Varicose Veins

The venous system is made up of a network of veins which includes:

  • Superficial veins – veins located close to the surface of the skin.
  • Deep veins located in the leg.
  • Perforator veins – veins that connect the superficial veins to the deep veins.

What is Varicose Reflux Disease?

Healthy leg veins contain valves that open and close to assist the return of blood to the heart. Venous Reflux Disease develops when the valves that keep blood flowing out of the legs and back to the heart become damaged or diseased. As a result, veins valves do not close properly, leading to symptoms like

  • Varicose Veins
  • Pains
  • Swollen limbs
  • Leg heaviness and fatigue
  • Skin changes and skin ulcers

varicose veins are gnarled, enlarged veins. Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins of your lower body.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins lead to more-serious problems.

Varicose veins may also signal a higher risk of other circulatory problems. Treatment may involve self-care measures or procedures by your doctor to close or remove veins.

here are may also be small spider veins and/or the more dramatically enlarged and bulging varicose veins. Many may have these symptoms without any visible signs.

Who is most likely to get Varicose reflux disease?

Many factors contribute to the presence of venous reflux disease, which include:

  • Older age
  • Family history
  • Obesity
  • Occupation which involves standing for long hours


Diagnosis is based on a combination of symptoms, a physical exam and, most important, an ultrasound (sound wave) test of the deep and superficial veins, which will determine if superficial venous reflux is present in your leg(s). This is a non-invasive test that can be quickly performed in the office.

Varicose closure procedure

The closure procedure is performed on an outpatient basis. using an ultrasound , the physician will position the closure catheter in the diseased vein through a small opening in the skin. The tiny catheter powered by Radio-Frequency (RF) energy delivers heat to the vein wall. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed. Once the diseased vein is closed, the blood then naturally re-routes to other healthy vein.

Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. The physician may encourage you to walk, and to refrain from extended standing and strenuous activity for a period if time. Patients who undergo the closure procedure typically resume normal activities within a day.

Procedural Highlights

The highlights of the closure procedure include:

  • Outpatient procedure
  • Local or general anesthesia
  • Minimal invasion
  • Relief of symptoms
  • Good cosmic outcome with minimal no scarring, bruising or swelling

What else should I know?

  • As with any medical procedure, the closure procedure is not suitable for all people and there are associated risks and considerations. You should consult your physician to receive more information.
  • The closure system is intended for endovascular coagulation if blood vessels in patients with superficial venous reflux.
  • Contraindicated in patients with thrombus in the affected vein segment.
  • Potential complications include, but are not limited to the following: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia, skin burns.
  • Treatment of veins located very closed to the skin surface may result in skin burn.


You may have no symptoms.

Pain, itching, swelling, burning, leg heaviness or tiredness, skin discoloration. Symptoms typically worsen throughout the day and are partially relieved by elevation or wearing compression socks or stockings.

Sometimes, varicose veins clot and become painful, hot, hard and discolored. This is called phlebitis, an uncomfortable but temporary condition that will get better on its own in 2-3 months. Clots associated with phlebitis are limited to surface veins, and not dangerous - unlike clots in the deep veins (deep vein thrombosis or DVT) that are dangerous because they can travel to the heart or lung and require prompt treatment with blood thinners.

A shower or minor trauma can cause a varicose vein to burst and bleed.

Skin tears or ulceration indicate a very severe case.


Among other things, veins are responsible for bringing blood back to the heart, sometimes working against gravity. When you walk, muscles in your leg squeeze the veins and help blood flow back into the heart. In normal veins, a series of valves assist this process. With varicose veins and with a related condition called chronic venous insufficiency, poorly functioning valves allow the blood to pool in the lower leg and cause symptoms.


You will be asked questions about symptoms and medical history, including questions about family members. The vascular surgeon will also perform a physical exam that includes gently probing for problem areas on your legs while you are standing.

A painless ultrasound is usually given during during the same office visit to pinpoint problem veins and determine the best way to treat them.


Symptoms worsen throughout the day, and can usually be improved with use of compression stocking or by elevating the feet.

Knee-high compression stockings, usually that provide 20-30 mmHg of compression, will often help relieve symptoms such as aching or swelling. These stockings compress the veins and prevent blood from traveling down pooling in the legs. If you have insurance, most companies require that you wear compression stockings for at least three months before covering any other type of treatment for varicose veins.

If compression stockings provide insufficient relief and if the affected veins are straight enough (determined by the ultrasound), some form of ablation therapy (laser, radiofrequency, or mechanical injection) is an option.

Treatment is administered at the vascular surgeon's office. Your leg will be cleansed and sterile drapes placed. The vascular surgeon will then inject numbing medication and insert a catheter (thin tube) into the vein. Typically, patients feel only the injection of numbing medicine. The tube is advanced through the entire vein and then all the surrounding skin is numbed. The ablation catheter is then started and the vein treated. This part of the procedure is painless and typically takes 20 minutes. After the procedure the leg is wrapped with a compression bandage.

If the affected veins are twisted and are not sufficiently straight, sclerotherapy may be recommended. With the help of ultrasound, a small needle is advanced through the vein to inject sclerosant, a chemical that causes the vein to spasm and clot. This type of clot is not dangerous and is broken down by your body's natural processes so that the varicose vein disappears. Small "spider" veins can be treated in the same way, using a very small needle.

After treatment, patients should continue to wear compression stockings to help prevent new varicose veins from forming, and to speed recovery after varicose veins are treated.