If you suffer from varicose veins, you’re a member of a very large club. Some 25 million Americans face a daily struggle with the swollen, ropey veins that can cause throbbing pain, severe swelling, and heavy, tired legs.
Half of all Americans over 50, and two-thirds of women over 60, have the condition. And many have dealt with it for decades, because varicose veins can appear even in teenagers too young to vote.
Heredity is a factor in venous reflux disease – if your parents or siblings have had varicose veins, you’re more likely to develop them – and people who are obese or have had multiple pregnancies are particularly susceptible, because the extra weight adds strain to the veins. Women are more vulnerable to the problem than men, partly because the hormonal changes brought on by menstruation, menopause and hormone-based drug therapy can relax vein walls and cause venous reflux.
Your lifestyle, particularly physical activity, can affect your odds of developing varicose veins as well. People whose careers require them to stand in place for long periods of time – nurses, teachers, waitresses, flight attendants and other service personnel, for example – have a higher-than-average risk of venous disease. So do people who do a good deal of heavy lifting.
Once it appears, venous reflux disease never goes away by itself – it’s a progressive condition that can only worsen unless treated. Fortunately, the minimally-invasive, device-based advances in medical technology that have so profoundly impacted heart, lung and brain surgery in recent years are now having a similarly revolutionary impact on the treatment of varicose veins. The next-generation VNUS ClosureFAST™ catheter represents the cutting edge of that technology.
What is Venous Reflux Disease?Venous reflux disease, also known as venous insufficiency, is a medical condition affecting the circulation of blood in the lower extremities. The tiny valves that normally force blood back up towards the heart no longer function, causing blood to pool up in the legs, and the veins of the legs become distended.
Venous reflux disease commonly produces varicose veins, the abnormally swollen and discolored superficial leg veins that affect more than 25 million Americans. Varicose veins can range from small, thin purple lines just under the skin (known as “spider veins”) to thick, bulging veins that can protrude well beyond the skin surface. In any form, varicose veins serve as indicators of venous reflux, a progressive disease that can cause significant circulatory problems as it worsens.
Common Symptoms Of Venous RefluxIn the absence of other symptoms, patients with cosmetic concerns due to the presence of varicose veins might be evaluated with only a physical examination. However, patients presenting with other symptoms of venous insufficiency, such as those listed below, should also undergo an in-depth evaluation, including a duplex ultrasound study.
- Leg pain, aching, tired or weak legs, especially after long periods of standing or sitting
- Varicose veins
- Burning or itching of the skin
- Swollen legs and/or swollen ankles (edema)
- Color and texture changes of the skin
- Open wounds (skin ulcers)
Varicose veins are most often swollen, gnarled veins that most frequently occur in the legs, ankles and feet. They are produced by a condition known as venous insufficiency or venous reflux, in which blood circulating through the lower limbs does not properly return to the heart but instead pools up in the distended veins.
More than 25 million Americans suffer from venous reflux disease. The symptoms can include pain and fatigue in the legs, swollen ankles and calves, burning or itching skin, skin discoloration and leg ulcers. In less severe cases, thin, discolored vessels – “spider veins” – may be the only symptom.
Gender and age are two primary risk factors in the development of venous reflux. An estimated 72% of American women and 42% of men will experience varicose veins symptoms by the time they reach their sixties. Women who have been pregnant more than once and people who are obese, have a family history of varicose veins or spend a great deal of time standing have an elevated risk for the condition, but it can occur in almost anyone at almost any age. Varicose veins never go away without treatment and frequently progress and worsen over time.
Severe varicose veins can have a significant impact on the lives of people who work on their feet – nurses, teachers, flight attendants et al. Research has shown that more than two million workdays are lost each year in the US, and annual expenditures for treatment total $1.4 billion.
Varicose veins are typically found in the superficial venous system and often involve the main trunk veins - the great and small saphenous veins - as well as tributaries.
