The Veining of Youth

Cresting the 30-year mark means entering a whole new world of self-care. A slowing metabolism makes it much more difficult to work off extra calories. Hair sprouts in unseemly places and, for many, varicose veins begin to make an appearance.

By some estimates, these gnarled, vine-like veins bulge along the legs of 40 percent of women and 25 percent of men. They are most common in people between the ages of 30 and 70 — and once they appear, the problem tends to slowly worsen over time if they aren’t treated.

Varicose veins can be embarrassing and inhibiting, but the potential problems they pose go well beyond the cosmetic. These veins are often painful. They are known to cause inflammation, external ulcers, blood clots, and bleeding.

Varicose veins are caused by a malfunction called venous reflux disease. Normally, a healthy vein’s valves open and close to push blood into the heart. In people who have venous reflux disease, however, the valves no longer open and close properly, instead of allowing blood to flow backward into the legs. Varicose veins become more prominent and often more painful as increasing amounts of excess blood pool in the leg veins.

They occur for many reasons, but perhaps the most common factor is heredity. Other reasons some people develop this affliction include age, gender, pregnancy, obesity, physical trauma, and standing for long periods.

Endovenous laser treatment, a new, minimally invasive therapy, treats varicose veins using a quick, relatively pain-free procedure. A thin laser fiber is guided by ultrasound into the great saphenous vein — a large vein that runs the length of the leg from groin to foot. The laser renders the vein inactive by gently heating and closing it. Once the vein is closed, venous reflux no longer occurs, and blood is simply rerouted to healthy veins. Without a source of blood, the varicose vein essentially disappears from sight.

Dr. Tod Engelhardt, a cardiovascular surgeon at the Heart, Lung, and Vascular Institute at East Jefferson General Hospital, says, “The procedure takes about 45 minutes under local anesthesia. Patients can get up and walk on a treadmill before getting discharged and can even go back to work that day if they choose.”

Although there are no harmful side effects associated with endovenous laser treatment, Dr. Engelhardt does offer one caveat. “The vein that is being ablated is the same one used as the major source of graft material in cardiovascular surgery. Once the vein is ablated, it is no longer viable for grafting. This becomes a problem if a patient needs cardiac bypass surgery three years down the road. I will not ablate the vein for anyone with a history of cardiac disease if the vein can be used for bypass later.” He advises all patients with a history of heart disease to approach varicose vein removal with caution.

For many people, however, this technique is a welcome option to surgical ligation or vein stripping and radiofrequency electrosurgery. The success rate for endovenous laser treatment is as high as 98 percent — better than other, more invasive options.

The smaller but still noticeable varicose veins that branch off the great saphenous vein can also be resolved with a simple, minimally invasive procedure called ambulatory phlebectomy. Kerri MacDonald, a registered nurse with the Heart, Lung and Vascular Institute explains, “We can treat those veins by using a local anesthetic on the problem area. The doctor will mark the dilated veins and remove them through tiny incisions.” The incisions are so small that no stitches are required, decreasing the likelihood of scarring and improving the cosmetic outcomes.

Recovery following either of these techniques is relatively simple. It usually takes a couple of weeks and requires patients to wear compression hosiery and take an over-the-counter pain reliever if they experience any discomfort.

“Patients come in with obvious, lumpy varicose veins, and when they come back in a few weeks, the veins are all unnoticeable,” MacDonald says. “The results are really remarkable.”