Unfortunately, varicose veins and spider veins can be and often are mischaracterized as a cosmetic problem. In fact, they are an indications of an underlying disorder of the circulatory system called venous insufficiency. By age sixty, 70% of women will suffer from this condition. Without treatment, varicose veins can lead to a chronic, debilitating, and sometimes limb-threatening condition. Unfortunately this disease process is under-diagnosed and under-treated. Sadly, many patients opt for treatments that address only the superficial appearance of veins only to find that the veins reappear. Some superficial, skin deep treatments leave the veins worse than before treatment and cause the skin to appear blotchy or discolored. The underlying cause is never considered, diagnosed, or properly treated. Modern treatment of this age old problem can now be accomplished with an array of minimally invasive techniques in an outpatient setting. Varicose vein disease afflicts women with twice the frequency as men. Many of my patients comment that the first veins became visible or worsened during the third trimester or in the peripartum. This is the result of being gravid and living with gravity. A woman's blood volume will increase significantly during pregnancy. Veins can serve as storage vessels for the extra blood volume. Late in pregnancy, that extra blood can overwhelm the veins below the heart, and can damage the valves within the leg veins that normally function to protect the skin veins below. After delivery, some women are fortunate as these valves snap back and function properly; however in many others the valves continue to malfunction. The blood in the leg veins does not flow properly back to the heart. Instead, gravity pulls that blood downwards, and ultimately causes the skin veins to bulge. Over time this unhealthy circulatory pattern can lead to tissue damage including swelling, dermatitis, and ulceration. As the blood is not flowing properly, the varicosities may clot, causing phlebitis, or they may rupture and bleed. Deep venous thrombosis and pulmonary embolism are additional risks of untreated venous insufficiency; this is a potentially fatal event. Aching, fatigue, itching or restless legs are common complaints of patients with venous insufficiency. Symptoms worsen at the end of the day. Relief is obtained with leg elevation, support stockings and pain medication. Because symptom onset is gradual, this disease may take decades to become apparent. All too often patients and physicians alike defer seeking care. "Spider Veins" or telangiectasias may be an early sign of venous insufficiency that appear when tiny skin veins, previously invisible, become engorged and enlarge. We evaluate many patients who present for treatment of spider veins, who have had superficial injection treatments, only to see reappearance after 6-12 months. Even worse, those who choose superficial laser treatments of leg spider veins exchange their spider veins for dark blotches in the skin. The underlying problem is never treated. A careful specialist ultrasound evaluation will usually show a deeper source vein. A new outpatient treatment called the Closure The procedure users radio frequency energy to shut off the leaky source vein, eliminating the major cause of varicose veins. With the Closure Procedure, a tiny catheter placed into the leaky source vein delivers a form of light energy to the vein wall. This energy causes collagen in the vein to change shape, closing the vein. This elegant procedure is completed in about an hour with minimal or no discomfort and a return to work or normal activity the same day. Closure is covered by most all insurances and is performed in our outpatient surgienter devoted exclusively to vein care. Clinical studies have shown outstanding safety, efficacy, and patient satisfaction. Patients are delighted with symptom relief and cosmetic improvement, 98% of whom would recommend Closure for a friend.
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