Frequently asked questions

Q. What are varicose veins?
A. Varicose veins are dilated, twisted veins in the legs, usually caused by small leaking valves(think of a water fall causing a stream).

Q. How do I get varicose veins?
A. Family history, pregnancy, obesity, and standing on feet without moving around and injury play important roles.

Q. Do varicose veins cause any problems?
A. At the beginning they are only of cosmetic concern, but later on they can cause clotting (phlebitis), bleeding, ulcers and severe skin changes (dermatitis).

Q. What is complete stripping?
A. Complete stripping means pulling varicose veins out through multiple incisions from groin to ankle. It leaves permanent scars, and could cause permanent numbness in the legs or feet. It usually sacrifices an important vein in the leg called the saphenous vein. This is the vein needed for future bypasses in the heart and legs. Cosmetically, it is unacceptable to most patients.

Q. What does a true varicose vein look like in contrast?
A. Varicose veins are larger, twisted and more prominent than normal veins. Quite frequently, they are associated with many spider veins.

Q. What causes varicose veins?
A. Leaking valves (perforators). These valves could be anywhere from the groin down to the ankle. It is crucial to identify and seal these leaking valves as well. There are about 80-90 perforators in each leg.

Q. What causes this leaking?
A. These so called perforators have tiny invisible one way valves within them. If any of these valves do not function properly, blood flows backwards, from the big veins to the small veins. This gradually increases pressure in the small veins, making them larger and twisted. Anytime varicose veins are treated, whether by surgery (which is called complete stripping) or by any other method, the leaks have to be identified and controlled. Many patients who have undergone many strippings of their varicose veins, these incompetent perforators have not been controlled.

Q. What is complete stripping?
A. Patients who undergo complete stripping usually require major anesthesia. Many incisions are made in the leg, and the veins are taken out. This includes a very important vein, called the long saphenous vein, which is a vein from the groin down to the ankle on the inside of the leg. Every attempt has to be made to preserve this vein if possible for future bypass surgeries in the heart or the legs.

Q. Is stripping a cure for varicose veins?
A. Not at all. The chance of recurrence is quite high after stripping. I see a few hundred patients every year who have undergone 1-4 strippings in the past, and they have recurrence of varicose veins in the same leg. Obviously, these are not the old veins which were removed. The reason for the recurrence is that the leaks (incompetent valves) have not been controlled during surgery.

Q. Why are women more likely to get varicose veins than men?
A. About 90% of patients are women. Heredity and pregnancy are the two most important factors. Pregnancy causes pressure in the pelvic region resulting in leaking (incompetent) valves.

Q. Is obesity a factor?
A. Yes, just like pregnancy, any factor that increases pressure in the veins could result in formation of varicose veins and spider veins.

Q. Is it always important to seek treatment for varicose veins?
A. Although, initially the concern is cosmetic in nature but almost invariably these varicose veins enlarge and can cause complications. Symptoms like cramps, aching, and heaviness in the legs are frequent complaints. Later on serious complications, such as ulcers, clotting, and bleeding, could occur some of which are potentially life threatening.

Spiders
Great majority of spiders arise from varicose veins. This does not mean that a patient with many spiders should have the big, bulging veins in the leg. Many of these varicose veins are quite small and have to be checked under good lighting with the legs elevated. A frequent example is spiders on the outside of the thighs which usually arise from tiny varicose veins coming from the back of the knee. To get rid of most spiders effectively, one has to close these tiny varicose veins and the responsible leak, otherwise the spiders will soon come back. Same rule applies if laser is selected for the treatment.