Mercy Vascular Surgeon Dr. Kurtis Kim Responds to Questions Regarding Varicose Veins
Kurtis Kim, M.D., FACS, RPVI, Director of The Vascular Laboratory at The Vascular Center at Mercy, was recently interviewed by the health and well-being website, HealthyWay, for a story about the nature of varicose veins. Here are his responses…
What is a varicose vein? We all see veins in our bodies ... so how do these differ?
Varicose veins are abnormally engorged and dilated superficial veins (vs deep veins) usually in the legs that develop over time. Studies show that majority of those who have varicose veins have family history of it so it does run in the family. It also relates to the job functions that keeps on ther feet without moving or sitting (all desk jobs, factory workers, hairdressers, teachers, surgeons!, nurses, etc). We do see them in abdomen and other parts of the body too but these are rare and have specific causes (abdominal varicosities suggest liver disease, shoulder or arm varicosities suggest central venous occlusive disease).
There are many ways to categorize veins in our bodies, but for the purpose of varicose veins we divide them into superficial vs deep veins. Superficial veins are ones that are more on the surface of the skin therefore being more visible. Deep veins cannot be visualized with naked eye but can be seen with ultrasound. It is the disease in the superficial veins that creates varicose veins, mostly in the legs as the gravity wants to pull the venous blood and our legs are at the bottom of our body. You can say that just as our gravity and weight of our body generate wear and tear to our joints that carries the weight, our veins goes through degenerative changes (dilate, thereby making the venous valves not effective) that creates varicose and spider veins, swelling, throbbing, burning, numbness and tingling, "restless leg," night cramps, and in severe cases skin changes in the ankle (stasis dermatitis) ulcers and infections. This ineffective venous valves allow reverse flow in the vein causing branch veins that surfaces to the skin which becomes engorged and enlarge which we call varicose veins.
Why are they more prevalent in women than in men?
Pregnancy. During pregnancy, body's blood volume expands and stretches the vein thereby making the one-way vein valves that are all over the legs toward the heart (against the gravity when you stand) ineffective. Also pressure of the enlarged compresses on the pelvic veins which create signfiicant venous limitations of venous flow toward the heart that creates leg swelling which is quite common during pregnancy. This ineffective venous valves allow reverse flow in the vein causing branch veins that surfaces to the skin which becomes engorged and enlarge which we call varicose veins.
Are there signs that they're developing that you can address before they show up? Anything we can do to simply prevent them?
No way to prevent, nor no known cure. This is a process that undergoes degeneration (again, just like joints after putting pressure on them for lifetime), and so recurrence at a different site after initial treatment is common.
There are ways to decrease the speed of progression which we call conservative management: compression stockings (at least 20-30mmHg), leg elevation, and exercise (exercise causes muscles to contract which pushes venous blood up toward the heart).
Signs can be varied between no symptoms, to throbbing, burning, heaviness, nightly cramps, discoloration at the ankle, "restless leg" "can't get comfortable with my legs at night types of symptoms.
Should you always seek medical care? Is there any danger (aside from cosmetic concerns) to not addressing a varicose vein? Or is there a point at which you must see a physician.
Not always. Simply having ultrasound finding of venous insufficiency does not justify or help pts undergoing procedures. Their symptoms should match the findings on ultrasound. Most of vein procedures are driven by patient preference. I don't mean that most procedures are for cosmetic results, but just having varicose vein itself is not in any way dangerous. When patients present with significant symptoms as I have described above, doing laser or radiofrequency ablation of affected superficial veins do a great job of relieving the symptoms along with cosmetic results.
It becomes medical necessity when there has been complications of venous insufficiency/varicose veins: venous ulcers, infections, bleeding from varicose veins. recurrent phlebitis (clot in the superficial veins).
What will you look for from a medical standpoint to diagnose varicose veins, and what are the treatment options?
Listening to the patient and how their leg feels throughout the day (i.e. my leg feels heavier as the day progresses, or get cramps at night, or get aches and throbbing etc). Physical examination looking for varicose veins , stasis dermatitis, swelling, spider veins. And ultrasound to confirm the diagnosis that demonstrates venous insufficiency (ultrasound can detect reversed flow or backward flow of blood in the vein).
Before a decade ago treatment was vein stripping which is an cutting operation where main superficial vein (great saphenous vein) was stripped and removed plus or minus focally removing several segments of varicose veins. With advent of laser and radiofrequency (RF) abliation, we do this without cutting, office-based outpatient procedure under local anesthesia where laser or RF is used to heat the vein from inside and close them thereby rerouting the blood that used to flow backward to more healthier vein and shutting the diseased vein closed to lessen the pressure it used to generate in the leg.
If we suspect the disease is in the pelvic vein being compressed, then we interrogate this using intravenous ultrasound to diagnose and treat with intravenous stent.
For spider veins, topical laser or sclerotherapy (needle injection) can be done to remove them.
Founded in 1874 in downtown Baltimore by the Sisters of Mercy, Mercy Medical Center is a 183-licensed bed acute care university-affiliated teaching hospital. Mercy has been recognized as a top Maryland hospital by U.S. News & World Report; a Top 100 hospital for Women’s Health & Orthopedics by Healthgrades; is currently A-rated for Hospital Safety (Leapfrog Group), and is recognized by the American Nurses Credentialing Center as a Magnet Hospital. Mercy Medical Center is part of Mercy Health Services (MHS), the parent of Mercy’s primary care and specialty care physician enterprise, known as Mercy Personal Physicians, which employs more than 200 providers with locations in Baltimore, Lutherville, Overlea, Glen Burnie, Columbia and Reisterstown. For more information about Mercy, visit www.mdmercy.com, MDMercyMedia on Facebook, Twitter, or call 1-800-MD-Mercy.