Q&A With Vein Doctor: Answers To Your Questions About Treatment

The vein experts at Vein Clinics of America have specialized knowledge in the diagnosis and treatment of vein disease and related disorders. In this blog, we interview Dr. Adam D. Corrado from our Avon, Connecticut vein clinic to discuss what patients can expect after vein treatment.

Read on for answers to your most common questions about varicose and spider vein treatments and common vein procedures.

Q: Will all my veins go away after vein treatment?

There are many ways to treat varicose vein disease. If you undergo surgical vein removal (known as microphlebectomy or ambulatory phlebectomy), in which a trained physician physically removes bulging varicose veins, those veins will be gone once the procedure is complete. If your treatment course includes noninvasive procedures, those veins will be closed, meaning blood flow will be diverted to normal, healthy veins. Over time, your body will begin absorbing those veins, which will turn into scar tissue and, for all intents and purposes, will be gone. If you’re looking for additional information on if veins will go away after treatment, check out this blog post.

Q: Once treatment is done will my veins ever come back?

Once you undergo your entire prescribed treatment process, your veins will be gone and the likelihood of them coming back is very slim. However, because chronic venous insufficiency (also known as varicose vein disease) is genetic, chronic, and a progressive disease, the likelihood of new varicose veins forming, or previously normal veins becoming diseased veins remains. This is called neovascularization (or new veins). By treating the diseased vein at the source however, it usually slows down the progression.

Q: Why am I scheduled for so many appointments?

Because vein disease is genetic, chronic, and progressive, the appropriate way to treat it is from “source to course”. Think of the veins in your leg as a tree – if all levels are affected, you must first treat the source, which is often the truncal veins (i.e. the trunk of the tree), once those are treated, the physician and team move on to focusing on the varicose veins (i.e. the branches of the tree), finally, the team treats the reticular and spider veins (i.e. the leaves of the tree). Depending on the extent of your vein disease, you may need to treat several trunks (all single appointments), several branches (requiring a few rounds of treatment), and many “leaves” to ensure surface (spider) veins are appropriately treated. In between these appointments, ultrasound scans will be scheduled to ensure safe and effective care.

Depending on continued symptoms, additional ultrasound scans may be ordered, followed by additional procedures. Vein treatment is not a cure but a process which aims to relieve symptoms and improve your quality of life.

Q: Will I have any veins left after treatment?

There are roughly 24 miles of veins in your legs alone! Veins that require treatment are those that are not functioning appropriately. The longer they are left untreated, the larger they become, and the more pressure they place on adjoining veins which eventually cause them to fail as well. Although it may seem as though your vein doctor is treating all of the veins in your legs, you have plenty left. In fact, varicose vein disease only affects the superficial venous system which carries about 20% of the blood volume in the legs. The deep venous system carries the majority (80%) of the blood in the legs; the veins are much larger and comparatively and rarely require intervention. When shutting down the veins that are not functioning properly, it actually forces the blood flow back into the healthy, functioning vessels.

Q: Will the vein procedures hurt?

Procedures are often described as slightly uncomfortable, but not painful. The most common response from a patient, following their first procedure is “Was that it? We’re done already??” Your phlebology team (physicians specializing in diagnosis and treatment of venous disorders) will walk you through every step of the procedure, with as much or little detail as you prefer. Mostly, you will feel small pinches from the injections, a slight burning sensation from the medication, and, at times, pressure from the fluid injection in your leg. Actual vein procedure times (excluding prep) vary from 15-25 minutes.

Q: Will receiving vein treatment help with my symptoms?

Symptoms caused by varicose vein disease or chronic venous insufficiency such as swelling, pain, restlessness, tiredness, and heaviness are greatly improved following procedures. Often, patients begin feeling relief following their first few procedures with most feeling a significant improvement within a few weeks of the last procedure, once legs are able to heal. Although rare, sometimes patients will experience a temporary increase in swelling as the body heals and blood flow reroutes.

Q: Why can’t I just have my spider veins treated?

Depending on the progress and extent of your vein disease, you may only have spider veins. This will be determined by your phlebologist based on your history, physical, and an ultrasound performed to rule out additional disease processes. If you only have spider veins, then you only need to have spider veins treated. However, more commonly, patients start to notice spider veins and ignore their other symptoms such as pain, swelling, tiredness, restlessness, tingling, instead blaming overexertion, age, etc. Once they meet with their phlebologist, these symptoms are uncovered, along with other visual changes such as spider veins around the ankle, redness or discoloration near and above the ankles, which are common signs of chronic venous insufficiency.

