NEW YORK—For some with varicose veins, 45 minutes and a few needle pricks can reduce the risk of preventable death.
Patients with larger varicose veins are at an increased risk of deep vein thrombosis (DVT), or a blood clot deep in the legs. If part of this blood clot breaks off and travels to the lungs, it can block the lung arteries, causing a pulmonary embolism.
DVT affects more than 2.5 million Americans (less than 8 percent of the population) each year. Up to 200,000 Americans (or less than .06 percent of the population) die each year from DVT-related pulmonary embolism, according to the University of Southern California.
Besides enlarged varicose veins, factors that increase the risk of clot formation include prolonged airplane travel, obesity, underlying blood-clotting disorders, and cancer.
When treating DVT, early detection is key and luckily not too difficult.
“[Detection] can be done in a short time in a vein specialist’s office,” said Dr. Ronald Lev of Advanced Varicose Veins, who has been practicing cardiovascular medicine in Manhattan for 14 years. “Ultrasound is an easy, non-invasive test that can often detect these blood clots.”
If caught early, treatments with compression and blood-thinning medications can help minimize long-term issues, he said.
Dr. Lev is one of about a dozen Manhattan vein specialists certified by the American Board of Venous and Lymphatic Medicine (ABVLM), which was founded in 2007 to improve standards for this relatively new and growing specialty.
Simple Solutions to Varicose Veins
The ropey bluish blights that are varicose veins show up on the legs of up to 73 percent of women and 56 percent of men sometime during their lives. But they are surprisingly simple to evaluate and vanquish.
Non-invasive ultrasound tests are used to diagnose potential problems, and most vein specialists can reduce or destroy the veins in under an hour using simple, nearly painless in-office procedures.
Afterward, some experience aching pain. But very rarely do they need more pain medication than what they can get over-the-counter.
Recovery time following most varicose vein treatments is short. The patient is asked to walk for 30 minutes after the procedure and almost always can go back to work the next day, Dr. Lev said.
Some procedures need multiple treatment sessions depending on severity and the depth of the veins that need to be tackled.
Usually, if the case is considered medical, most insurance, including Medicare, will cover part or the entire cost of treatment.
There is a wide spectrum of severity among vein patients, Dr. Lev said, so there’s no need to panic at the first sign of varicose veins.
However, if you have “throbbing, aching, restless legs, then that would be enough reason to get evaluated,” he said.
For mild cases of varicose veins, patients may not need any medical treatment at all.
“Exercise, leg elevation, over-the-counter pain medicine, or compression stockings” can be enough, Dr. Lev said.
For more severe cases, Dr. Lev employs a variety of treatment options that close, remove, block, or dissolve the problematic veins. When a vein closes, the body automatically diverts blood to healthy veins in the legs, and normal function resumes.
A major risk factor for varicose veins is family history. The condition also becomes more prevalent with age, and mothers often develop varicose veins while pregnant.
Poor diet, obesity, and inactivity contribute mightily to the development or worsening of varicose veins. Those who spend most of their time on their feet or sitting could have inhibited blood flow in their legs.
In a healthy circulatory system, veins deliver deoxygenated blood from the extremes of the body back to the heart to be replenished. When this fails to happen efficiently, the condition is called venous insufficiency, and blood pools in the veins of the legs.
If left untreated, varicose veins escalate into venous insufficiency, which is less serious but more common than DVT.
Venous insufficiency happens in up to 40 percent of women who have varicose veins and 17 percent of men, according a study published on the National Institutes of Health. Symptoms of venous insufficiency include ulcers and open sores.
“Often the first visual sign of venous insufficiency may be spider veins, especially on the feet and ankles, where gravity has more of an effect,” Dr. Lev said.
You should also see a doctor if you have bulging varicose veins that cause pain or skin discoloration, or if you have open wounds or ulcers.
Vein Treatment Options
In the past, vein stripping was the most common way to tackle vein problems. This involved cutting at a few points along the vein then tying a wire around it pulling the vein out. The treatment was brutal and painful, left scars, and necessitated long recovery.
Today, vein stripping is almost never used because it has been replaced by new, minimally invasive methods like sclerotherapy, laser treatment, and radiofrequency ablation.
Below are the preferred treatments Dr. Lev uses for various types of varicose vein issues.
Ultrasound-Guided Foam Sclerotherapy. A chemical foam is injected into the vein, causing scarring inside the vein so that it becomes blocked. Ultrasound imaging is used to monitor the foam’s progress inside the vein. Multiple sessions may be needed to completely block the vein.
Endovenous Radiofrequency Ablation. A catheter is threaded up the vein through a small incision. Radiofrequency heats the vein from within in 20-second intervals, destroying the tissue.
Endovenous Laser Treatment. This treatment is similar to endovenous radiofrequency ablation, but instead of a catheter, an optical fiber is used to shine laser light inside the vein, causing it to contract and collapse.
ClariVein. This treatment involves sliding a rotating catheter guided by ultrasound into the vein. A liquid is injected into the vein to close it. ClariVein can be used to treat all sizes of varicose veins with no anesthetic.
VeinGogh. This procedure is used specifically for smaller spider veins and cosmetic veins. It uses microbursts of focused electrical energy to heat and destroy the affected veins.
Phlebectomy. This is the surgical removal of a vein. A hook is used to remove the affected vein through a series of small incisions made in the adjacent skin. A phlebectomy can usually be completed in 30 minutes to 1 hour.
Varicose Vein Warning Sign
Any of the following signs can be a warning that varicose veins pose a health risk, according to Dr. Lev:
• Legs are painful, swollen, or fatigued.
• Veins become inflamed (phlebitis).
• Skin on the feet, ankles, or calves changes color to pink, purple, or blue.
• Skin develops a leathery feel, with a brownish or reddish discoloration.
• Skin becomes delicate and has ulcers or bleeding.
Dr. Ronald Dr. Lev
Advanced Varicose Veins
111 John St. New York, NY 10038