Causes of Varicose, Spider, and Reticular Veins

The main purpose of veins is to return blood from your body to your heart, so blood can be recirculated. Healthy veins have one-way valves that keep blood travelling in the direction towards the heart. For reasons that we don’t know the valves can fail. This usually occurs in the legs. This in turn allows for sluggish circulation in the involved veins. This leads to internal pressure and swelling, which causes the noticeably enlarged usually blue or red coloured veins at the skin surface.

While the direct cause of varicose veins is uncertain and anyone is at risk of developing them, there are certain factors that seem to increase this risk.  

These risk factors include:  

• Family history of varicose veins and/or blood clots
• Pregnancy can result in enlarged veins in your legs partially due to an increase in the volume of blood in your body  
• Obesity or being overweight can place added pressure on your veins
• Standing or sitting for prolonged periods. As your blood doesn’t flow as well if you’re in the same position for a long period of time.  
• Women are also more likely to develop varicose, reticular or spider
• Ageing.

Prevention:

It is hard to completely prevent varicose veins. But in order to reduce the risk it is important to improve your circulation and muscle tone. The same methods that you take to treat the discomfort caused by varicose veins can be applied to help prevent them. This includes: – exercising – maintaining a healthy weight – eating a high-fiber, low salt diet – avoiding high heels and tight hosiery – elevating your legs, and alternating you sitting or standing position regularly.

Signs and symptoms to look out for:

• Pain
• Ache
• Restless legs
• Itching
• “Heavy” legs
• Ankle swelling
• Skin discolouration
• Ulcers

In comparison to varicose veins, spider veins are smaller. They are found closer to the surface of the skin and are often red or blue in colour. They get their name Spider veins because they often look like a spider’s web.  

Which specialist do I see?

The causes and forms of varicose veins varies from person to person, therefore, it is important to seek uation from a vein specialist.

At Specialist Vein Care, Dr Ivor Berman (link) is a Phlebologist (Vein specialist) and Radiologist, who provides state of the art techniques in the diagnosis and treatment of vein disease, including Varicose, Reticular and Spider veins.  

Treatments

It is worth considering booking an appointment with Specialised Vein Care when self-care techniques such as exercise, lifting your legs while sitting and/or wearing compression stockings have not worked or even for aesthetic improvement.

We offer different treatments depending on your diagnosis, such as Endovenous Laser Ablation (EVLA), Ambulatory Phlebectomy (AP), Ultrasound Guided Sclerotherapy (UGS),Glue(Cyanoacrylate), Microsclerotherapy and Conservative treatment. (links)

To make an appointment today to have your venous disease assessed by Dr Berman, please phone (03) 9561 5155.

The post What causes Varicose, Spider, and Reticular Veins? first appeared on Specialist Vein Care.

So which treatment is more effective and are varicose veins curable without surgery?

The short answer to the second question is that treatment of varicose veins by any method is one of “control” rather than cure, as no method of therapy can prevent the natural history of vein disease which is that of recurrence. In answer to the first question, the results with the non-surgical methods should give anyone with varicose vein disease confidence as discussed below.

The American Venous Forum and the Society for Vascular Surgery as well as the European Society for Vascular Surgery recommend that non-surgical methods of venous therapy including endovenous thermal ablation and ultrasound guided sclerotherapy are recommended over surgical treatment. Up until recently studies have shown no significant difference in the long term recurrence of varicose veins. However recent studies have shown a better long term outcome with reduced recurrence with the non-surgical treatment options.

In addition, there is no doubt that the non-surgical methods are preferred due to lower complications including reduced rates of nerve damage, infection and haematoma, reduced discomfort post procedure and with faster return to normal activities, work and sport. One of the questions that is generally asked is whether treating the affected area will lead to an emergence of the problem elsewhere. The short answer to that is no. New veins may develop over time, however we are uncertain as to its cause and this is not preventable. This can occur irrespective of the method of therapy.

There is also a level of misinformation about the success of non-invasive varicose vein treatment for those with severe varicose vein disease. In other words; that the non-invasive methods of treatment are only valuable or possible in those with minor disease. This is absolutely incorrect. The non-surgical methods are effective irrespective of the severity of the disease. It is actually the opposite. Non-surgical means are not only as effective as surgery for severe disease but it is also recommended for minor disease that would not be readily treated by surgery.

