before approving definitive therapy.A few days of using compression stockings after some  vein treatments can be also useful to achieve the best results.

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