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I’ve got good legs. Now before anyone accuses me of vanity, let me explain. Like many women, if given the opportunity I would make some “minor adjustments” to various parts of my body. Maybe narrow the hips a little, shave a little off the thighs and belly … nothing major, just tweak things a bit to enhance them. But honestly, I don’t have any complaints about my legs. In fact, they have served me well. While not terribly long, they are nicely shaped and with my chocolate brown coloring they look good year-round – even without pantyhose. I’m ashamed to admit that I seldom give them a second thought unless I’ve injured one of them or they otherwise ache or hurt. Yet they faithfully carry me along on my merry way.
Not everyone is so lucky. Varicose veins (in varying degrees) affect about 25 million Americans and are more common in women than men. In some instances, they cause no symptoms other than being unsightly. For others, they can cause moderate itching, considerable pain and swelling. The exact causes vary, but varicose veins are more common in:
• Women
• Smokers
• People who sit for prolonged periods
• Pregnant women and women with hormonal imbalances (i.e. menopause)
• Older women (prevalence increases with age)
• The obese
• People with a family history of varicose veins.
Christopher Brennig, MD, is the medical director of the Austin Vein Institute and the lead physician at Austin Vascular. Although fellowship trained in vascular surgery and board certified in general surgery, Dr. Brennig has become recognized for his expertise in minimally invasive treatments for varicose veins.
“I try to teach my clients and patients about good vein health,” says Brennig. “So many problems can be avoided if people just take good care of their blood vessels.”
Unfortunately some people are just more prone to varicosities. As Brennig explains, people with varicose veins actually have venous valve problems. They may have primary valve incompetence, which is congenital. Or more commonly, they have secondary valve incompetence, which results from fluid overload (as occurs during pregnancy), can result from increased elasticity (which occurs with hormonal imbalances) or it can result from a blood clot that sticks on the valve and damages it. The incompetent valves then don’t close properly and as a result, blood is allowed to flow backward. This backflow further damages the valve worsening the condition.
“Venous valves are very delicate, much like the thin skin of an onion,” says Brennig. “Yet they are extremely strong and do their job well. Unfortunately, when the valve leaflets are damaged and unable to meet, the result is backflow of blood.”
Brennig is a staunch proponent of prevention. He advises people to avoid prolonged sitting and recommends that people get up to stretch and walk around every hour. He also recommends that when people are relaxing, they elevate their legs to promote blood return back to the heart. “This prevents pooling of blood in the lower legs and feet,” says Brennig. For people who work on their feet or for really long plane trips, he recommends compression stockings to help with venous blood return back to the heart.
“Graded compression stockings encourage blood flow back towards the heart,” says Brennig. “The compression is highest around the ankle and lowest around the calf or thigh (depending on the height of the stocking).”
For those prone to varicosities, Brennig stresses early intervention. “The earlier you treat a vein problem, the easier it is to fix and the quicker the resolution.”
So what are the treatment options? It really depends on the type and severity of the varicosities. What’s really nice is that most of the treatments can be done in Brennig’s office, a pleasantly decorated space complete with the latest technological devices. Minimally invasive procedures produce minimal pain and trauma and patients go home the same day and return to their regular activities in just a couple of days.
Spider Veins
For the tiny spider veins (telangectasias) that are typically located on the inside of the knees or ankles, Brennig recommends sclerotherapy or laser therapy. In sclerotherapy, a small amount of irritant solution is injected directly into the veins causing them to collapse and close. Laser therapy causes a similar reaction. The laser energy heats the hemoglobin (the pigmented portion) in blood irritating the vein causing it to collapse. Once the veins collapse, they shrink away from the skin surface and are no longer visible.
Reticular Veins
These are the slightly larger veins typically seen behind the knees and often referred to as “road maps”. These are classically due to venous valve incompetence and the treatment of choice is sclerotherapy.
Varicose Veins
These are the tortuous “worm-like” veins seen in people’s legs. These arise as a result of venous valve incompetence in the Saphenous vein (the large vein that carries blood away from the legs towards that heart). Today, laser therapy is the treatment of choice for varicose veins. The leg is first numbed with lidocaine and then a catheter with a laser tip is inserted into the distal (ankle) end of a vein through a small puncture and threaded up towards the groin to where the saphenous vein meets the femoral vein. Then the actual laser is turned on and as it is withdrawn, the heat from the laser collapses the vein.
Before there was laser treatment, people underwent the painful process of vein stripping. Under anesthesia, an incision was made at the lower (ankle) end of a vein. An instrument with a cup-like tip was inserted into the length of the vein almost to the groin. Then, with firm pressure, the instrument was pulled back, turning the vein inside out and then removing it when the instrument was brought out via the incision. Not only was this a much more painful procedure, it was much more invasive, required anesthesia and its associated risks and put the patient at risk for infection.
Of course, preventive care is always the first step in great looking legs (second only to great genes) and Dr. Brennig has shared specifically how we can all take better care of our legs. But if you weren’t blessed with strong venous valves and hence, smooth legs, Dr. Brennig and his staff at the Austin Vein Institute can help you get the gorgeous legs you seek.
Who is at Risk for Varicose Veins?
• Women
• Smokers
• People who sit for prolonged periods
• Pregnant women and women with hormonal imbalances (i.e., menopause)
• Older women (prevalence increases with age)
• The obese
• People with a family history of varicose veins.
Symptoms of Varicose Veins
• Itching
• Swelling
• Pain
• Leg weakness or cramping
• Discoloration
• Poor wound healing
MORE INFO
Christopher Brennig, MD, Medical Director
Austin Vein Institute
7000 N. Mopac Expwy, Ste. 320
Austin, TX 78731
512.346.2727
www.veinaustin.com