A specialist physician working in this area has a number non-invasive varicose vein procedures on the table as part of any treatment plan and these are tailored to the patient’s individual needs. I strongly believe that people should take control of their own health and obtain as much information as possible to make an informed decision as to the best way to treat their individual problem. Although there is no miracle cure or treatment for varicose veins the best way of treating varicose vein disease is becoming clear with the current non- surgical methods being just as good and likely better than the traditional methods and in addition with far less complications and a much quicker return to normal activities.

At Specialist Vein Care, Dr. Ivor Berman and his staff are specialists in the diagnosis and treatment of vein disease, utilising minimally invasive procedures. We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155.

The post Are Varicose Veins Curable Without Surgery? first appeared on Specialist Vein Care.

There are three main reasons as to why varicose veins come back again after treatment. These include:

1. The incorrect veins were treated or not all veins that required therapy were treated.
2. The right veins were treated but with incorrect techniques.
3. New varicose veins form over time.

Let’s look at these three reasons in more detail.

 The incorrect veins were treated or not all veins that required therapy were treated.

 It is imperative that when uating somebody with varicose veins that a duplex ultrasound is performed. We need to know which veins are involved before the correct treatment can be performed.

The bulging veins that are seen at the skin surface are typically just the “tip of the iceberg”.

This scan should be performed by a person experienced in performing venous ultrasound otherwise there is the potential that veins that are a significant part of the problem may not be recognised and therefore not treated.

These scans take time.  If your scan took just a few minutes then it would not be surprising that some important contributing veins would be missed and not treated leading to suboptimal outcomes.  Wrong veins could be treated and those that should be treated – missed!

Scans should take 15-20 minutes, or even longer, per leg, especially if there is significant disease.

The right veins were treated but with incorrect techniques

 The type of treatment performed depends on the size and distribution of veins.  There are many techniques available to treat veins.

This inevitably leads to 2 separate issues:

The first is variation in cost. With so many techniques and devices available, it is not surprising that there is a wide discrepancy in what an individual may be charged by different practitioners or even the same practitioner.

The second is the correct choice of technique employed in a particular patient (every patient has to be assessed for their individual needs).

This is where the expertise and experience counts; choosing the correct method of treatment in a particular patient.

Surgical approach, endovenous laser ablation, ultrasound guided foam sclerotherapy, ambulatory phlebectomy or micro-sclerotherapy could be performed, alone or in combination; this will depend on many factors, including vein distribution and size, patients age, background medical disease and outcome from previous therapies.

It is therefore very important that one does research when choosing a person to treat your veins. Choose someone who has the experience and is well recognised in vein therapy management, so one can achieve the best possible outcome. This may not necessarily be the cheapest option.

New varicose veins form over time. This is the most common reason.

The natural history of vein disease is that new valveless veins develop over time. Family history/genetics is the most common reason that this occurs. Neo-vascularisation – This term means that tiny veins grow over time. The body is programmed to grow these new veins. The cause for this is not known. In addition, some patients have more than one site from where the veins originate, this not being evident at time of treatment.

Of course poor or suboptimal / incomplete treatment and removal of existing varicose veins that then continue to grow/enlarge can occur.

People create significant varicose veins after treatment is variable, but usually in the order of 4-5% per year.

What can I do as a patient to help?

There is a limitation to what an individual person can do to limit recurrence. The best one can do is as follows:

1. Maintain healthy weight
2. Regular exercise
3. Don’t smoke
4. Avid excessive periods of standing
5. Wear compression stockings/socks if necessary

If you have venous disease but are unsure whether these are of any clinical significance or if you have spider vein disease that worry you, please give us a call and organise an appointment.

We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 95615155

The post Can one avoid recurrent Varicose Veins? first appeared on Specialist Vein Care.

The post A Current Affair – Non Surgical Management of Varicose Veins first appeared on Specialist Vein Care.

I sometimes get questioned as to why this is necessary and so important.

The reason is that management of the venous disease depends on identifying abnormal aspects to the vein disease not able to be seen at the skin surface and responsible for the clinical or cosmetically visual problem. A person can and not uncommonly does have classic signs and symptoms of venous disease with no visible abnormality at the skin surface. The only way to accurately determine the cause of a person’s problem and the best treatment methods are by performing an ultrasound duplex scan.

Also multiple different patterns of incompetent vein disease can result in a similar appearance of abnormalities at the surface.

