FAQ | Monahan Vein Clinic

What causes varicose veins?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:30:30 +0000

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 blood flows back into superficial veins and back down the leg, known as venous reflux. This results in surface 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.

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Why do varicose veins occur in the legs?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:29:37 +0000

Gravity is the culprit. The distance from the feet to the heart is the furthest blood has to travel in the body. Consequently, if the vein valves fail, those vessels experience a great deal of pressure. The backflow of blood causes the surface veins to become swollen and distorted.

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Who is at risk for varicose veins?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:26:34 +0000

Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, 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.

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What are the symptoms?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:26:15 +0000

Varicose veins may cause legs to ache, feel heavy, and tire easily. Feet and ankles may swell towards day’s end, especially in hot weather. Varicose veins may be itchy, and the veins themselves may ache. Leg cramps can be caused by varicose veins. Varicose veins can get sore and inflamed, causing redness of the skin around them. In some cases, patients may develop venous ulcerations.

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What is the short term treatment for varicose veins?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:12:56 +0000

Typical advice for treating varicose veins is summed up by the letters ESES (pronounced SS). It stands for Exercise Stockings Elevation and Still. Exercising, wearing compression hose, elevating and resting the legs will not make the veins go away or necessarily prevent them from worsening because the underlying disease (venous reflux) has not been addressed. However, it may provide some symptomatic relief. Weight reduction is also helpful. Insurance companies often require some time in use of compression stockings, anti-inflammatories (aspirin, ibuprofen, naproxen), and leg elevation before authorizing treatment. This may seem to reflect a conservative approach to treatment, but actually demonstrates an outdated understanding of vein disease, since these measures will not change the underlying problem. At best, they may slow the advances of the complications of chronic vein disease, but will not reverse them. Hopefully, one day the insurance companies will update their knowledge of vein disease and drop these requirements. In the meantime, it serves as a delay tactic in patients getting timely treatment.

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What is sclerotherapy?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:02:09 +0000

A solution is injected into a vein causing a chemical injury resulting in the vein closing through a scar-like reaction. It is most effective when underlying sources of venous reflux have been treated. Leg wrapping or stockings are used following the injections, depending on the size of vein injected.

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What solutions do you use for sclerotherapy?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:01:47 +0000

We use the only two FDA approved solutions for sclerotherapy, sodium morrhuate and sodium tetradecyl sulfate (sotradecol). Saline has been used in the past for sclerotherapy. It is very painful. It is not more effective than other solutions. Many physicians used it because it was cheap. Others still use it in order to avoid allergic reactions which were reported in the past in association with other solutions. These were probably not true allergic reactions. Some physicians are now using “foam sclerotherapy.” The solution is turned into a foam by injecting it with air back and forth between two syringes. This is not FDA approved. Informed consent for foam sclerotherapy should include this fact, as well as the fact that there are disturbing side effects (e.g.,dry cough, blindness), which are transitory. The long-term effects are not documented. For these reasons, we do not use foam sclerotherapy at Vein Surgery and Treatment Center.

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What is ambulatory phlebectomy?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:01:29 +0000

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.”

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What is vein stripping?

Dr. Daniel Monahan — Fri, 19 Feb 2016 00:01:07 +0000

When the source of the reverse blood flow was due to damaged valves in the saphenous vein, the vein was removed by a surgical procedure known as vein stripping. Under general anesthesia, all or part of the vein was tied off and pulled out. The legs were bandaged after the surgery but swelling and bruising lasted from days to weeks. Now that ablation has been proved to be effective, vein stripping should be regarded as a procedure of the past. It carries higher risk, greater pain, greater disability, longer recovery, greater cost, and, historically, less effectiveness than modern treatment.

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When is VNUS Closure used?

Dr. Daniel Monahan — Thu, 18 Feb 2016 23:59:07 +0000

VNUS Closure is used, instead of vein stripping, to eliminate reverse blood flow in the saphenous vein, but without physically removing the vein, and can be performed in the office with local anesthesia. With Closure, or Radiofrequency Ablation, the vein is closed using radiofrequency energy through a catheter to heat the inside of the vein. Ultrasound is required to make the diagnosis and indicate whether a patient is a candidate for the procedure. Like other venous procedures, the Closure procedure involves risks and potential complications, but these are much less likely than with traditional surgery.

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