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Venous disease affects greater than half the U.S. adult population. Those who suffer from varicose veins know it is more than “just” a cosmetic problem. Varicose veins can cause significant leg pain or swelling that can impact your lifestyle or predispose you to the development of travel-related blood clots. My guest today is Dr. Saundra Spruiell. She is a Diplomat of the American Board of Venous & Lymphatic Medicine at the Center for Venous & Lymphatic Medicine with Greenville Health System. Dr. Spruiell, welcome & thank you for joining us today. Tell us, what are varicose veins?

DR. SPRUIELL: Varicose veins are large, bulging veins that are ropey or twisted. You can often see them protruding from someone’s leg. It’s actually possible to have a ropey or twisted vein under the skin that is only visible with an ultrasound machine.

HOST: How do I know if I have a varicose vein versus a spider vein?

DR. SPRUIELL: Many people confuse a varicose vein with a spider vein. A spider vein is the size of a thread. A varicose vein is usually larger than a pencil. It might be the size of your pinky finger or your thumb.

HOST: I understand. SIZE is the difference and varicose veins are usually pinky finger size or larger. What causes them, varicose veins?

DR. SPRUIELL: Varicose veins are caused by vein valves that don’t function properly. Normally, blood moves up the leg toward the heart with the help of one-way valves that prevent blood from backing down the leg when you stand. If the vein is not healthy, the valve is deformed and won’t close properly, so the blood flows backward or down the leg causing the vein to dilate or enlarge eventually becoming ropey and tortuous.

HOST: You mention having Varicose Veins is a common health problem. Just how common is it and why is it important?

DR. SPRUIELL: If we look at the breakdown, close to 25% of adults in the US have varicose veins. If we add spider veins that # grows to 80%. This means having abnormally functioning leg veins is extremely common. In fact, it is 10 X more common than PAD or peripheral arterial disease and 6 X more common that CAD or coronary artery disease. Women are affected more than men 3:1 and all age groups are affected. Children can have varicose veins as part of congenital vascular problems, women at risk develop them related to pregnancy and men tend to develop them after age 40 or related to sports trauma. WHY IMPORTANT? Simple reason, the symptoms are a slow erosion to your quality of life.

HOST: Dr. Spruiell, you just shared that 25% of us have problematic varicose veins. That means if we had 4 people in the room, one of us would have bulging leg veins! Who is at risk…how do people know if they are at risk?

DR. SPRUIELL: Turn to your parents and grandparents. This is a GENETIC illness. If both of your parents have varicose veins or even spider veins, you’re risk of having vein problems is 90%. If only one parent is affected, the risk is 47% …so, nearly 50%. If neither parent is affected, your risk is still high, approximately 20%. …Or…, said another way, we might divide the causes into 2 groups: primary and secondary causes. With primary causes being things like heredity, hormones and pregnancy and secondary causes being obesity, trauma and gravity, e.g. jobs that involve prolonged standing or sitting.(Factory workers, nurses, teachers). Also, we sometime see varicose veins develop after deep vein thrombosis.

HOST: Before we all rush home to look at our parents or grandparents legs, tell us, what are they symptoms of vein problems?

DR. SPRUIELL: When vein blood runs down the leg and pools in the legs it will make them hurt. Typical types of pain are Leg heaviness, leg tiredness, legs that ache or throb. Abnormal veins can sting, itch, or burn if they are becoming inflamed. In addition, the calves or ankles may swell.

HOST: If a listener has symptoms what should they do?

DR. SPRUIELL: The first thing I would do is call the Center for Venous & Lymphatic Medicine for an appointment at 454-8346 (VEIN). It is not necessary to have a doctor referral but if you do seek referral from your doctor, ask them to give you a prescription for gradient compression stockings. These are woven in a way that prevents so much vein blood from accumulating in the lower leg and they will make your legs feel better. Start a daily walking program of 30 continuous minutes or an alternative calf pumping exercise; elevate the legs intermittently throughout the day, avoid standing or sitting in one spot for > 1.5 hours. Get up, move around 5 min out of every hour or 10 min out of every 2 hours. If you are overweight, start a healthful weight loss program.

HOST: Dr. Spruiell, what about the creams and supplements we see on television and the internet reported to help vein problems? Are these things actually helpful?

DR. SPRUIELL: As far as the creams are concerned, absolutely not. There is no such thing as a “vanishing vein cream”. Regarding oral SUPPLEMENTS, some of these are beneficial. Many vein supplements have been well researched with proven benefit and proven safety. By well researched, I mean the most desirable type of research, Randomized Double-blinded Placebo Controlled trials. Only two of the beneficial supplements are available to us in the US: Diosmin/hesperidin and horse chestnut seed extract. Most people can take them without side effects or drug interactions. The exceptions are do not take them if you are pregnant, trying to get pregnant, breast feeding or on a blood thinner.

HOST: If someone calls the Center for Venous & Lymphatic Medicine, what can they expect from a consultation visit?