If vein reflux is identified and contributory to spider vein disease, then in order to get a good outcome this needs to be treated either before or in conjunction with treatment of the spider veins.Treatment decisions based solely upon clinical uations are often fraught with errors and often accounts for unsuccessful outcomes.

Therefore, it is imperative that all patients undergoing uation for lower extremity varicose or spider vein disease undergo an ultrasound study of the superficial venous system to determine the pattern or patterns of incompetence prior to making any treatment recommendations.

The goals of the ultrasound examination is to identify all incompetent truncal and other veins and to determine whether they are responsible for the patient’s clinical problem.

The ultrasound examination should be performed with the patient either near vertical or in the standing position. Generally, the examination begins at the saphenofemoral junction (SFJ) at the groin, and proceeds down to the ankle.  A relatively standard protocol exists to ensure all relevant veins are examined. In addition to reflux, the truncal veins are measured as this has implications towards method of therapy. We also simultaneously examine the deep venous system as again this has implications with respect to treatment and outcomes. As the above examination takes time to perform, usually 30-60 minutes are required (one or two legs) to get an accurate complete picture

Ideally this should be performed by an expert vascular sonographer to ensure accuracy of the scan.  We regularly have to repeat scans at our practice due to inadequate or incorrect studies performed elsewhere.

If you have venous disease but are unsure whether these are of any clinical significance or if you have spider vein disease that worry you, please give us a call and organise an appointment.

We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155

The post Why is it important to perform a duplex scan in a patient with venous disease ? first appeared on Specialist Vein Care.

Although they may not necessarily require treatment they are indicative of an abnormality of the circulatory system. The issue with vein disease is that there is sluggish flow within these veins causing local issues. Varicose veins are not always visible, sometimes the disease is deep seated and symptoms develop where there is little to see visually. Symptoms of vein disease are a sign that there is more serious disease that may require therapy.

Signs or symptoms which may indicate that you have venous disease include the following:

• Pain in the legs.
• Heaviness in the legs.
• Leg aching and muscle cramps.
• Exercise intolerance
• Bursting pain the calf after exercise.
• Burning sensation calf, night cramps.
• Itchiness in the legs.
• Leg rash.
• Swelling in the ankles.
• Tightness in the legs.
• Restlessness in the legs.
• Bulging veins.

Patient’s often experience relief of symptoms when walking or elevating their legs.

If minor these signs and symptoms are often ignored.However it may be worth having an assessment and discussing whether any of your issues are vein related and whether this requires any treatment.

At Specialist Vein Care, Dr. Ivor Berman and his staff are specialists in the diagnosis and treatment of vein disease, utilising minimally invasive procedures.  We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155.

The post Early Signs of Vein Disease first appeared on Specialist Vein Care.

General

Sclerotherapy remains the gold standard for treating the venous disease of small to moderate size. This includes small varicose veins and spider veins. Sclerotherapy involves an injection of a solution directly into the vein. There are three major solutions that are used in Australia in the treatment of venous disease. These include hypertonic saline, aethoxysklerol and sodium tetradecyl sulphate. Which one is used depends on a particular practitioner’s preference as well as the size of the veins.The solutions work by the solution irritating the lining of the blood vessel, causing it to collapse down and stick together, effectively turning the vein into a “bruise” that one’s body slowly resorbs over time.

Sclerotherapy has a long history dating back to the 1930s. The methods of treatment therefore have a long history with respect to best practice, outcomes and known complications.

Importantly, there are no known long term side effects of sclerotherapy.

For the vast majority of patients this treatment is generally extremely well tolerated and safe with minimal side effects or complications.Like any treatment available sclerotherapy is not without potential complications.

uation and Experience

For the best outcomes and to limit complications as much as possible, prior to any therapy one should be properly assessed by the treating practitioner.

This typically involves a consultation as well as an ultrasound to uate and map the varicose vein disease. Even if one has spider veins. It is most useful to perform an ultrasound to exclude and characterise any underlying and contributing venous vein disease.From this, a personalised treatment plan can be discussed and planned.

Probably the biggest “complication” of therapy is the failure to achieve the desired clinical outcome and adequately removing the spider veins or much less commonly the larger reticular and varicose veins. About 10% of patients who have their spider veins treated fail to get the result they desire. We do not yet understand why some patients are more resistant to treatment than others and it is not possible to predict this prior to commencing therapy.

Usually if I treat a patient with a particular solution and fail to get a great response I would switch to another solution. Why in a particular person one type of solution would work better than another is not known and again cannot be determined prior to starting any given treatment.