Usually, an ultrasound is ordered to assess the extent of the vein disease. If you are found to have disease that extends beyond spider veins, and are experiencing the above-listed chronic symptoms, you will be advised to undergo treatments to treat the source of the chronic venous insufficiency. You may have heard a friend, colleague, neighbor, or family member say, “I had my spider veins injected and they all came back within months”. This may either be due to improper treatment technique and/or failing to treat the source of the disease. As one of our physicians puts it “you can keep painting over a hole at the bottom of your boat, but until you fix it, it will continue to leak”.

Q: Can I exercise following the procedures?

This will depend on your treating physician’s preference, the extent of your vein disease, and the type of exercise. For example, you will not be advised to run a marathon or go through an intense bootcamp class days after a procedure but swimming, moderate biking as well as lots and lots of walking is highly encouraged. In fact, you will be asked to walk 20 minutes a day, at least twice a day, for 3-5 days following each procedure, so lace up your shoes and take the family and dogs for a walk! Learn more about the benefits of walking daily.

Q: Do I need to take off work for the procedures?

One of the benefits of undergoing these noninvasive procedures in an outpatient setting (versus a hospital) is that they are performed efficiently and effectively, so no, there is no need to take off from work for medical reasons. You can expect to have several appointments, ranging from 45-60 minutes in length, depending on the procedure type. Many patients come in during their lunch break, have the procedure, and then return to work. Be mindful that you will need to wear compression stockings and will be asked to walk 20 minutes twice a day for several days following each procedure so plan accordingly and lace up your shoes.

Q: I have vulvar varices, will treatment help?

Everyone’s experience with vein disease is different; which veins are affected, what is the “source” (cause – meaning which main set of vein or veins are causing varicose veins to appear) of varicose vein disease, which procedures are required, etc. The best answer will come once you have had a consultation, and then initial ultrasound scan in your local vein clinic.

Some patients have both vulvar and leg varicose veins. In this case, both will need to be treated separately but most likely, the cause of vulvar varicose veins rests in your pelvis. Symptoms for pelvic venous insufficiency include fullness, pressure, and pain in the genitals, side (flank) pain, back pain, blood in urine, painful intercourse, etc. If you are found to have pelvic venous insufficiency, the source (veins within your lower abdomen or pelvis) will need to be treated first, followed by the varicose veins in your leg. If you are experiencing any of the symptoms listed above, or are seeing vulvar or leg varicose veins, schedule a visit with at local vein clinic today.

Q: Can I get vein treatment if I’m pregnant?

Although every case is different, women who are pregnant are typically not encouraged to undergo treatment of their varicose vein disease. Most often, compression stockings are provided to help alleviate symptoms. Your phlebologist may order an ultrasound of your legs and schedule treatment or procedures once you have given birth. Remember that your blood volume nearly doubles while you are pregnant which may be causing your venous valves to fail. You are very likely to see veins protrude or “bulge” in your legs and may even develop vulvar varices. After you’ve given birth, some of the symptoms and the appearance of your veins may improve as well but unfortunately, your vein disease, if present, will not “go away” once you’ve had the baby.

Q: What if I’m breastfeeding?

This is a very common question, and one related to the topic above. Women who are pregnant and often miserable due to their symptomatic varicose vein disease cannot wait to begin the treatment process once they’ve given birth. Depending on the severity of your symptoms, the extent of your disease process, and your personalized treatment plan, your physician may recommend you begin your treatment process while still breastfeeding. However, be prepared to be instructed to your breast milk (“pump and dump”) once to twice prior to resuming breastfeeding following each procedure.

Q: My feet are always cold, will treatment help?

Typical symptoms of varicose vein disease or chronic venous insufficiency are known as the HASTI symptoms: Heaviness, Aching/pain, Swelling, Tiredness and Itching.

Cold hands and feet are more commonly related to arterial (versus venous) circulation, as well as neurological causes. Most likely, you just have cold feet and nothing to worry about. However, if you notice the tips of your toes turning blue or black, seek medical attention as you may be experiencing signs (what you see) and physical symptoms (what you feel) of peripheral arterial disease.

Q: I’ve had treatment done before elsewhere, but the veins all came back. How do I know vein treatment will work this time?

