VEIN TREATMENT BECOMING POPULAR IN SOUTHEAST MISSOURI

Dr. Gregory Tobin of Midwest Physicians and Surgeons, injected sclerosant into a patient's spider veins.

Sclerosant injected into veins hardens them, causing them to close down. The body then absorbs the vein much like a bruise.

Two painless treatments for spider veins are available. One uses an injection to kill the veins while the other uses a pulsing flash from a bright light.

Millions of people suffer from unsightly spider veins and painful varicose veins. Now, in the past 15 years, treatments for these conditions have improved to make it more convenient and accessible to those wishing to have a new look.

Where once the treatment required a week-long stay in the hospital and surgery under general anesthesia, now almost all vein treatment has become an office procedure, said Dr. Jonathan Foley, a physician with Vein Treatment Specialists in Cape Girardeau.

Reasons from patients for wanting to have vein treatment vary.

"We have to divide our cases into 'medical' varicose veins and 'cosmetic' veins," said Foley. "Insurance companies have cracked down on vein treatments and their willingness to pay because of the differentiations between the two types. If it's truly a medical need, most insurance companies will pay. If it's for a cosmetic look, they more than likely won't."

"Spider veins and varicose veins are not the same," explains Dr. Gregory Tobin with Midwest Physicians & Surgeons in Cape Girardeau. "Spider veins are much smaller and are referred to by the name telangiectasias. They may represent abnormal connections between the arteries and the veins.

"Varicose veins," continued Tobin, "are caused because of increasing blood pressure in the venous system of the legs. Then there's a player in the middle which we call reticular veins. They're larger than spider veins but smaller than varicose veins."

People with varicose veins often notice that their legs feel tired or heavy and sometimes experience swelling, pain, itching or burning around the area. People with advanced stages of venous disease may develop an ulceration, or open sore, in the affected area.

Sclerotherapy and phototherapy are most effective on spider veins.

Sclerotherapy, is when the physician uses tiny needles to inject a hardening agent into the abnormal vein. The size of the needle allows the procedure to be done without local anesthetic and with little discomfort. The solution causes the interior of the vein to become scarred and prompts the vein to close down. The body absorbs the scarred vein in the same way it absorbs a bruise, and blood flow in the area remains unobstructed.

"When you start talking about varicies and injections, you have to be more careful because you're talking about bigger vessels which are tributaries to very large vessels and the sclerosing agent can act on those larger vessels and you can get into a very big problem."

For larger varicose veins, it's usually best to tie them off.

Screening for this type of procedure is usually done with an ultrasound to determine if a major blood valve is functioning improperly. During the ligation procedure, a surgeon ties off or removes the affected area of the vein.

"We're taking one avenue of blood return to get blood back to the heart," explained Foley. "What you do is create a diversion. The blood will find another way to go... The integrity of the leg is still good."

Another form of therapy is phototherapy, or light therapy. Phototherapy uses intense, laser-like pulsed light and selectively penetrates the abnormal veins without damaging the surrounding tissue. Since there are no needles involved, patients usually feel a pinch like the snap of an elastic band and local anesthetic is not required.

Each of these methods has some side effects. Other than slight discomfort and swelling, many can stain the skin if the vessel ruptures and releases hemoglobin into the skin. These iron deposits take weeks or months to disappear with very few becoming permanent. Occasionally there will be swelling or itching if the sclerosant is injected under the skin instead of into the vein.

"It's not a one-time thing," said Foley. "Sometimes you get fooled into thinking that you can come in and get them treated and that's it. Other than surgical therapy, which is a one-time deal, sclerotherapy or phototherapy treatments are a crescendo treatment. You start, some heal and some come back. So you have to come back and hit them again. You might have to do that four or five times. And many are surprised that their legs look worse for a few weeks after the therapy. It's not like you're going to the prom tomorrow and you come in and get zapped and look beautiful. It takes weeks to be effective.

After treatment, patients are urged to wear compressive stockings to help keep swelling down and to help prevent new varicies.

"Those who are predispositioned to varicies can benefit from wearing long-term support stockings every day," said Tobin. "It won't be completely effective, but it will help in preventing true varicies in those people."