As there are complications even in the best most experienced hands, it is important that this treatment is performed by someone trained and experienced in vein therapy. Someone who knows what treatment is best in your particular case and is best able to limit the risk of complications and is able to recognise them and know how to manage them if they occur.

Temporary Side Effects of Sclerotherapy – these can be expected during /post treatment.

These are minor and well-tolerated and do not occur in every patient.

• Mild itching at the injection site which can last for one or two days after the procedure.
• Bruising may also occur around the injection site and can last from several days to a couple of weeks.
• Mild discomfort during the injection which last for a few seconds. Larger veins this can last up to a minute or two.
• Red, raised areas at the injection sites. These are similar to hives, and should disappear within a day or so.
• “Trapped blood” – Larger veins that have been injected may become lumpy and hard and may require several months to dissolve and fade. If these are present and annoying the patient, the treating practitioner will often drain these using a small needle. This is not dangerous and will resolve.

Other side-effects / complications of therapy include:

• Brown lines or spots may appear along a treated vein. On average this occurs in about 10% of patients with varicose veins. This usually settles over three to six months, but they may also last indefinitely. This occurs with all forms of therapy.
• Matting. This is the development of new, tiny blood vessels which may occur at the site of sclerotherapy treatment. This is thought to be an inflammatory response. This occurs not just with venous therapy but can occur with any kind of trauma to the skin. These tiny veins can appear days or weeks after the procedure, but often fade within three to twelve months without further treatment. This can even look like a small bruise.
• Inflammation. This is usually mild but may cause swelling, warmth and discomfort around the injection site. This is usually self-limiting but may require treatment such as anti inflammatories, ice and compression.
• Deep vein thrombosis. This is extremely uncommon.
• Allergic reaction. It’s possible that you may have an allergic reaction to the solution injected, however this is rare
• Skin ulcers. These are very small and fortunately are rare. Most occur within 2 weeks of injection. They heal slowly and may leave a small pale scar.
• Visual disturbance – this is a rare complication (about 1%) for patients undergoing foam sclerotherapy. Patients experience a sparkling appearance in their vision which resolves spontaneously after about 15 minutes.
• Transient stroke has been reported. This is very rare.
• Intra-arterial injection. This is an extremely uncommon complication, which may result in muscle and skin damage.

If you have venous disease but are unsure whether these are of any clinical significance or if you have spider vein disease that worry you, please give us a call and organise an appointment.

We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155

The post Is Sclerotherapy safe ? first appeared on Specialist Vein Care.

The good news is that in most people varicose veins are unlikely to ever cause them harm and that treatment is not essential !

For those who need or want treatment, a variety of non-surgical options are available.

It is important that people undergoing therapy understand that veins recur.Treatment really, irrespective of method is control not necessarily cure.I regularly hear the following: “I had my veins treated but they have come back”.This is both correct and incorrect. Veins that are removed are gone. There are new veins, yes, but these are not the same ones. What is happening is that over time, and commonly, new varicose veins grow.We do not know the reason for this.I often tell my patients that “One cannot treat veins that have not developed as yet”.

On average it is about 7 years between having ones veins treated and them returning to a similar degree.

So the best thing to do after vein therapy is to have an early follow up at 3-6 months and then 1-2 yearly, so that if treatment becomes necessary, the treatment is much easier and less involved. In other words keeping them at bay.

There is little one can do to prevent the recurrence of veins.It is also not possible to predict who is more likely to redevelop varicose and/or spider veins or when.

Patients for whom discomfort is the main problem can wear support stockings or compression socks. Elevation of the legs may relieve symptoms.General advice includes: Regular exercise – however there is no real supportive evidence that this helps.Keeping ones weight under control may reduce symptoms but be aware that excessive weight loss can make ones veins more visible!

Of course if veins are of concern from a cosmetic point of view they can be treated regardless of whether they are producing any symptoms.

There are published guidelines re the management of venous disease. These are the NICE guidelines as stated below: Timing of treatment ranges from routine to urgent. If one has a bleeding varicosity this requires immediate attention. If a varicosity has bled or is likely to bleed again, this should ideally be treated in the next few days/week. If there is an ulcer, treatment should be planned in the near future. These ulcers tend not to heal unless the underlying venous disease is attended too. Routine, means that the veins should be treated but this can be is something that be planned at a convenient time.

