Causes, prevention and treatment of varicose veins by Dr. Jack Shellito at the Via Christi Women's Connection July Luncheon.

1. You're (not) so vein:
Causes, prevention and
treatment of varicose veins
Women's Connection Luncheon
Dr. Jack Shellito, MD, RPVI
July 10, 2012

2. Acropolis in
Greece
5th Century B.C.

3. Anatomic Drawings of Leonardo Da Vinci

4. What are Spider Veins and
Varicose Veins?

5. Spider Veins
and Varicose Veins
 Telangiectasias (“Spider Veins”)
 Venulectasias
 Reticular Veins
 Varicose Veins

7. Telangiectasias
<1mm Diameter (“Spider Veins”)

8. Reticular Veins
1-3 mm (“Blue Veins”
“Venulectasias”)

9. Varicose Veins-
Subcutaneous Dilated Veins >3mm Diameter

10. What Causes Varicose and
Spider Veins?

11. Normal Vein
Valve Function

14. Incompetent Vein Valves With
Varicose Veins

17. How Common are
Abnormal Leg Veins?

18. Venous Disease —
Scope of the Problem
 Vein Problems seen in
50-55% of females
 40-45% of males
 Varicose veins present in 1 out of 2
people age 50 and older

20. What Are The Risk Factors For
Varicose and Spider Veins?

21. Risk Factors for Developing
Varicose or Spider Veins
 Family members with vein problems
 Increasing age
 Hormonal changes
 Puberty
 BCP’s
 Hormonal Replacement
 Pregnancy
 Obesity
 Leg injury
 Prolonged standing (weakens valves)
 Sun exposure (spider veins)

22. Why do Varicose and Spider
Veins Usually Appear
in the Legs?

23. Gravitational Pressure Can Overwhelm Vein’s One-Way Valves

24. Are Varicose and Spider
Veins Painful or
Dangerous?

25. Spider and Varicose Veins
Spider vv usually do not need medical
treatment. But varicose vv usually enlarge
and worsen over time.
Severe varicose veins can cause health
problems including:
 Blood clots
 Sores or skin ulcers
 Ongoing swelling and skin
irritation/rashes

26. Eczematous Skin Changes

27. Pigmentation

28. Pigmentation

29. Active Venous Ulcer

30. What are the Symptoms
of Varicose Veins?

31. Common Symptoms of
Varicose Veins
 Aching pain
 Easily tired legs
 Leg heaviness/fatigue
 Leg swelling
 Darkening of the skin
 Numbness in legs
 Itching
 Irritated rash in legs
 Night cramps
 Restless legs
 Bleeding/skin breakdown

32. How Can I Prevent
Varicose and Spider Veins?

33. Prevention/Symptom Relief
of Venous Disease
 Wear sunscreen (prevents spider
veins)
 Exercise to improve leg strength,
circulation, and vein strength
 Control weight to reduce the
pressure on your legs
 Elevate your legs when resting as
much as possible

34. Prevention/Symptom Relief
of Venous Disease (cont.)
 Do not stand/sit for prolonged periods of
time. Stand up and move around every
30 minutes
 Wear elastic support stockings
 Eat a low salt diet to reduce swelling
 Eat a high fiber diet to reduce
constipation

35. Should I See a Doctor
About My Varicose Veins?

36. See a Physician
About Your Varicose Veins If:
 The veins become swollen, red, tender,
or warm to the touch
 There are sores/rashes on the leg or
near the ankle with the varicose veins
 You have bothersome symptoms as
described above

37. How Are Varicose
and Spider Veins Treated?

38. Closure of Varicose Veins
With Laser Fiber Inside Vein
(Endovenous)

39. Endovenous Laser Closure
of Varicose Veins
 Treatment for larger varicose veins of legs
(saphenous veins)
 Successful in 98% of patients
 Performed in-office
 Well tolerated with local anesthesia
 Fewer complications with avoidance of general
anesthesia
 Has replaced old procedure of ligation and
stripping of varicose veins

43. Laser Endovenous Ablation

44. Endovenous Laser Procedure

45. Endovenous Laser Treatment-
Video

46. Postoperative
Endovenous Laser Treatment
 Dress leg with compression bandage
 Walk for 20 minutes
 Compression stocking for 2–4 weeks
 Resume normal activities
 Anti-inflammatories for 2–4 weeks
 Over-the-counter pain medications
(Ibuprofen)

47. Great Saphenous Vein
Pre-Treatment
Pre-Treatment 1 WkWeek Post Treatment
One Post-EVLT

48. Small Saphenous Vein
Pre-Treatment 1 Wk Post-EVLT
Pre-Treatment One Week Post Treatment

49. Advantages of Endovenous Laser
Treatment of Varicose Veins
 Lower treatment costs compared to surgery
 Minimal scarring
 Minimal down time
 Faster return to normal activity
 Excellent symptom relief
 Vein closure maintained with long term
follow-up

50. Sclerotherapy for Spider
Veins

51. Injection Sclerotherapy
for Spider Veins
 Office procedure, no anesthesia
 Physician injects solution (Polidocanol)
into vein that causes vein walls to swell,
stick together, and seal shut
 Same vein may need to be treated more
than once
 Most patients can expect 50-75%
improvement
 Out-of-Pocket expense

55. Topical Laser Therapy
for Spider Veins

56. Topical Laser Sclerotherapy
for Spider Veins
 Topical laser beam sends burst of light
through skin into vein to make vein slowly
fade and disappear
 No needles, but heat from laser on skin
can be painful
 2-5 treatments/site generally needed
 Not effective for veins > ¼ inch diameter
 Out-of-Pocket expense

57. Combined Topical Laser and Cooling Unit

58. Topical Laser Sclerotherapy
Before After

59. You’re (Not So) Vein —
Conclusions
 Venous disease is an epidemic in the U.S.
 Most is inherited (don’t say your parents never
gave you anything)
 Treat smaller (spider) veins with topical laser
or sclerotherapy (out-of-pocket expense)
 Treat larger (varicose) veins with endovenous
laser (usually covered by insurance for
patients with symptoms)

60. Thank You For Your
Kind Attention!
Questions?