Mount Auburn Healthcare Connection

Learn More:

• Related Links
• Quiz

Varicose veins are one of the most common chronic conditions found in women, affecting up to 72 percent by the time they reach age 70. Varicose veins can also be found in men and younger women as well, especially women who have recently given birth. For many, varicose veins are primarily a cosmetic concern; however, for others these veins can cause great pain or lead to a more serious health concern.

A varicose vein is a twisted, bulging, enlarged vein found mainly in the lower leg or foot. They protrude from the leg or foot and are blue or purple in color. Frank Vittimberga, M.D., chief of vascular surgery at Mount Auburn Hospital in Cambridge, a teaching hospital of Harvard Medical School, says there are several reasons why veins can become varicose; the main reason is a valve malfunction, or backflow of blood toward the feet.

Arteries carry blood away from the heart and veins bring blood back to it. Veins carry blood in one direction – up to the heart. Veins in the legs and feet must work against gravity to get blood where it needs to go. It’s the job of the valves to make sure blood keeps flowing up to the heart. When our leg muscles are in motion, the valves are open allowing blood to flow. Sitting or standing for long periods of time means our muscles aren’t contracting and the valves stay closed; that causes blood to pool or flow back toward the feet.

Dr. Vittimberga says varicose veins can also be the result of a congenital defect, hormonal changes or for reasons unknown.

Pregnancy can trigger varicose veins because of hormonal changes and also because there is more blood circulating through the body with a decreasing amount of blood flow from the legs to the pelvis.

“The presence alone of varicose veins does not warrant medical treatment,” says Dr. Vittimberga. “But these varicose veins can produce conditions that are extremely serious.” Varicose veins can lead to blood clots. He suggests seeking medical attention if: the veins cause pain or discomfort; your legs feel heavy; the skin around the vein changes color or there is inflammation; ulcers appear on the skin. An ulcer is an open sore in the surface of the skin that exposes bare nerve endings. The bigger the ulcer, the more pain a person will feel.

Patients must first undergo a thorough examination to determine if, in fact, the varicose veins are causing pain or whether they are associated with problems in the other veins. This requires an ultrasound. “An ultrasound determines the competency of the valves in the veins – whether they are working properly or not,” explains Dr. Vittimberga.

There are several methods used to treat varicose veins, ranging from surgical to non-surgical methods. An elastic compression stocking is a common non-surgical treatment option. The stocking increases pressure in the legs and feet, allowing blood to flow freely to the heart. This, in turn, helps to control the size of veins.

A minimally invasive procedure called Radiofrequency Ablation uses heat sent from a radiofrequency wave and applies it to the inside wall of the varicose vein. Heat causes the vein to essentially close down and is no longer functional. This same technique can also be performed with a laser; however, Dr. Vittimberga says using a laser is sometimes more risky, because it can apply excessive heat to the skin, depending on the amount of fat tissue near the vein.

Injection therapy is a non-surgical treatment option that also closes off veins. This therapy is reserved primarily for smaller veins and spider veins. Spider veins are much smaller than varicose veins and are not as likely to lead to a serious vein disorder.

“Along with the elimination of veins, we will also frequently perform a procedure called stab avulsion. Stab avulsion is the removal of veins through several tiny incisions. These incisions are so small, they do not need to be sutured,” says Dr. Vittimberga.

Side effects to procedures are generally very minimal and patients go home immediately afterwards. Dr. Vittimberga advises patients to stay off their feet or limit walking to a minimum for two days. Patients must have another ultrasound to ensure the closure procedure was indeed effective and that there is no clotting in the deep vein system.

So what can you do to prevent unsightly varicose veins in your legs? Dr. Vittimberga suggests, “Get up and move around, especially if you mostly sit or stand at your job.” Walking and running help to prevent stasis, or the lack of movement in the blood. Regular exercise will also help in weight management. People who are overweight also have circulation problems, which may lead to varicose veins or other venous disease complications.

For a free Mount Auburn Hospital physician directory, please call us at 617-499-5094.