Varicose vein disease or chronic venous insufficiency is a chronic (long term), progressive disease with no cure. The key to vein treatment success is:

• Detailed and high-quality ultrasound which provides an accurate representation of your specific disease process, which leads to a…
• Personalized treatment plan, that is created based on your specific needs, the success of which relies on
• Compliance with post treatment instructions that may include wearing compression stockings, limiting certain types of exercise immediately following procedures, and starting or continuing light, low impact exercise to promote healthy circulation, that is then complemented by…
• Regular follow up visits, based on your symptoms; this prevents your vein disease from progressing.

We often see patients who have received incomplete treatments, often targeting visible veins without intervention to the nonvisible “source” veins. Our scan and treatment approach is “source to course” so that we can take care of the entire issue. As one of our physicians noted, “you can mop water up off the basement floor but unless you fix the leaky pipe, your flooding will always return.”

Explore all of the varicose and spider vein treatments we offer at VCA.

Q: What if I need my vein for a bypass graft?

Grafts are used to bypass blockages in your arteries, often those leading to your heart, or in your legs. Synthetic grafts are often used and have a high patency (flow) rate. For heart bypass, typically radial arteries are used. When veins are used, as a graft, they are indeed typically the superficial veins in the leg. However, if your veins are affected by varicose vein disease or chronic venous insufficiency, surgeons will rarely choose to use them. This is due to the stretching and vein wall weakening that happens over time. Short answer: don’t worry about receiving treatment for your veins; if you find yourself in need of a bypass graft, you will be offered several options, aside from the use of these veins.

Q: Do I need to stop taking my blood thinners for the procedures?

Your phlebologist will help you weigh your options when seeking treatment for your varicose vein disease. There are many different types of blood thinners, and many reasons why they are prescribed. Your phlebologist will discuss your disease process, personalized treatment plan, risks, and benefits, and based on your specific criteria, may proceed with treatment. Often, patients are encouraged to remain on blood thinners throughout the treatment process.

Q: What do you mean I might feel dizzy or lightheaded during the scan? Why would that happen?

Each time you walk into the ultrasound room, the technologist will remind you of the symptoms you may experience during your scan (also known as your “mapping”). These scans are performed with you in the standing position and may lead to you feeling warm, dizzy, lightheaded, and even nauseated. This may be for a few reasons:

• • You are dehydrated or haven’t eaten – make sure you drink plenty of water and eat a light meal prior to all of your scans. Often, patients think they should be fasting for this “medical test”. In contrast to this, we need you to be well hydrated and to have eaten.
  • You see or hear the ultrasound. Some patients become dizzy while viewing the live ultrasound scan image, describing what they view as a “moving ocean”. Others become nervous and symptomatic when they hear the “woosh” sound as the blood flows through the vein following the technologist’s squeeze of their leg.
  • You become vasovagal. This can occur when your body reacts to the sight of blood, the thought of blood or veins, and is often combined with emotional distress (nervous about being in a physician’s office, nervous about results, what the procedures will consist of, etc.). You can also experience neurocardiogenic syncope (losing consciousness) as your heart rate and blood pressure drop suddenly due to standing still for an extended period of time; blood pools in your legs and once the technologist squeezes your leg, your blood rushes upward causing a feeling of dizziness, which can lead to losing consciousness.

Your phlebology team is well trained to recognize these signs to protect you from injury. You will be provided information on prepping for the exam, prompted to move around to circulate your blood, the volume will be shut off on ultrasound units, you will be encouraged to look away from the screen if the movement bothers you, and you will be prompted to chat during the scan and let the ultrasound technologist know if you begin having any of the symptoms listed above so they can instruct you to sit down right away.

Please note that these reactions are uncommon but can occur in some patients.

Q: There’s no way I can do this, I hate needles!

We have often thought of ourselves as “Needle Whisperers”. Let’s be honest, no one likes needles and some of us are downright terrified of them. Needle sticks are minimal, needles used are smaller than those used to draw blood, and the provider will walk you through the entire process with as little or much detail as you wish. Let me assure you, the most common comment we hear from patients following procedures is “You’re done?”. It is very common for patients to fear needles, but it is just as common for patients to become accustomed to the treatments and in fact thank us for helping them get over this fear.

We hope this gave you a sense of what to expect before, during and following your vein treatment with Vein Clinics of America. Contact us below if you have additional questions, or if you’d like to schedule a consultation with one of our vein specialists.