1. Varicose Veins: More Than Just a Cosmetic Problem
Jeffrey Stein, MD
Charlotte Radiology Vein and Vascular Center
Vascular and Interventional Radiology
Charlotte Radiology
February 8, 2012

2. What are Varicose Veins?
abnormally enlarged superficial veins
tortuous, twisted, widened or lengthened
bulging under skin surface
due to a defect in the valves within the veins themselves (venous valve insufficiency)
blood pools in sections of the vein causing the vein to bulge and swell

3. What are Varicose Veins?
Normal vein:
cusps of valves close & prevent backward flow of blood
Varicose vein: cusps cannot close because vein abnormally widened and blood can flow in the wrong direction

4. Introduction may be no symptoms
for some a problem in terms of appearance
may result in mild discomfort
may cause severe pain
may result in additional medical problems

5. Introduction
Images of varicosities:

6. Introduction Telangiectasia, more commonly known as spider veins:
Spider veins on the leg usually appear in one of three patterns:
simple linear
arborizing, which appear branch-like
spider, which appear as a cartwheel shape with a dark center point.

7. Incidence and prevalence
15% of males over 18
30% of women over 18
increases with age, being present in more than half the population by age 65
20 Million adults with varicose veins or chronic venous insufficiency (CVI)

8. Risk Factors
Genetics / Hereditary - those with a family history are at greater risk
family history of varicose veins 15 % of patients
Increasing Age
Gender - women are at greater risk than men
related to female sex hormones estrogen and progesterone which relax blood vessels, allowing the vein valves to separate
pregnancy

9. Risk Factors
Obesity- excess weight increases pressure on the saphenous vein valves, causing them to weaken
Pregnancy
varicose veins may surface for the first time during pregnancy
progesterone smooth muscle relaxation
later in pregnancy the uterus exerts greater pressure on the pelvic and leg veins and may cause or worsen varicose veins

10. Risk Factors
Standing and sitting- those who have jobs that require them to stand or sit for long periods also are at increased risk
prolonged standing can weaken the walls of veins
prolonged sitting can aggravate inflamed veins

11. Symptoms pain leg heaviness aching or tension
tenderness along the course of a vein
burning sensations
pruritus / itching
exercise intolerance
restless legs
paresthesias
night cramps
edema
skin changes

12. Complications
Thrombophlebitis

13. Complications
Stasis Dermatitis/
Varicose eczema

14. Complications Stasis Dermatitis/ Varicose eczema &
Lipodermatosclerosis

15. Management of Varicose Veins and Venous Reflux
Conservative treatment (will not solve the problem but will help with symptoms):
elevation
avoid prolonged sitting/standing
no leg crossing
exercise
weight reduction
compression stocking therapy

16. Management
Compression Stocking Therapy

17. Management Treatment options:
Surgical stripping: old way of removing the vein. Typically required a hospital stay and weeks of recovery time.
Injection sclerotherapy: often treats the surface veins, but does not treat the underlying problem.
Endovenous laser treatments: much less invasive way of “eliminating” the vein. The procedure seals off the vein while leaving it inside of your leg.

18. Management Benefits of laser treatments vs. traditional stripping:
Minimally invasive, in-office treatment alternative to surgical stripping of the great saphenous vein
No sedation
Most procedures take less than 30 minutes
Patients are able to walk immediately after the procedure and most individuals are able to return to work the next day

19. Ultrasound Evaluation: Before
During a consultation, you will meet with the doctor and have an ultrasound to determine which veins are not functioning properly. Your doctor will then discuss your treatment plan and review your insurance requirements. Most procedures are covered by insurance.

20. Varicose Veins: More Than Just a Cosmetic Problem
If you are interested in a consult, please give us a call. We accept all major insurances.
Southpark: 4525 Cameron Valley Parkway
Charlotte, NC 28211
ext. 2220
Concord: 212 LePhillip Court NE
Concord, NC 28205