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Vein Services > Vein Basics
You may have reached this page via a link from another site where you might have seen a quoted success rate of 99.9% for eliminating varicose veins.
You are in the right place. We have indeed achieved the quoted success rate. And it has been achieved with no surgery, no scars, no downtime, and minimal discomfort.
If you have been told that you need surgery for your veins, keep reading, because virtually no one needs surgery any more.
If you have been undergoing treatments for your veins over and over through the years and they just don't want to go away, keep reading. When done properly (i.e. find the source of the problem with ultrasound and eliminate it first), you should get long-lasting results.
And that's as close as we get to giving you hype.
The rest of the information you are going to find here is solid science, delivered to you in language that is easily understood. If you still have questions when you have finished reading this page and the pages on spider vein treatment and varicose vein treatment, please feel free to email or call for more information.
But the best way to get comprehensive information is to come in for a consultation. There is no charge for consultations.
(If you just can't wait to find out how we achieve this kind of success with varicose vein therapy, here is the short answer. At York Vein and Laser Clinic you will be cared for by a doctor who is certified in vein treatments by the American Board of Phlebology. The first thing we do is map out your varicose veins using ultrasound. Then using a systematic approach, we start treating your veins by eliminating the source of the problem. We use lasers and foam sclerotherapy, two amazing innovations that began rapidly rising in popularity around the world in about 2002. And we use ultrasound at every visit to give us a clear picture of what we need to treat. The ultrasound also allows us to reach veins that could previously only be eliminated through surgery.) Questions and AnswersVeins are blood vessels that return blood to the heart. Arteries carry blood away from the heart. Blood moves in arteries because it is pumped by the heart. The pressure generated by the heart is lost as blood moves down the arteries into smaller and smaller channels, ending in capillaries. These capillaries are so small that red blood cells can only move through them in single file. On the far side of the capillary bed, the vessels join to form larger and larger vessels called veins.
There are two systems of veins in the legs, the deep venous system and the superficial venous system. The deep system lies within the muscles. This deep system is well-supported by the muscles of the legs and rarely causes problems. The superficial system lies just below the skin. It receives very little support from the skin, and it is therefore, prone to problems. It is in the superficial system that spider veins and varicose veins are found.
Back to topAs explained above, the pressure generated by the heart is lost in capillary beds, so veins have very little pressure. Because there is little pressure, there has to be a system for keeping the blood moving back to the heart. Therefore, veins contain a system of one-way valves. These valves allow blood to flow only toward the heart and prevent blood from flowing backwards.
In the legs, the pressure required to make blood move is generated by muscle contractions as you walk. The muscles squeeze veins of the deep system, and blood flows easily. Because of the valves, it can only move toward up the heart. About 80% of the pumping action for leg veins is produced in the calves. The feet and thighs each add another 10%.
In the superficial system muscle action does not squeeze veins, because the skin gives way. These veins depend on a system of perforators, veins that join the superficial veins to the deep veins. Blood moving in the deep veins helps to pull blood through the perforators to drain the superficial veins.
Back to topVaricose veins are veins in which blood no longer moves efficiently toward the heart. Blood in these veins actually flows away from the heart and back into the legs.
The formation of varicose veins probably starts with a weakness of the vein wall. This is most commonly inherited. When the vein wall weakens, it gives way under pressure and begins to dilate. Eventually, the vein dilates to a point at which the valve halves can no longer touch, and the valve fails to hold the blood above it. Blood backs up adding to the pressure and dilatation of the vein, causing valves up and down the vein to fail. Blood actually starts to flow backwards, down the vein and away from the heart. The vein bulges under the skin. This is a varicose vein.
The increased pressure in the varicose veins will also affect smaller vessels that feed into these varicose veins, and they will dilate. These smaller vessels are known as reticular veins, venulectasias, or telangiectasias (spider veins) depending on their size and location.
Back to topVaricose veins are an enormous problem. At any one time, 30-40% of the population has vein problems.
Back to topSex: females are about twice as likely to develop varicose veins as males (thank your hormones again!)
Pregnancy: weight gain, hormone changes, and pressure on the veins from the baby in the pelvis all contribute to varicose veins in pregnancy. Varicose veins that develop in pregnancy will often disappear following the birth. But if they're not gone 9 months later, they are probably permanent.
Heredity: almost all of our patients have a family history of vein problems. If you have one parent with varicose veins your risk is about 40%. If both parents have varicose veins your risk is about 90%.
(You can blame your mother for giving you varicose veins, but she'll blame you for giving them to her when she was pregnant with you!)
Age: varicose veins become more common with advancing age. In women about 30% of 30 year olds have vein problems, 40% of 40 year olds, 50% of 50 year olds, etc.
Sedentary lifestyle: if you are inactive or have a job that requires a lot of standing without being able to walk around, you are at higher risk of varicose veins. Teachers, hair dressers, and cashiers are at risk. The risk for mailmen is much lower.
Back to topBlood in varicose veins is moving backwards down into the legs instead of up toward the heart. This old blood is full of toxins* that are recycling through the legs instead of returning to the lungs, liver, and kidneys to be removed. These toxins cause problems as described in the next question.
* "Toxins", in medical terms, are by-products of metabolism. They include carbon dioxide, carbon monoxide, lactic acid, peroxides, nitrogenous substances like ammonia, and a lot more.
