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Getting a Leg Up on Varicose Veins
Excerpt By Jennifer Thomas, HealthScoutNews

Troubled by the sight or ache of bulging blue varicose veins?

Take heart. New treatments -- often available at your local dermatologist's office -- can make getting rid of varicose veins much easier and less painful than longstanding procedures.

"A lot of women today don't realize there are treatments available that will clear up their legs beautifully," says Dr. Bruce Katz, director of the JUVA Skin and Laser Center in New York City. "They can wear shorts, bathing suits without feeling embarrassed. They don't have to live with those nasty veins."

Until recently, patients had few options for dealing with varicose veins, says Dr. Mitchell Goldman, an associate clinical professor of dermatology at the University of California, San Diego.

One of those options was a painful surgery called "stripping," in which the surgeon cut through the skin, tied off the vein and removed it. Stripping, which required general anesthesia, often left scars and meant weeks of recovery, Goldman says.

Doctors can now use radio frequency devices and lasers to eliminate different types of varicose veins. The procedures, which take about an hour, are done under local anesthesia and patients can walk out of the office.

"I had one patient who did a marathon a week later," says Goldman, who is also director of the Laser and Skin Surgery Center of La Jolla, Calif. "There is no scarring, no down time, no pain, as long as you go to the right doctor, a dermatologist or vascular surgeon who specializes in veins."

For the deepest, largest veins, doctors are now using radio frequency devices. Using ultrasound imaging for guidance, doctors thread a catheter through the vein. The radio frequency device at the end of the catheter heats up the inside of the vein. The heat then seals the vein, which later shrivels up and is absorbed into the body.

For smaller, surface veins, doctors are turning to laser surgery.

The lasers work like the radio frequency device. Again, using ultrasound for guidance, the doctors thread a tiny, fiber-optic laser through a catheter into the vein. The laser heats up the vein from the inside, causing scar tissue to form and the vein to disappear.

"Lasers can hurt on big veins," Goldman says. "It's only appropriate to use on the tiny veins that remain after sclerotherapy."

Sclerotherapy is a widely accepted treatment that doctors have been using for decades. A chemical solution is injected into the vein with a very fine needle. The chemical causes scar tissue that is eventually absorbed into the body. When the procedure works, the vein becomes barely noticeable within a few weeks or months. But the treatment doesn't work on all varicose veins, Katz says.

Varicose veins develop when the valves in veins are damaged and begin to leak, Katz explains.

Normally, veins push blood up to the heart using a system of one-way valves. But when these valves are damaged, the backflow of blood pools in the veins, increasing pressure and causing the veins to expand and push to the surface. As the blood pools, the valves leak more, making matters worse.

Doctors aren't sure why this happens, although genetics is believed to play a role, Katz says.

Varicose veins, whether mild or severe, almost always occur in the legs. And women are more likely to develop them than men. By age 55, 50 percent of women and about 15 percent of men are afflicted with the condition. Doctors believe female hormones may play a role in the creation of varicose veins because birth control pills, pregnancy or hormone-replacement therapy seem to exacerbate the problem.

For some, varicose veins are mainly a cosmetic issue. But for others, varicose veins can cause pain, from dull, throbbing, tender legs to a burning sensation. The worst cases can cause skin ulcers.

Although most people think of varicose veins as the ones you can see through the skin, they can also be buried deep within the legs, Goldman says.

What To Do

There are several things you can do to help prevent varicose veins and to give yourself relief, short of seeing the dermatologist, says Dr. Wilma F. Bergfeld, head of clinical research at the Cleveland Clinic's department of dermatology in Ohio. She recommends that you:

  • Wear support stockings from first thing in the morning until you go to bed.
  • Walk at least three times a week for 20 minutes, and keep your weight within recommended guidelines.
  • Avoid standing or sitting in the same position for more than 20 to 30 minutes.
  • Elevate your legs whenever possible.
  • Avoid high-heeled shoes, which can decrease the pumping ability of the calf muscle.

"It's a chronic, progressive problem and you really need to take care of it," Bergfeld says.

For more information about varicose veins, check out the American Academy of Dermatology, or the National Library of Medicine.

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