Great Basin Vein Specialists

What are varicose veins?

Varicose veins are enlarged veins that can be blue, red, or flesh colored. They are often raised above the skin on legs and look like twisted, bulging cords. Often misunderstood as a cosmetic issue, varicose veins can progress to CVI, which is a more serious condition.

What is CVI (Chronic Venous Insufficiency)?

CVI is a progressive medical condition in which the valves that carry blood from the legs to the heart no longer function, causing blood to pool in the legs and veins to swell. Healthy leg veins are designed to allow blood to flow against gravity from the legs back toward the heart. CVI occurs when stresses on the venous system like pregnancy, age, or standing for long periods of time weaken and stretch the vein, causing it to become weakened and diseased.

What are the signs and symptoms of CVI?

Without treatment, people with CVI may experience progressive symptoms that can be debilitating and significantly impact the quality of life. People who suffer from CVI may experience:

• Leg heaviness or tiredness
• Leg or ankle swelling
• Leg pain, aching, or cramping
• Varicose veins
• Skin changes or rashes
• Ulcers, open sores
• Itching, restless leg
• Brown, colored skin on leg

Who is at risk for CVI?

CVI can affect anyone. Gender and age are large factors that may increase a patient’s risk for developing the disease. For example, women older than 50 are more likely than others to develop venous disease that can lead to CVI. The disease is often hereditary and can affect several members of the same family.

The following factors may increase risk:

• Family history
• Gender
• Age
• Lack of exercise
• Prolonged sitting or standing
• Obesity or excess weight
• Smoking
• Current or previous pregnancies
• Leg injury or trauma

Can varicose vein and CVI be prevented?

For mild forms of venous disease, lifestyle changes may be recommended to control existing symptoms and prevent others. The following measures may help prevent varicose veins and CVI:

• Manage blood pressure and body weight
• Exercise regularly, focusing on exercise that works the legs (run or walk)
• Elevate legs whenever possible
• Avoid prolonged standing or sitting
• Avoid clothes that are tight around the waist, thighs, or legs
• Strengthen calf muscles and avoid shoes that limit use of calf muscles (i.e., high heels)
• Eat a diet low in salt and rich in high-fiber foods

Are spider veins the same as varicose veins?

Spider veins, which often cover the legs and even the face, are damaged veins that appear to be similar to varicose veins, only thinner. They may be red or blue and look like thin spiderwebs or branches. These veins are closer to the surface of the skin and can spread over a range of areas. Unlike varicose veins, spider veins are typically not raised above the skin’s surface. Spider veins can be treated with sclerotherapy or laser treatment. Though spider veins may be associated with varicose veins or CVI, the issue is seen as cosmetic and treatment is elective.

Can a patient get screened for CVI?

Screening for CVI is done through a simple, noninvasive ultrasound test conducted by a registered vascular technologist (RVT) or sonographer. The ultrasound test uses sound waves to measure the speed and blood flow through the vessels in the leg. This test is typically performed while a patient is standing and while they are lying flat on their back. The ultrasound test also produces an image of the vein structure, offering a vein specialist a visual of the veins, valve damage, and any vein obstructions that may be causing CVI. If the ultrasound confirms a patient has CVI, the specialist will discuss treatment options and help the patient identify the best fit for their lifestyle.

What are the treatment options for varicose veins and CVI?

Today, there are a number of available treatment options for CVI that are covered by many insurance plans. While conservative treatments like compression stockings are often first prescribed to manage symptoms, there are a variety of other therapies that can treat the underlying disease to eliminate varicose veins and halt the progression of CVI.

Endovenous thermal ablation

Endovenous thermal ablation is a minimally invasive treatment that involves the insertion of a thin, flexible tube called a catheter into a diseased vein to seal it shut using heat. Blood that would normally return to the heart through these veins will then travel through other veins instead, as is the intent with all treatments listed. The treated vein dries up, shrinks, and is absorbed by the body. Two types of thermal energy may be used:

• Radiofrequency ablation (RFA) uses radiofrequency energy to provide uniformly distributed heat to contract the collagen in the vein walls, causing them to collapse and seal off. An example of this treatment option is the ClosureFast™ RFA system.

Nonthermal treatments

Endovenous nonthermal treatments use a minimally invasive approach that involves insertion of a catheter into the diseased vein. With nonthermal methods, tumescent anesthesia is not needed.

• VenaSeal™ closure system is the only approved treatment that is nonthermal, non-tumescent, and non-sclerosant. It uses a proprietary cyanoacrylate adhesive delivered through a catheter into the diseased vessel. The VenaSeal procedure closes the vein by sealing it with a combination of the adhesive and external compression.
• Injectable foam sclerotherapy uses polidocanol injectable microfoam through a catheter inserted into the diseased vein to fill and collapse the vessel.