12 Vein Therapy

• Large veins are best treated with surgery, and small veins with injection.
• The new large-vein removal techniques are easy, comfortable and safe compared to the old style "stripping," which involved large incisions.
• Complications for these procedures if performed in the modern manner are exceedingly rare, but they can be serious in unusual cases.
• Patients frequently report relief of aching legs after either injection or surgery.

Vein surgery is one of the most common cosmetic procedures performed in the U.S. Nearly half a million individuals had vein surgery every year in the mid 1990s. As technology advances and the surgery becomes simpler and more risk-free, the numbers continue to increase.

The vast majority of people with vein problems are women, particularly those who've been pregnant. Veins get worse with second pregnancies, though we're really not sure why. Heredity, weight gain, and hormones all seem to play a role.

Until the last few years, the only option besides tight compression stockings for the treatment of unsightly and uncomfortable varicose veins was major surgery requiring general anesthesia, occasionally involving a hospital stay of several days. It was a big procedure, which involved making as many as ten incisions of one-half to one inch in length and vigorously removing the veins with large instruments. It was a brutal process compared to modern methods, and the recovery period was longer and more difficult. Patients were often advised to have extended bed rest, as severe bruising occurred and infections were more frequent.

In the last few years, however, new therapies have been developed. "Sclerotherapy," or injection therapy, vein therapy, is a minor procedure that is easily done in a physician's office and has become commonplace. Vein removal using new "hooking techniques" with tumescent anesthetic (please read about tumescent anesthetic in chapter 13) is a relatively minor procedure usually done in an outpatient surgical center. In either case, the patient is up and on her feet soon after the procedure. Sclerotherapy is most effective for smaller veins (less than one eighth of an inch in diameter), while hooking is used for larger veins. Scarring is minimal compared to the old procedure, although any incision can be unsightly. There are also new lasers which can be used on the tiniest of spider veins.

People seek help for vein problems when visual clues, such as bulging veins, brown pigment, "spider veins," and possibly even a firmer surface of the surrounding skin, indicate that the system isn't functioning properly. Veins carry the blood through the body and back to the heart. They have valves every inch or so, which keep the blood flowing in the proper direction. When these valves become defective, the blood is not conveyed back to the heart efficiently. Instead, the blood will "pool," usually in the legs because they're lowest and subjected to a long column of pressure. This can cause cosmetic problems — varicose and spider veins are not pretty. But in some cases, circulatory problems can occur, as well as aching legs. In the worst cases, circulation can be seriously affected and skin ulcers develop.

The beauty of vein treatments is that they can simply eliminate bad veins, which will then free the entire system to start running smoothly again. There are many, many extra veins, and the normal healthy ones simply take over when the bad ones are removed.