Transcript of live web chat: Varicose veins, spider veins and more

Readers: Today’s health chat topic is on veins — varicose and spider and more.

Our expert today is Susan Hancock, of the Hancock Vein and Surgical Center in Newport News. She can answer your questions about vein problems and how to treat them.
Susan — Please let our readers know when you’re online and ready.

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We’re just waiting for our expert, Dr. Susan Hancock, to finish up with a patient and then she’ll be with us.

hello i am here

Today’s topic is on VEINS — ask your questions now.

do they cause you any pain or discomfort?

Let’s assume that they don’t cause her pain but she just wants to look good.

I’ll bet that there are lots of people like Janice.

Yes, often the blue or purple lines represent spider veins that viewed as a cosmetic problem by most. If you don’t have aching legs, you likely don’t have a deeper problem…. although people ofte dismiss tired and heavy legs as part of older age, so I often review this with patients when talking about spider veins.

So, what can you do for spider veins?

Spider veins without an underlying problem are typically addressed with sclerotherapy, a technique whereby a chemical is injected into the spider veins that over times causes them to collapse. The process takes weeks to months and often more than one treatment is necessary determined by the extent of the problem. It is important to realize that wearing compression stockings after sclerotherapy helps ensure the best outcome.

Also, before you answer other questions, could you tell our readers what causes spider veins and also varicose veins. What are they? Are they dangerous to your health?

Is it saline that’s injected or something else?

The short answer is…. varicose veins and spider veins both have a significant hereditary component. They are both caused by increased venous pressure in the legs. Longterm, venous disease can cause health problems due to skin changes such as ulcerations, infections, and chronic leg swelling.

Readers: We are talking with Dr. Susan Hancock of the Hancock Vein and Surgical Center in Newport News. She can answer all your questions about vein-related problems.

Large varicose veins do not do well with sclerotherapy and generally require phlebectomy or local stripping after reflux has been addressed.

What do you mean by “increased venous pressure”?

Sclerotherapy in the past has been performed with hypertonic saline which can be painful. There are newer FDA approved agents that are more effective now.

Can you answer Marc’s question about high blood pressure?

Venous pressure=venous reflux or pooling of venous blood in the legs due to dysfunctional valves.

High blood pressure is a risk factor for venous reflux disease, yes.

Readers, Dr. Hancock is here until 12:30 p.m. to answer your vein-related questions.
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Marc,

Just because your young does not mean you should not address your varicose veins. I have treated numerous young people with varicose veins and the key is to treat them before they become complicated!

Spider veins do have symptoms of itching, burning, and throbbing. There is an inlammatory compenent to all venous disease that causes these symptoms.

Dr. Hancock — I think you already answered Marc’s question, but you mentioned possible complications by leaving varicose veins untreated. What would those complications be?

Varicose veins get progressively worse with time and cause the skin changes I mentioned above. Compression stockings can help but do not provide a definitive fix. Unaddressed venous reflux disease will over time will result in enlarging varicose veins.

Is the difference between spider veins and varicose veins just the size?

Longterm, venous disease can cause health problems due to skin changes such as ulcerations, infections, and chronic leg swelling. Also, advanced venous reflux disease that cause swelling and skin changes can lead to something even more problematic called lymphedema.

Earlier you mentioned a phlebectomy for larger varicose veins. What does this involve?

Spider veins are the tiny superficial veins that are less than 1mm. As they get bigger, you have venulectasia, then varicose veins up above 3mm. It is a size difference which also dictates best methods of treatment.

Phlebectomy means local vein stripping through small 2mm incisions.

Good question from guest. Is there anything else you can do to PREVENT varicose veins.

I’m not sure I understand what you mean by “vein stripping” …please clarify.

Yes, exercise help to prevent venous reflux disease by building the calf muscle pump which helps keep the venous circulation efficient.

Vein stripping simply means local removal of veins.

Readers – ask your questions about veins now. We have a couple more minutes with Dr. Hancock.

I have a question — years ago I had blood vessels on my face “zapped” with some electrical device I think. (It hurt.) Is this still practiced to shrink burst vessels?

Preventative measure include other things considered helpful to your general health…. exercise, maintaining proper weight, managing other issues such as hypertension, and wearing compression stockings if you see early signs, have family members with venous problems, or have an occupation that requires long periods of standing or sitting.

Facial spider veins or telangiectasia to respond well to Veinwave which is a device used to ‘zap’ these veins. It’s not considered laser. It does sting a bit, but is fairly effective in treating facial veins.

Susan Hancock practices at the Hancock Vein and Surgical Center in Newport News; www.hancockvein.com.

Awareness of venous reflux disease is the most important thing when discussing proper identification and treatment. Early signs of aching and heaviness that are often dismissed as being caused by other things should be investigated with an ultrasound. Unfortunately, when people don’t have obvious varicose veins, primary care doctors and patients don’t think about venous reflux being the potential problem.

And how would it be treated in the early stages – before veins are visible?

When I see patients in the office with suspected venous disease, we start with compression stockings to determine if they get relief. An ultrasound is performed to assess for the presence of reflux. After a trial of compression therapy, they generally proceed to definitive treatment which means “closing’ the underlying refluxing vein.

Thank you. I’ll be closing the chat in just a couple of minutes. I want to thank Dr. Hancock so much for answering readers’ questions and shedding light on the issue of spider veins and varicose veins.
Dr. Hancock — if you have anything else you’d like readers to know, please pass along the information now. Thanks again for your expertise and participation.

Venous reflux disease is more common than heart disease and other circulation disorders. If you believe you may have symptoms we have talked about, you should have your legs checked early.

Readers: Join us every Wednesday at noon for our weekly chats on health-related topics.
Dr. Hancock – thanks so much. Please let readers know how they can reach you.

Yes for local places. Some local distributors will file with insurance though insurance most often does not pay. Lots of online sources are available and prescription is not required.

You can find us on www.hancockvein.com or call the office at 873-0138.
Thanks.

Thanks very much. I’m closing the chat now.