Varicose Veins

Veins

Veins can be so ugly and unsightly, so confusing that they seen to have a mind of their own. Veins often do what they want to do in response to genetics, hormones, trauma, disease, pressure, and pregnancy.

Varicose veins are the larger rubbery, knotty, huge convoluting vessels on the legs. They usually appear like a rope or pencil and can often be extremely painful. Reticular veins are the greenish smaller than varicose, and they can be painful as well. Spiders are often misunderstood and are usually short, thin, usually half the size of a fine hair. They can form in four general superficial patterns or just be an individual veins. These vessels are very small.

The old methods of surgery have been to cut into the vessel at both ends, insert a piece of piano wire into the vein and pull it inside out, stripping the vessel. This is very effective, but often can leave a lot of excess blood in the skin. Blood has iron in its composition. Iron is what is used to tattoo the skin and cause brown and green pigments. The vessel is now gone, but the unpredictable modern art of that tattooing is now present and forever from the residual blood left behind. Scalping or pulling them out in 1, 2, or 3 inch sections. Scalping involves several cuts in your skin to get the pieces of the vessel out. This is a very effective method of removing them, but again the tattooing effect will usually be an outcome of this procedure. The incisions of scalpels will usually leave scars. Endoluminal puts a laser inside the vessel and advances it to the end. It then backs its way out burning the vessel and sometimes leaving tattooing, but it does destroy the vessel forever.

Everybody loves the laser but let’s just think about it for a second… you have a vessel filled with blood under or in the skin. A laser from outside of the skin burns a hole through the skin, subcutaneous fat, and other blood vessels and explodes the vein in your leg. You must literally burn holes in the skin and you do use a laser to burn a trench in the flesh to remove the problem. This allows blood to come to the surface of the skin and under the skin and again we have this modern art problem of tattooing.

Aestheticians and others generally with good intention and truly wanting to help you usually want to put an IPL (intense pulse light) on your legs and explode the spider veins and the smaller reticular veins. Guess what? We are back to the tattooing problem again and they usually will reoccur because the problem is not solved.

Possibly your best solution could be sclerotherapy. Often from trauma, genetics, or hormones during pregnancy the circulation in the legs and thighs are changed. The heart pumps blood out to the big toe and the veins return about 99% of the blood back. Some of them are deep into the muscle and some are more superficial. There are additionally communicating ones that travel back and forth between the deep and superficial veins. Deep, communicating and superficial vessels have one way valves pointing the blood back to the heart. These communicating vessels start to leak from pressure due to the structure and this usually causes the problem. If you do not fix the leaky valves other will appear at the surface over and over again from the pressure.
Think of a clock, the deep high pressure veins are the motors and stem of the clock feeding up to the surface. The superficial veins are the hands of the clock making it 2:00PM. We burn or cut out the hands of the clock at 2PM. The doctor takes a photo of your new legs and you are happy. You then go home, several days, weeks, months, or years later it is now 4:30 p.m. on the clock. Another procedure is done and you are happy again. Now its 7:45PM and here we go again and again. A great general solution is taking a very fine needle and injecting the tips of the hands on the clock. This destroys the hands and then it travels down into the feeder from below and usually eliminates the problem once and for all. The blood is pushed back deep; the vessel constricts, it cannot let go and then it dies to never return. It is the absorbed by the body with very minimal scarring, holes in the skin, and tattooing, if any are minimal.

The technique needs to be done by a very experienced physician who is unrushed. He may wish to use an ultrasound, vessel illuminator or Doppler to assess the complex plumbing problem. Once a careful diagnosis is made and a logical plan is flowed, great results usually occur with the correct diagram and tools, your time with great care great results will follow. You and many of our patients can and will proudly wear shorts again. We see this happening again and again.

You’ll love wearing shorts again and with the proper diagnosis plan and procedure performed with time and care, you will.
John Drew Laurusonis M.D.
Doctors Medical Center