How Significant Are Those Unsightly Leg Veins


By Dr. Kimberly Moskowitz, MD

In the fourth century B.C., Hippocrates, the Father of Medicine, believed that ”…the veins alone contained blood destined for the body’s nourishment…”. It took three centuries to disprove his exaggerated dogma. It has taken nearly a century to re-prove how important our veins really are.

As the heart beats 72 times each minute in the average human being, the blood flows continuously in a circle and never stops until we die. As the arteries deliver oxygen-rich blood to our body, the veins serve as the conduit for returning this blood from the skin and tissues back to the heart. One system without the other is obsolete. Why then do so many physicians and patients perpetuate the belief that abnormal veins, varicose and spider veins, are merely a nuisance cosmetic complaint?

Abnormal leg veins affect over 80 million adults in the United States alone. There is no single cause; however, predisposing factors include heredity, female gender, pregnancy, and occupations requiring prolonged standing. Vein disorders range in severity from trivial telangiectasias to life-threatening blood clots such as deep vein thrombosis and pulmonary emboli. At least 50% of people that seek treatment do so because of symptoms such as leg pain, aching, swelling, or discomfort. Varicose veins have a well-proven association with venous hypertension which, if untreated, can lead to abnormal skin discoloration, ulcers, phlebitis (inflammation of the veins), bleeding, and dangerous blood clots.

Diagnosing and treating abnormal veins early, before complications arise, is now the standard of practice. 25% of people who appear to have only spider veins, actually have more serious underlying disease. Because of this, a duplex ultrasound exam of the leg veins is necessary to diagnose underlying problems and guide proper intervention. During the past few years, intervention has rapidly shifted from traumatic surgical stripping and ligation to minimally invasive procedures such as EVLT (Endovenous Laser Treatment), sclerotherapy and foam sclerotherapy. Since its FDA approval in 2002, tens of thousands of EVLT procedures have been performed throughout the world. This minimally invasive, non-surgical procedure is performed as an outpatient in about 30- 40 minutes and patients return to normal activities the next day. As the abnormal veins close, the body re-directs blood flow to normal veins in the leg resulting in improved circulation and symptoms. EVLT has quickly become mainstream, as it has a success rate of 98-99% compared with a 30-40% recurrence rate of surgical stripping.

Sclerotherapy, injection of a solution into abnormal veins using a very tiny needle, is the treatment of choice for smaller varicose and spider veins. 85% of patients treated for spider veins and varicose veins report relief of symptoms and improved cosmetic appearance. Today’s hot topic in treating varicose veins is called foam sclerotherapy. Visible with ultrasound, the foam is injected into the abnormal vein, where it acts like a sponge, displacing the blood. The foam, acts strongly on the vein wall to obliterate the abnormal channels.

The field of Phlebology is exploding as we have replaced traumatic surgical stripping with tiny laser fibers and injectable solutions. We have come so far in two thousand years. Of varicose veins, Hippocrates said, in 460 BC, “…what cannot be cured by the knife is cured by the searing iron, whatever this cannot cure must be considered incurable.” Centuries of research has not been in vain.





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