Treating the Right Vein
NEW YORK—When it comes to treating visible varicose and spider veins, many specialists can and do. Gynecologists treat because their clientele often run into vein problems, and dermatologists treat because surface vein problems are unaesthetic.
The procedures for treating surface veins issues are relatively simple, require little equipment, are outpatient, and tend to be covered by insurance. But because venous medicine is a relatively new field, no regulatory body has been established to qualify physicians and procedures, leaving the door relatively open for medical specialists to get into the business of zapping veins.
But not all veins are created equal and if the inappropriate vein is treated, the specialist could make the leg worse, according to thoracic surgeon Dr. John Anastasi.
Anastasi is the medical director of Vein Cure Center in New York and has had 25 years of experience treating cardiac and vascular disease, doing everything from treating spider veins, commonly thought of as a cosmetic issue, to open heart surgery.
Heart surgeons need to understand the ins and outs of the circulatory system in order to operate on the heart. This makes them more aware than perhaps other types of specialists—such as gynecologists and dermatologists—of complications that can arise with vein treatment, Anastasi said.
Treatments of faulty veins involve removing, blocking, or closing off the vein so that blood will be rerouted into healthy ones.
The legs have over 20 veins so “if vein is abnormal and you take it out of circulation, it doesn’t hurt you,” Anastasi said.
However, if a doctor accidentally removes a healthy vein, the patient can develop swelling in the affected leg, exacerbating the problem the surgery was meant to correct.
Sometimes the line between operable and not worth operating on is very narrow, and even if a vein is refluxing, but not too much and is still not too wide, it may not need closing.
“The vein should be at least .5 centimeters and have at least four seconds of reflux to be appropriate for treatment,” Anastasi explained.
In cases where the patient has a refluxing vein that is narrower than .5 centimeters, but the patient has no clinical manifestations of venous disease, Anastasi said he would not recommend treating that vein.
Vein Function and Malfunction
The legs have four kinds of veins: superficial, perforator, deep, and reticular. Superficial veins drain blood from the skin; perforators connect superficial veins to the deep vein system. Deep veins drain blood from the legs, and reticular veins connect branches of any of the other three types of vein.
“Think of the venous system like a tree,” Anastasi said. “The deep vein system is the trunk. The branches and leaves are spider veins.”
The purpose of the venous system is to bring deoxygenated blood back to the heart to be replenished. Valves are supposed to control this flow, allowing blood to flow upward despite gravity.
But in patients with venous disease, these valves weaken or fail, and the blood refluxes, pooling in the lower extremities. The increased pressure causes the veins to get larger, resulting in sore, swollen legs; bumpy, bulging varicose veins, and even bleeding through the skin around the ankles.
This condition is called venous insufficiency.
It can be asymptomatic at first, and later signs are attributed to other conditions. If a doctor does not know what to look for, venous disease may not be recognized until it is far advanced.
“Swelling, ache, lower ankle brownness—people often think it’s just due to aging,” Anastasi said. “But next they develop varicose veins that get larger and painful and cause ulcers and bleeding.”
Cautions for Vein Care
Diabetes, arterial insufficiency, and heart disease can complicate vein treatments. A decade of experience specializing in venous problems has taught Anastasi that he needs to examine the whole patient before treating vein issues.
“The heart, lung, kidneys—we look at whole system. I look at the patient in total … I take into consideration whether they have diabetes, arterial insufficiency, and potential heart disease.” Anastasi said.
Diabetes inhibits a patient’s ability to heal and diabetics are more prone to infection. “Therefore a surgeon needs to be careful about making incisions in these patients especially down in the ankle or foot region,” he said.
Arterial insufficiency reduces the blood supply to the legs, which makes it more difficult for the body to heal incisions on the legs and can also put a patient at greater risk of infection.
Severe heart disease increases the risks associated with vein treatments, and patients need to be monitored more closely, Anastasi cautioned.
Dr. John Anastasi
Vein Cure Center of NYC
1041 Third Ave.
New York, NY