Varicose veins are swollen, twisted, blue veins that are close to the surface of the skin. Because valves in them are damaged, they hold more blood at higher pressure than normal. That forces fluid into the surrounding tissue, making the affected leg swell and feel heavy.
Unsightly and uncomfortable, varicose leg veins can promote swelling in the ankles and feet and itching of the skin. They may occur in almost any part of the leg but are most often seen in the back of the calf or on the inside of the leg between the groin and the ankle. Left untreated, patient symptoms are likely to worsen with some possibly leading to venous ulceration.
The normal function of leg veins–both the deep veins in the leg and the superficial veins–is to carry blood back to the heart. During walking, for instance, the calf muscle acts as a pump, contracting veins and forcing blood back to the heart.
To prevent blood from flowing in the wrong direction, veins have numerous valves. If the valves fail (a cause of venous reflux), blood flows back into superficial veins and back down the leg. This results in veins enlarging and becoming varicose. The process is like blowing air into a balloon without letting the air flow out again–the balloon swells.
To succeed, treatment must stop this reverse flow at the highest site or sites of valve failure. In the legs, veins close to the surface of the skin drain into larger veins, such as the saphenous vein, which run up to the groin. Damaged valves in the saphenous vein are often the cause of reversed blood flow back down into the surface veins.
Gravity is the culprit. The distance from the feet to the heart is the furthest blood has to travel in the body. Consequently, those vessels experience a great deal of pressure. If vein valves can’t handle it, the backflow of blood can cause the surface veins to become swollen and distorted.
Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing or sitting, and past vein diseases such as thrombophlebitis (i.e. inflammation of a vein as a blood clot forms). Women suffer from varicose veins more than men, and the incidence increases to 50% of people over age 50.
Varicose veins may ache, and feet and ankles may swell towards day’s end, especially in hot weather. Varicose veins can get sore and inflamed, causing redness of the skin around them. In some cases, patients may develop venous ulcerations.
Venous ulcers are areas of the lower leg where the skin has died and exposed the flesh beneath. Ulcers can range from the size of a penny to completely encircling the leg. They are painful, odorous open wounds that weep fluid and can last for months or even years. Most leg ulcers occur when vein disease is left untreated. They are most common among older people but can also affect individuals as young as 18.
ESES (pronounced SS) is an easy way to remember the conservative approach. It stands for Exercise, Stockings, Elevation, and Still. Exercising, wearing compression hose, elevating, and resting the legs won't make the varicose veins go away or necessarily prevent them from worsening because the underlying disease (venous reflux) hasn't been addressed. However, it may provide some symptomatic relief. Weight reduction is also helpful.
If there are inflamed areas or an infection, topical antibiotics may be prescribed. If ulcers develop, medication and dressings should be changed regularly.
There are also potentially longer-term treatment alternatives for visible varicose veins, such as ablation and phlebectomy.
A chemical injection, such as a saline or detergent solution, is injected into a vein causing it to “spasm” or close up. Other veins then take over its work. This may bring only temporary success and varicose veins frequently recur. This treatment is most effective on smaller surface veins, which are 1-2mm in diameter or less.
As with sclerotherapy, ambulatory phlebectomy is a surgical procedure for treating surface veins in which multiple small incisions are made along a varicose vein and it is “fished out” of the leg using surgical hooks or forceps. The procedure is done under local or regional anesthesia, in an operating room or an office “procedure room".
Vein stripping is an older procedure for treating varicose veins that involves inserting a wire into the affected vein and then pulling it out of the body. This is no longer recommended for patients. Standards-setting medical organizations such as American Venous Forum now recommend more modern techniques such as laser and radiofrequency ablation, which are offered by Center for Vein Restoration. Vein stripping requires a long recovery time (two-to-three weeks off work), and can cause pain, bruising, and other problems, such as increased risk of DVT.
In the simplest terms, arteries pump oxygen-rich blood from the heart, while veins return Oxygen-depleted blood to the heart.
Deep leg veins return blood directly to the heart and are in the center of the leg, near the bones. Superficial leg veins are just beneath the skin. They have less support from surrounding muscles and bones than the deep veins and may thus develop an area of weakness in the wall. When ballooning of the vein occurs, the vein becomes varicose. Perforator veins serve as connections between the superficial system and the deep system of leg veins.
In this procedure, a medicine called a sclerosant is injected into the problem vein. It “foams," filling the vein and initiating a reaction that results in vein closure. Blood is then naturally rerouted around the affected area and the vein later is reabsorbed by the body. The physician administering the treatment uses ultrasonography–sound waves–to guide the procedure for maximum accuracy and safety.
Insurance coverage for the treatment of venous insufficiency varies depending on both your insurance provider and your specific policy. In general, most insurance providers separate vein treatments into two categories—those that are deemed “medically necessary” versus those that are “cosmetic” in nature.
As the presence and extent of venous insufficiency is best determined via ultrasound, we encourage anyone thinking about seeking vein treatment—cosmetic or otherwise—to better understand the complete status of their veins through one of our comprehensive ultrasound screenings as, more often than not, venous insufficiency is not readily visible. Most insurance providers cover this initial, comprehensive screening.
Typically, larger veins that are symptomatic (i.e. those that are causing discomfort such as pain, aching, burning, itching, swelling, fatigue, and heaviness as well as other symptoms that may be specified by your insurance provider) are usually considered “medically necessary” and are therefore covered by your insurance.
By contrast, procedures your insurance provider considers “cosmetic” are usually not covered. Treatments such as sclerotherapy for small, non-symptomatic spider veins are typically considered not medically necessary and, as such, require an out-of-pocket payment by the patient.
Center for Vein Restorations accepts insurance from numerous insurance providers such as Aetna, Amerigroup, Anthem, Blue Cross Blue Shield, Cigna, MultiPlan, Pomco, United Healthcare, Medicaid, Medicare, and many others depending on your specific location. Whether you’re inquiring for yourself or for someone you love, our Patient Services Specialists are available Monday through Thursday 7:30 AM – 7:00 PM and Friday until 5:00 PM to address all your questions and help put your mind at ease.
To best understand the specific details of your policy and its coverage, contact your insurance provider.
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