DR. SPRUIELL: The consultation visit consists of an analysis of your symptoms, a physical exam and typically a diagnostic step is arranged. The diagnostic step is a venous ultrasound that looks for reflux or backward flowing blood in the leg veins. It extracts a lot of detail about the diseased veins and is more involved than leg ultrasounds that look for blood clots. The consultations are of course performed by our physicians or physician assistant.

HOST: Once the diagnosis of varicose veins or venous reflux is made, how is the problem treated?

DR. SPRUIELL: Treatment is always divided into 2 categories: Treating conservatively or without procedures and treating with procedures.

Treating without procedures aka conservative treatment, we have already touched on: wearing gradient compression stockings, elevating the legs as needed, daily walking program, weight loss, use of vein supplements (venotonics, rhutosides , phlebotonics)

Procedural treatment depends on which and what type of veins are abnormal. We very rarely strip veins anymore. Vein stripping has been replaced by newer, kinder, gentler techniques that can be performed in the office. A patient does not have to be placed in the hospital under sedation or stay overnight. Laser fibers can be placed inside main abnormal veins or saphenous veins to use heat to seal them closed. There is an adaptation of surgical glue that can be placed inside abnormal saphenous veins and used to seal the vein. These two, laser called Endovenous Laser Treatment and glue, called Venaseal, are performed on main superficial veins that are straight. If the veins are twisty and ropey, they can be injected, called sclerotherapy, or they can sometimes be gently teased from underneath the skin through multiple small incisions. It is usually a combination of techniques that makes veins close or go away. It takes several months. So, it is always a good idea to seek consultation in late summer and early fall to have the legs looking and feeling healthy by spring or summer.

HOST: Varicose veins causing leg pain, especially in people who spend long days on their feet or long days sitting, is a common health problem. There are procedural and nonprocedural ways to treat them. How do I know if I am someone who should seek treatment?

DR. SPRUIELL: If you have prominent or abnormal appearing leg veins and symptoms, you should seek an evaluation. The symptoms again are: heavy, achy, throbbing, tired legs with or without swelling. VV that itch, sting or burn. Also, look for signs. Some signs of vein problems are discoloration or bronzing of the lower calf and ankle, development of venous wounds or ulcers, scaly patches of leg skin called venous eczema or the development of superficial vein clots. If you have any of these things you are at risk for the symptoms or signs to become worse if left untreated. In fact, 20% of patients with painful varicose veins go on to develop venous leg ulcers. Through treatment, the progression of the disease can be slowed and symptoms can be eradicated.

HOST: Is treatment safe? Is it okay to close off abnormal leg veins?

DR. SPRUIELL: Treatment is safe, as I said earlier, the procedures are office-based. Most of them take < an hour to perform. There is no need for general anesthesia. After most procedures, you are required to walk 30 minutes later in the day. You are also required to wear compression stockings for several weeks after vein treatments. And, yes, it is okay to close veins that do not function normally. There are times that we purposefully spare some veins in spite of them being abnormal because they can still be used for other medical purposes. Any vein doctor who is certified in Venous & Lymphatic Medicine will know this.

HOST: Are there any special precautions people with varicose veins need to take when they travel?

DR. SPRUIELL: Yes, XXXX, there are. If you have the condition that causes varicose veins, venous insufficiency, you are considered to be at a low, increased risk to develop travel-related deep vein thrombosis. This is also known as economy class or coach class thrombosis syndrome. The recipe for developing a blood clot is: have a varicose vein, be in a setting where you cannot move around … for most of us this is a car or an air plane trip of > 1.5 hours in length…and become dehydrated. In this setting, blood clots can develop. They may initially develop as a clot in the varicosity and can progress to include deep veins. Those at risk can Prevent travel-related blood clots by: wearing compression stockings during travel, walk 10 minutes out of every 2 hours during travel and stay well-hydrated.

HOST: Dr. Spruiell, we are running out of time. I’m sure our audience would like to know if insurance covers vein problems.

DR. SPRUIELL: Most insurance carriers understand varicose veins can significantly hurt or cause leg swelling which can negatively impact the quality of life, cause missed days at work, or cause disease progression to the point of developing painful venous ulcers. In most instances, the treatment of varicose veins is covered by medical insurance.

HOST: To conclude, can you give us your best advice? So many people suffer from varicose veins. Women after pregnancy, men in their 40’s, 50’s, 60’s, 70’s start to notice them. Please give us your best advice about those suffering from varicose veins and what they should do about them.

DR SPRUIELL: My advice is times have changed. It is time to step out of the dark ages when it comes to recognizing & treating vein problems. You don’t have to “just live with it” any more. Realize that stepping out of the dark ages means that many doctors aren’t aware of venous disease, how prevalent it is and the problems it creates for patients. As a result, painful varicose veins are sometimes ignored. This does not have to happen. Don’t hesitate to seek treatment from a physician certified in venous and lymphatic medicine. You will find the expertise to guide you in a diagnostic evaluation and to the proper care – FOR YOU. You will have much better satisfaction with your life if you are not living with daily discomfort and pain in your legs. So, please seek medical advice and know that we, at the Center for Venous & Lymphatic Medicine, are available to help you.