Varicose veins are superficial veins that have expanded in response to increased pressure caused by incompetent or absent valves. Progressive vein dilation eventually prevents the valve cusps from closing properly resulting in reflux. Alternatively, a lack of competent valves can also cause dilation of the vein. As one valve fails, increasing pressure is exerted on each more distal valve until it, too, becomes incompetent. Diameters of varicose veins can range from 3 mm to > 8 mm.2
What are Spider Veins?
Spider veins, also known medically as telangiectasia or venulectasias, are the mildest manifestation of venous insufficiency, similar to varicose veins but smaller. They are small, often tangled groups of tiny blood vessels just under the skin surface that frequently resemble spider webs or tree branches. They are generally red, blue or purple and are clearly visible, usually on the thighs, lower legs and face. Spider veins can sometimes cover large areas of skin, but they are a cosmetic problem only, rarely causing physical symptoms. At least a third of all women and a smaller percentage of men are believed to display the condition.
Spider veins are capillaries, thin vessels directly connected with the larger venous system, and like varicose veins they are caused by venous reflux. Spider veins may be isolated or associated with "feeder" veins or with larger underlying varicose veins, but they are not varicose veins – they do not bulge above the skin surface and do not require medical treatment.
Spider veins can be diagnosed merely by sight. They tend to take on one of three characteristic patterns – a "sunburst" or spider-web pattern radiating outward from a central point, a "tree-branch" pattern, or a "matting" or linear pattern that may be nothing more than a set of thin lines. Even in the absence of physical discomfort, some physicians observing spider veins prefer to conduct ultrasound exams to determine the extent of the problem and the underlying causes of the condition.
Risk factors for spider veins are similar to those for varicose veins – age, heredity, pregnancy, hormonal changes, obesity and extended periods of standing – as well as sun exposure, particularly in fair-skinned people, and injuries to the skin surface. Some physicians believe that exercise, weight loss and the wearing of support hose and flat shoes instead of high heels can reduce the incidence of spider veins.
Treatment of Venous Insufficiency
The VNUS Closure procedure is a minimally invasive treatment alternative with less pain and less bruising when compared to traditional vein stripping surgery and laser treatment. Using the Closure system, physicians close the diseased veins by inserting the Closure catheter into a vein and heating the vein wall using temperature-controlled RF energy. Heating the vein wall causes collagen in the wall to shrink and the vein to close. After the vein is sealed shut, blood then naturally reroutes to healthy veins.
The Closure procedure provides the following benefits for patients and physicians:
Venous reflux or venous insufficiency develops when the valves that usually keep blood flowing out of your legs become damaged or diseased.
- Minimally Invasive Outpatient Procedure. Closure catheters are inserted into the vein via a tiny incision in the lower leg, eliminating the need for groin surgery and general anesthesia. The Closure procedure can be performed using local anesthesia in a physician’s office, as well as in an outpatient hospital setting or surgicenter.
- Clinically Proven Less Post-Operative Pain. The Closure procedure does not involve pulling the diseased vein from the thigh as with vein stripping surgery, or using 700° C laser energy which boils blood to occlude a vein as with endovenous laser (EVL)12. In the RECOVERY Trial, a multi-center head-to-head comparative randomized trial comparing the Closure procedure with EVL, the Closure procedure was found to have less patient pain and less patient bruising than EVL for the best patient recovery experience available from a minimally invasive vein treatment.10 Additionally, in other randomized comparative studies have shown that patients receiving the Closure procedure return to normal activity and work significantly faster than those receiving vein stripping.3
- Excellent Clinical Outcomes. The ClosureFAST catheter, which represents the latest advancement in the Closure procedure, has been shown in a multi-center study to have a 97.4 efficacy rate at one-year.11 This shows that the treatment is highly effective and, as proven in the RECOVERY trial, is gentle on the patient.10
- Cosmetically Appealing. Because treatment with Closure is minimally invasive and is catheter-based, it results in little to no scarring. As with any medical procedure, you are encouraged to review all safety information associated with the procedure by consulting your physician.