Vein Basics:

You Don't Need Surgery!

Now you can treat varicose veins 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 surgery is rapidly becoming a thing of the past. It has been supplanted by foam sclerotherapy and endovenous laser.
 
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
 
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 and advice that is specific to your condition is to come in for a consultation. There is no charge for consultations. You do not need a referral from your family doctor.

(If you just can't wait to find out how we achieve high success rates 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 Venous Medicine and the Canadian Society of Phlebology. The first thing we do is map out your varicose veins using ultrasound with the most important aspect of this being to identify the source of the problem. Then using a systematic approach, we treat your veins starting at the source. We primarily use endovenous laser 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 treated with surgery.)
 

 

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*Results may vary.

Questions and Answers

 

What are veins?

Veins 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. It does most of the work of draining blood from the legs. 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.

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What makes the blood move through veins?

As 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 way to keep 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 up toward 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 connecting veins called perforators that join the superficial veins to the deep veins. Blood moving in the deep veins basically sucks blood through the perforators to drain the superficial veins.

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What are varicose veins?

Varicose 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 so far that the valves pull apart, and they fail 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.

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How common are varicose veins?

Varicose veins are an enormous problem. At any one time, 30-40% of the population has vein problems.

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What are the risk factors for developing varicose veins?

Sex: 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. If they haven't diappeared 9 months later, they probably won't ever go away. Vein problems tend to get worse with each pregnancy.

Heredity: almost all of vein 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.

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Are varicose veins bad for you?

Blood 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.

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Why should varicose veins be treated?

There are four reasons people choose to treat varicose veins:

1) They are unsightly.

2)
They can cause discomfort in the legs including itching, burning, aching, heaviness, fatigue, cramps, and restlessness (the result of backpressure and toxins). They sometimes cause swollen ankles.

3)
Long-standing varicose veins can lead to thickened discoloured skin (from long term deposition of blood pigment and other factors) and leg ulcers (from toxins and other factors).

4)
People with varicose veins are more prone to blood clots in the legs. There are two kinds of blood clots:

i) Superficial venous thrombosis 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. It is less dangerous than deep vein clots (see next paragraph).

ii) The second type of blood clot is deep vein thrombosis. This 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. Deep vein clots can break loose and travel to the lungs (pulmonary embolism). This is fatal in about 20% of cases. 

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What can be done for varicose veins?

Support hose (aka graduated compression stockings) 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 a 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 treatment of varicose veins involves 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 2002, technological advances have made the treatment of veins far more predictable and far less invasive.

SURGERY :

Stripping of varicose veins has been done for several decades, but it is rarely offered now. It has almost completely been replaced by less invasive techniques. This procedure is only used to treat the largest veins (the greater saphenous and short saphenous veins). Under general anesthetic, an incision is made in the groin and just below the knee, and the vein is located. A wire is passed through the length of the vein, and it is used to pull the vein out. This surgical procedure results in painful wounds, one to three weeks of downtime, a lot of bruising, and scars. The recurrence rate (development of new varicose veins) is about 25% within 3 years. OHIP stopped paying for stripping in 2012 unless you have complictions of vein disease like leg ulcers.

Microphlebectomy is a minor 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. No sutures are required. 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, require sutures, and leave noticeable scars.

SCLEROTHERAPY :

This 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) and foam, a revolutionary innovation in sclerotherapy that came on the scene in about 2002. 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 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.

ENDOVENOUS TECHNIQUES :

This procedure is only used to treat the largest veins (the greater saphenous and in some cases the short saphenous veins). Under local anesthetic, a thin optical fiber or RF catheter is inserted into the vein. A laser beam (endovenous laser) or radio frequency signal (RF occlusion) is passed through, burning and closing the vein. The procedure is very safe, mildly painful, and involves minimal or no downtime. 

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.

 

 

Surgery (Vein stripping) Ultrasound-based Foam Sclerotherapy Endovenous Laser or RFClosure
Downtime

7-20 days

None

None

Pain

lots

Minimal

Minimal

Success rate* 

99+%***

99+%***

99+%***

Recurrence rate**

25%***

25% on average***

(lower for small veins, higher for large veins)

2-5%***

Anesthetic

General

Local or none

Local

Cost

OHIP (plus work loss)

As of 2012 OHIP only covers stripping in certain situations.

OHIP + medication fee for veins over 5mm

$2,500-3000/treatment

Scars

Lots

None

Minimal

* Succes rate is the per centage of veins that close immediately after treatment

** Recurrence rate is the per centage of veins that come back within a few years

***van den Bos et al, JVS 2009;49:230-39

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What will happen if I just leave my varicose veins alone?

Varicose 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 40, those veins are more like 70 years old. They have weakened before their time. 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 more likely 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 or give you a blood clot.
 
The bottom line is: fix your varicose veins early! Don't wait until they are big or they are causing complications!
 
 
 
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