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Unsightly veins may appear or worsen with the birth of your baby, but even before delivery you can minimize the damage. by Heshmat Majlessi, MD, F.I.C.S., F.A.C.S.
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Interview with Dr. Majlessi
New York Times Article, Sunday April 7, 1996
Beyond the Cosmetics in Varicose Veins

It is estimated that as many as 50 million people in the United States have varicose veins, 90 percent of whom are women. To many, these twisted, discolored veins are just a cosmetic problem or something that causes a little discomfort. But all varicose veins have the potential for serious complications and, therefore, should be examined by a specialist, said Dr. H. Majlessi, a vascular surgeon who heads the Rye Vein - Laser Center in Rye and the Park Avenue Vein Center in Manhattan.

Dr. Majlessi is a member of the American and British Phlebology Societies and adapted his techniques of treating varicose veins from Dr. George Fegan of England, a pioneer in the field. He is skeptical of common methods of treating varicose veins because, he said, they do not usually cure the problem but just treat the symptoms.

Here are excerpts from a recent conversation with Dr. Majlessi.

Q. What are varicose veins and why are they more than a cosmetic problem?
A. Varicose veins are normal veins that have become much more dilated and twisted. They become very unsightly at the beginning. Then they develop their complications. This starts as swelling, heaviness and cramps in the legs and could progress into phlebitis, which is formation of clots in the legs, ulcers, and bleeding. There are other complications as well, which can be disabling and cause about $2 billion in annual health care costs to the U.S. economy. Another result is a change in the color of the skin, which is called dermatitis.

Q. Is it only in the legs, or one can get varicose veins in other parts of the body?
A. You could have them in other places, but over 99 percent of them are in the legs because of the gravity due to standing.

Q. If a person sees a little bit of a protrusion from a vein, is that necessarily a varicose vein?
A. Not necessarily. In thin, active people, normal veins can enlarge without truly being a varicose vein. They should be left intact.

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 spiders.

Q. What causes Varicose veins?
A. Leaking valves. These valves could be anywhere from the groin down to the ankle. It is crucial to identify and seal these leaking valves as well.

Q. What causes this leaking?
A. There are hundreds of connecting veins in the lower extremities. These veins contain a very smalll valve. Any time any of these valves does not do its job properly, blood flows backward, from the big veins to the small veins. This gradually puts pressure on the small veins, making them larger and twisted. Any time that varicose veins are treated, whether by surgery - which is called stripping - or by my method, the leak or leaks have to be identified and controlled. And that's what the drawback of stripping is. It usually does not find and control the leaks.

Q. What is stripping?
A. The patient goes to the hospital under a major anesthesia usually; many cuts are made in the leg, between 10 to 40 or 50, and the veins are taken out. This includes a very important vein called the saphenous vein, a long vein from the groin down to the ankle on the inside. This vein in the leg has to be preserved for possible future bypass surgeries in the heart and the lower extremities. In majority of patients most of this vein can be preserved without actually sacrificing it.

Q. Is stripping a cure for varicose veins?
A. Not at all. The chance of recurrence is great. I see about 300 to 400 patients a year who have had one or more strippings. They have recurrence of varicose veins in the same leg. Obviously, these are not the old veins, because those were taken out. It's because the leak in the valve has not been found in the leg or the thigh or the back of the knee. A treatment that has been done by dermatologists is sclerotherapy. This is good for the spider-size veins - it basically closes them -but not for the larger varicose veins. It makes sense that when you get a treatment you cure the condition. You don't want the patient to come back to your office with the same problem. In order to accomplish that, the doctor should have the expertise to not only treat the large varicose veins but to find the source- and close the source as well.

Q. Why are women more likely to get varicose veins than men?
A. About 90 percent of the cases are in women, and these are mainly due to two factors: heredity and pregnancy. If your mom, grandma, sisters or aunts had varicose veins, it increases the chance that you could have varicose veins. Pregnancy causes pressure in the pelvic area and a lot of patients develop varicose veins during pregnancy.

Q. Is obesity a factor?
A. Yes, any factor that increases pressure in the veins, such as straining and weight lifting can theoretically increase pressure in the vein.

Q. Is it always important for people to seek treatment for varicose veins?
A. At certain stages, varicose veins are only cosmetically important. But almost invariably the veins enlarge, and could result in complications. Symptoms like cramps, aching, and heaviness in the legs are frequent complaints. Treatment is performed to improve cosmetic appearance of the leg, and also to relieve symptoms.

Excerpts taken from article in the Sunday New York Times, April 7, 1996