Vein Q & A

Frequently Asked Questions About Varicose Veins

If you are currently suffering from varicose veins or at risk of developing them in the future,
here are a few helpful answers to common questions about venous health.

Varicose veins are a common circulatory disorder, affecting as many as 23% of American adults. Despite its prevalence, however, many patients still have questions about them, with many patients having little understanding of their condition or possible courses of treatment. We’ll clarify some of the more common queries about varicose veins to help you better understand them.

Q: What is the difference between “varicose veins” and “spider veins”?
A:  Varicose veins are large, bulging leg veins. “Spider veins” (or, telangiectasis) are very small, fine superficial veins just beneath the skin. They are about 1 millimeter or even less in width, and they look like “spiders”, hence the name. (we should include pictures of each on this page for clarification.) The larger varicose veins are more likely to be the cause of pain, swelling, and skin changes that can require treatment for medical reasons. Spider veins, on the other hand, are generally more of a cosmetic issue but can cause minor symptoms such as itching and discomfort.

Q: Do varicose veins have to be treated?
A: From the standpoint of medical necessity, treatment of varicose veins is usually recommended when they are the cause of symptoms such as pain and swelling. In more severe cases the varicose veins can also cause skin damage and even skin ulcers. When varicose veins cause these medical problems medical evaluation by a vein specialist is recommended to determine the optimal treatment method. In the absence of any medical symptoms such as those described above, the varicose veins can still be treated for cosmetic purposes if desired. In the absence of any of these medical symptoms, varicose veins can be safely observed or treated with conservative measures such as stockings.

Q: If my varicose veins are causing medical problems, how can they be treated?
A: Many years ago, there were limited options for treating varicose veins. Almost everyone knows someone who had “vein stripping” surgery in the past – many people who have varicose veins and maybe even their doctor are unaware that there are now many newer treatments that are non-surgical, and performed conveniently and safely in the vein specialist’s office, with minimal discomfort and no “down-time.”

There are many such minimally-invasive techniques available. Most of these newer techniques fall under two main categories – ablation and injection. The ablation techniques use a thin, flexible, plastic tube (catheter) that is placed into the leg vein using local anesthesia to numb the skin and ultrasound imaging to guide the catheter into position. The tip of the catheter has a tiny heating element that when activated, closes the vein from the inside to eliminate the varicose veins. With the injection techniques, a tiny needle is inserted into the vein, usually guided by ultrasound, and then a chemical is injected that damages the inside of the varicose vein causing it to close and be eliminated.

Q: How are “spider veins” treated?
A: “Spider veins” (or “telangiectasias) are treated with injections using specially formulated chemical liquids that damage the inside of the spider vein causing it to close and be eliminated. This treatment is called “sclerotherapy” – the chemical injection “scleroses” the spider veins. The injections are done using a tiny needle (much, much smaller than those used to draw blood in a doctor’s office!). It is very common for someone to have multiple spider veins, so in many cases more than one treatment session is required.

Q: Does insurance cover treatment of varicose veins?
A: Medicare and almost all commercial insurance companies do cover treatment of varicose veins when the veins are causing medical problems such as pain and swelling, or if there is skin damage resulting from the varicose veins. Coverage options and criteria of “medical necessity” vary between various insurance companies, so this is something to discuss with the physician treating your veins. Sclerotherapy for spider veins, on the other hand, is almost never covered by insurance as it is considered a “cosmetic” procedure. While sclerotherapy is not covered by insurance, we strive to make this treatment method affordable, and we tailor the number of treatments to the person’s needs and cosmetic priorities.

Q: I went to a “vein center” for a few varicose veins on only one leg, and I was told I needed multiple treatments, even on the leg that isn’t bothering me. What’s up with that?
A: Great question! We have seen many patients who have come to us for a “second opinion” after being told at the “vein center” they need as many as 10 or more treatments, even including “the other leg” where there are no visible veins and no symptoms! Every situation is unique and different, but in our opinion many of these “recommended treatments” are unnecessary. This is where the expertise and vascular training of the vein specialist is so important. At Carolina Vein Care & Aesthetics, we will only recommend procedures that we believe are truly necessary – we treat the patient, not the ultrasound test (or the doctor!).

Q: If you “close” my varicose veins, how will the blood return out of my leg and back to the heart?
A: This is actually one of the most common questions we get, especially while describing the various procedures available to treat varicose veins. The answer is all “good news” – the vast majority of the blood that returns to the heart from the legs travels in the “deep veins” of the leg, which are larger and beneath the muscles. These deep veins are NOT closed or damaged in the process of treating your varicose veins, which are “superficial” veins, and contribute very little (less than 10%) of the venous blood return from the legs. In fact, since the varicose veins are abnormal, and have reflux (which is essentially a “backwards” flow of venous blood due to the non-functioning one-way valves in the varicose veins), closure of the abnormal varicose veins will actually improve the return of venous blood from the leg to the heart.

If you have further questions or are currently looking for treatment, call our office today and schedule an appointment with one of our physicians. At Carolina Vein Care & Aesthetics, our vascular specialists use advanced techniques to treat vein conditions causing you pain and discomfort.

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