Referral guidance for varicose veins from the National Institute for Health and Clinical Excellence (NICE)

Emergency—Bleeding from a varicosity that has eroded the skin

Urgent—Varicosity that has bled and is at risk of bleeding again

Soon—Ulcer that is progressive or painful despite treatment

Routine—

Active or healed ulcer or progressive skin changes that may benefit from surgery

Recurrent superficial thrombophlebitis

Troublesome symptoms attributable to varicose veins, or patient and doctor feel that the extent, site, and size of varicosities are having a severe impact on quality of life

Also worth noting the following:

People are often reluctant or nervous to seek treatment as they do not wish for an operation or have heard about unpleasant experiences form others. Treatment these days is restively non-invasive and well tolerated with little if any downtime.

It one has concerns it is worth exploring. One does not necessarily require therapy and may just need reassurance. If treatment is warranted the individual situation can be assessed and discussed. Mostly fears about treatment are inappropriate and can be allayed by explanation and reassurance

Also remember that leg pain can be due to other reasons such as referred pain from the back. Careful history and examination will usually sort this out.

At Specialist Vein Care, Dr. Ivor Berman and his staff are specialists in the diagnosis and treatment of vein disease, utilising minimally invasive procedures.  We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155.

The post What should people with varicose veins know? first appeared on Specialist Vein Care.

In the product information provided for both STS and POL it state: “it is not known whether (STS or POL) is excreted into human milk…. Use in lactations is not recommended (STS)… Caution should be exercised when used in nursing mothers (POL).” The half-life for POL is 4h and that of STS is unknown.

These drugs have been available for more than 50 years. There is no evidence that these drugs have any effect on a baby, however there is no conclusive evidence regarding their safety.

These drugs are quickly metabolized by the liver and excreted by the kidney, so it is safe to resume breast feeding very soon after treatment.  Weiss recommends waiting for a period of 4-6hrs after treatment before breast feeding (Weiss RA, Feied MA, Weiss MA. Vein Diagnosis and Treatment: a comprehensive approach, USA: McGraw-Hill, 2001; p165).

Hypertonic saline is a less commonly used sclerosing agent, but it is completely safe to use during breast feeding.

I usually tell my patients to express before treatment and have enough available for a couple of feeds.

It is also worth mentioning here the timing of therapy post partum. It is generally accepted to wait about three months post partum as there is often regression of venous disease during this period as well as the regression of risk of deep vein thrombosis towards baseline.

At Specialist Vein care we are experts in the management of venous disease.If you have any concern, then please let us help!

Please give us a call and make an appointment.We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155

The post Breast Feeding and Sclerotherapy first appeared on Specialist Vein Care.

Natural remedies that are often associated with the management of vein   disease include the following:

• Bilberry,
• Gotu Kola
• Horse Chestnut
• Butcher’s Broom
• Gingko
• Bacopa
• Grape Seed
• Silica and Calcium Fluoride

Topical remedies include:

• Apple cider vinegar (ACV)
• Witch hazel
• Lemon essential oil
• Mustard oil

Diet tips for varicose veins:

• Increase foods which contain high concentrations of Oligomeric Procyanidins (OPC’s) such as apple, pear, and grapes, and in chocolate and tea.

OPCs in nutritional supplements are generally extracted from grape seeds or pine bark.

• Reduce salt and sugar
• Anti-oxidant rich foods –  e.g. blueberries, green tea, grapes, berries, pineapples,
• Foods that stimulate circulation – e.g. chilli, garlic, ginger and onions.

I would advise that if you are considering using any of the herbal supplements above (or any other) that you please don’t forget to consult with your doctor to ensure that they don’t interfere with any medications that you are currently taking or cause any unexpected health problem in your particular circumstance.

In addition it may be useful to talk to a naturopath to obtain advice on what would work best in your particular situation.

However, overall there is little that one can do to limit the development of venous disease.

Until more evidence is gathered, the non-surgical means of vein treatment including injection sclerotherapy and endovenous laser ablation remain the most successful and proven methods of removing varicose veins and spider veins. 

If you have venous disease but are unsure whether these are of any clinical significance or if you have spider vein disease that worry you, please give us a call and organise an appointment.

We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.

To make an appointment today to have your venous disease assessed by Dr Berman, please phone 9561 5155

The post Creams, Vitamins & Minerals and Herbal Remedies for Vein disease – Do they actually work? first appeared on Specialist Vein Care.