You're (not) so vein


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Causes, prevention and treatment of varicose veins by Dr. Jack Shellito at the Via Christi Women's Connection July Luncheon.

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You're (not) so vein

  1. 1. Youre (not) so vein:Causes, prevention andtreatment of varicose veinsWomens Connection LuncheonDr. Jack Shellito, MD, RPVIJuly 10, 2012
  2. 2. Acropolis in Greece5th Century B.C.
  3. 3. Anatomic Drawings of Leonardo Da Vinci
  4. 4. What are Spider Veins andVaricose Veins?
  5. 5. Spider Veinsand Varicose Veins Telangiectasias (“Spider Veins”) Venulectasias Reticular Veins Varicose Veins
  6. 6. Telangiectasias<1mm Diameter (“Spider Veins”)
  7. 7. Reticular Veins1-3 mm (“Blue Veins” “Venulectasias”)
  8. 8. Varicose Veins-Subcutaneous Dilated Veins >3mm Diameter
  9. 9. What Causes Varicose and Spider Veins?
  10. 10. Normal VeinValve Function
  11. 11. Incompetent Vein Valves With Varicose Veins
  12. 12. How Common are Abnormal Leg Veins?
  13. 13. Venous Disease —Scope of the Problem Vein Problems seen in 50-55% of females  40-45% of males Varicose veins present in 1 out of 2 people age 50 and older
  14. 14. What Are The Risk Factors For Varicose and Spider Veins?
  15. 15. Risk Factors for DevelopingVaricose or Spider Veins Family members with vein problems Increasing age Hormonal changes  Puberty  BCP’s  Hormonal Replacement Pregnancy Obesity Leg injury Prolonged standing (weakens valves) Sun exposure (spider veins)
  16. 16. Why do Varicose and Spider Veins Usually Appear in the Legs?
  17. 17. Gravitational Pressure Can Overwhelm Vein’s One-Way Valves
  18. 18. Are Varicose and Spider Veins Painful or Dangerous?
  19. 19. Spider and Varicose VeinsSpider vv usually do not need medicaltreatment. But varicose vv usually enlargeand worsen over time.Severe varicose veins can cause healthproblems including:  Blood clots  Sores or skin ulcers  Ongoing swelling and skin irritation/rashes
  20. 20. Eczematous Skin Changes
  21. 21. Pigmentation
  22. 22. Pigmentation
  23. 23. Active Venous Ulcer
  24. 24. What are the Symptoms of Varicose Veins?
  25. 25. Common Symptoms ofVaricose Veins Aching pain Easily tired legs Leg heaviness/fatigue Leg swelling Darkening of the skin Numbness in legs Itching Irritated rash in legs Night cramps Restless legs Bleeding/skin breakdown
  26. 26. How Can I Prevent Varicose and Spider Veins?
  27. 27. Prevention/Symptom Reliefof Venous Disease Wear sunscreen (prevents spider veins) Exercise to improve leg strength, circulation, and vein strength Control weight to reduce the pressure on your legs Elevate your legs when resting as much as possible
  28. 28. Prevention/Symptom Reliefof Venous Disease (cont.) Do not stand/sit for prolonged periods of time. Stand up and move around every 30 minutes Wear elastic support stockings Eat a low salt diet to reduce swelling Eat a high fiber diet to reduce constipation
  29. 29. Should I See a Doctor About My Varicose Veins?
  30. 30. See a PhysicianAbout Your Varicose Veins If: The veins become swollen, red, tender, or warm to the touch There are sores/rashes on the leg or near the ankle with the varicose veins You have bothersome symptoms as described above
  31. 31. How Are Varicose and Spider Veins Treated?
  32. 32. Closure of Varicose Veins With Laser Fiber Inside Vein (Endovenous)
  33. 33. Endovenous Laser Closureof Varicose Veins Treatment for larger varicose veins of legs (saphenous veins) Successful in 98% of patients Performed in-office Well tolerated with local anesthesia Fewer complications with avoidance of general anesthesia Has replaced old procedure of ligation and stripping of varicose veins
  34. 34. Laser Endovenous Ablation
  35. 35. Endovenous Laser Procedure
  36. 36. Endovenous Laser Treatment-Video
  37. 37. PostoperativeEndovenous Laser Treatment Dress leg with compression bandage Walk for 20 minutes Compression stocking for 2–4 weeks Resume normal activities Anti-inflammatories for 2–4 weeks Over-the-counter pain medications (Ibuprofen)
  38. 38. Great Saphenous VeinPre-Treatment Pre-Treatment 1 WkWeek Post Treatment One Post-EVLT
  39. 39. Small Saphenous Vein Pre-Treatment 1 Wk Post-EVLTPre-Treatment One Week Post Treatment
  40. 40. Advantages of Endovenous LaserTreatment of Varicose Veins Lower treatment costs compared to surgery Minimal scarring Minimal down time Faster return to normal activity Excellent symptom relief Vein closure maintained with long term follow-up
  41. 41. Sclerotherapy for Spider Veins
  42. 42. Injection Sclerotherapy for Spider Veins Office procedure, no anesthesia Physician injects solution (Polidocanol) into vein that causes vein walls to swell, stick together, and seal shut Same vein may need to be treated more than once Most patients can expect 50-75% improvement Out-of-Pocket expense
  43. 43. Topical Laser Therapy for Spider Veins
  44. 44. Topical Laser Sclerotherapy for Spider Veins Topical laser beam sends burst of light through skin into vein to make vein slowly fade and disappear No needles, but heat from laser on skin can be painful 2-5 treatments/site generally needed Not effective for veins > ¼ inch diameter Out-of-Pocket expense
  45. 45. Combined Topical Laser and Cooling Unit
  46. 46. Topical Laser Sclerotherapy Before After
  47. 47. You’re (Not So) Vein —Conclusions Venous disease is an epidemic in the U.S. Most is inherited (don’t say your parents never gave you anything) Treat smaller (spider) veins with topical laser or sclerotherapy (out-of-pocket expense) Treat larger (varicose) veins with endovenous laser (usually covered by insurance for patients with symptoms)
  48. 48. Thank You For Your Kind Attention! Questions?