American Medical Association Family Medical Guide - American Medical Association [358]
Locating varicose veins
To find the damaged valves that are causing your varicose veins, your doctor will apply a tourniquet to your leg to stop the flow of blood through the vein while you are lying down. If a valve is damaged in a section of the vein directly below the tourniquet, blood will leak back through the valve when you stand up, making the vein clearly visible through the skin. To detect other damaged valves in veins, the doctor repeats the procedure by moving the tourniquet to various points down your leg.
Surgery is usually the most effective treatment for varicose veins that are causing symptoms. The most common type of surgery involves removing the affected veins from the leg in a procedure called stripping. After the damaged veins are removed, the remaining small veins quickly enlarge and take over the work of the damaged veins. For surgery to remove varicose veins, a person usually receives epidural anesthesia (see page 532). The procedure may be performed in an outpatient facility, or you may need to stay overnight in the hospital.
For the stripping procedure, the surgeon makes an incision about 2 inches long at the top of the inner thigh and a similar incision at the ankle to expose part of the affected vein. He or she also makes several very tiny incisions down the leg where branches of the main vein go deeper into the leg. The branches are then cut and tied to stop them from bleeding. The surgeon inserts a flexible wire (with a hook at the tip) into the incision at the ankle and passes it through the main vein to the thigh. As the surgeon withdraws the wire, the hook pulls the vein from beneath the skin. At the same time, the doctor or nurse bandages the leg tightly to prevent bleeding. The procedure usually takes about 30 minutes per leg.
An alternative to stripping is a procedure called sclerotherapy, in which a small amount of an irritant solution is injected directly into the damaged veins. The solution causes the walls of the veins to become inflamed and stick together, effectively blocking blood flow. Healthy veins nearby then take over the work of the treated veins. This procedure is usually performed in two or three visits to an outpatient facility or a doctor’s office. Sclerotherapy is usually not effective on varicose veins in the thighs. Doctors often recommend stripping the veins first and treating any minor recurrences with sclerotherapy. New varicose veins may develop elsewhere after either treatment.
Sclerotherapy
Sclerotherapy is a nonsurgical treatment for varicose veins in which a doctor injects a small amount of an irritant solution directly into a damaged vein, closing it off to blood flow. The blood then reroutes itself through healthy veins nearby. Treatment is usually completed in two or three visits to an outpatient facility or a doctor’s office.
After undergoing stripping or sclerotherapy, you will need to wear support stockings for about 6 weeks. Your doctor will recommend that you walk as much as possible, avoid standing for long periods, and frequently sit with your legs elevated above the level of your chest.
Spider Veins
Spider veins are very tiny veins that are visible under the skin of the thighs and legs. Although they may be unsightly, spider veins do not cause any health problems. Cosmetic laser treatments or chemical injections can make spider veins less visible, but these procedures may not produce permanent results.
Thrombophlebitis
Phlebitis is inflammation of a vein, usually caused by infection or injury. When phlebitis occurs, blood flow through the roughened, swollen vein may become sluggish, encouraging blood clots (thrombi) to develop and adhere to the walls