Back to topThere are four reasons people choose to treat varicose veins.
- They are unsightly.
- They can cause discomfort in the legs including itching, burning, aching, heaviness, fatigue, and restlessness (the result of backpressure and toxins). They sometimes cause swollen ankles and feet.
- Long-standing varicose veins can lead to thickened discoloured skin (from long term deposition of blood pigment) and leg ulcers (the result of toxins).
- People with varicose veins are more prone to blood clots in the legs. There are two kinds of blood clots: i) Superficial phlebitis is an inflamed vein just under the skin. It is warm, red, and extremely tender. This type of clot is very common in people with varicose veins, but really amounts to nothing more than a nuisance, because clots of this nature resolve spontaneously and rarely travel to the lungs. ii) on the other hand, deep vein thrombosis is very dangerous. As the name implies, these clots occur in the deep vein system. Because they are located in the muscles, rather than just beneath the skin, they are not as easy to detect as superficial phlebitis. And unlike superficial phlebitis, deep vein clots can break loose and travel to the lungs (pulmonary embolism). This is fatal in about 20% of cases. People with significant varicose veins are about nine times more prone to deep vein thrombosis than those without varicose veins.
Back to topSupport hose is very beneficial in relieving symptoms and slowing the progression of varicose veins. Hose also reduces the likelihood of complications of vein disease such as leg ulcers and blood clots.
Exercise and maintenance of healthy body weight are also beneficial.
Bioflavonoids found in yellow and orange fruits and vegetables, especially citrus fruits, increase venous tone and improve venous elasticity. Horse chestnut, taken internally or applied as a lotion, decreases capillary permeability and helps to reduce swelling.
The elimination of varicose veins is accomplished using three techniques: sclerotherapy, surgery, and laser treatments.
For several decades, varicose veins were treated either surgically or by sclerotherapy (injections). Both types of treatment have been fraught with complications, recurrences, and failures. However, since about 2001, technological advances have made the elimination of veins far more predictable and far less invasive.
SCLEROTHERAPY :
This safe and effective technique has stood the test of time, coming into common use in the 1920s. It involves the injection of various fluids into veins to kill them. These veins subsequently turn into scar tissue and disappear. Veins of all sizes can be treated in this way. The largest veins are treated using ultrasound-guided injections (echosclerotherapy). Ultrasound is used to guide a needle into leg veins that are too deep to see or feel. In the past, these veins could only be treated surgically (vein stripping). The success rate is very high. The recurrence rate is much lower than for surgery. The procedure is very safe, virtually painless, inexpensive, and involves minimal downtime. Please refer to our section on spider vein treatment and varicose vein treatment for in-depth information.
SURGERY :
Stripping of varicose veins has been done for decades. This procedure is only used to eliminate the largest veins (the greater saphenous and short saphenous veins). It requires a general anesthetic and results in painful wounds, a lot of bruising, and scars. The recurrence rate (development of new varicose veins) is 20-40%.
Ambulatory phlebectomy is a surgical technique that can be used to treat medium-sized veins. Under local anesthetic, several tiny incisions are made along the course of the vein, and it is extracted bit by bit through these tiny wounds. When it is done well, it is effective, mildly painful, leaves scars that are virtually invisible, and involves minimal downtime. Unfortunately, very few people know how to do this well. Most commonly, the incisions are too large and leave scars.
ENDOVENOUS TECHNIQUES :
As with stripping, this procedure is only used to eliminate the largest veins (the greater saphenous and in some cases the short saphenous veins). Under local anesthetic, a thin fiber-optic cable or wire is inserted into the vein. A laser beam (endovenous laser) or radio frequency signal (RF occlusion) is passed through, burning and closing the vein. It requires a lot of local anesthetic. The procedure is very safe, mildly painful, and involves minimal downtime. The success rate is 98-99%. The recurrence rate is about 5%. It costs $2,500-$3,000 for each leg.
This table summarizes the methods that are available to treat the largest superficial vein, the greater saphenous vein. This vein runs from the top of the foot all the way up to the groin.
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Surgery (Vein stripping) |
Ultrasound-based Foam Sclerotherapy |
Endovenous Laser or RFClosure |
| Downtime |
5-10 days
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4 hours
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4 hours
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| Pain |
lots
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Minimal
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mild
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| Success rate |
99+%
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99+%
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98-99%
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| Recurrence rate |
30-40%
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1-2%
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~5%
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| Anesthetic |
General
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Local or none
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Local (lots of it)
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| Cost |
OHIP (plus work loss)
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OHIP + medication fee
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$2,500-3000/treatment
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| Scars |
lots
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None
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None
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Back to topVaricose veins tend to get worse as time passes. One of the risk factors for varicose veins is age. Even if you have no other risk factors, you can't avoid this one. Basically, all our tissues wear out as we age. Veins are no exception. If you have varicose veins at the age of forty, those veins are more like 70 years old. Now imagine what they will be like when they really are 70 years old!
The second thing to consider is touched on in the question "Why should varicose veins be treated?" The secondary problems caused by varicose veins (eg. ulcers) get worse over time. So, even if your veins are already as big as they are going to get, leaving them alone gives them time to cause skin damage and give you a blood clot.
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