Fresh Legs

It's not vain — it's smart to ask your doctor about varicose veins

Fresh Legs
Eric Tra
Dr. Renu Sinha: "Ultrasound has really revolutionized how we treat veins."

Colville resident Alice Borders, 73, has spent most of her life feeling self-conscious about her legs. She’s had varicose veins since her teens and was uncomfortable about their bumpy appearance. Pain, leg cramps and stinging were common.

“It’s embarrassing. I never wore shorts. All doctors ever said to me was, ‘You’ve got some bad-looking veins there.’ I never knew what to do about it except for stripping, and that scared me,” Borders says.

For years, the only treatment available for varicose veins was surgery — vein-stripping — that entailed having damaged veins tied off and removed in a hospital operating room. Now, after undergoing a newer, less invasive technique called endovenous laser ablation on both legs this year, Borders is pain-free and happy about her appearance.

“I’m so thankful. I can walk better, and there’s no pain and stinging. My legs are smoother now and feel so much better,” Borders says.

Renu Sinha, a surgeon and board-certified phlebologist with the Rockwood Vein Care Clinic, performed Borders’ outpatient procedures in her office. It took less than one hour, and Borders was free to resume normal activities immediately afterward. “Varicose veins are not just a cosmetic problem,” says Sinha. “We have to change that perception among patients and health care providers.

Varicose veins are a spectrum of disease, and can cause problems with ambulation, fatigue or swelling, as well as tissue damage and venous ulcers.”

From science class, you may recall that arteries carry oxygen-rich blood away from the heart to the body’s tissues, while veins bring blood back to the heart. One-way valves inside veins prevent blood from flowing backwards and keep it from pooling.

If the valves in veins don’t work properly, though, blood can collect and veins can develop a worm-like appearance, like a winding trail under the skin.

Aside from the aesthetic issue, more serious complications of varicose veins include spontaneous bleeding from the vein, tissue damage, or a blood clot, known as a deep vein thrombosis (DVT). If a clot breaks free, it may travel to the lungs and block blood flow, causing a potentially deadly condition called a pulmonary embolism.

Sinha has performed thousands of minimally invasive vein procedures since 2004. She’s excited about advancements in treatments for varicose veins that include ultrasound, lasers and sclerotherapy (injection of a chemical to shut down veins), none of which requires a hospital stay.

“Ultrasound has really revolutionized how we treat veins. We used to do one-size-fits-all vein-stripping surgery. Now we can treat them with less invasive modalities and get better results than stripping. That means people are more likely to have accurate and long-lasting treatments and less downtime,” Sinha says.

In endovenous laser ablation, the procedure Borders underwent, the patient is asked to wear compression stockings or socks for three months to help improve blood flow. On the day of the procedure, the patient is given oral pain medication and a sedative. The surgeon then administers a local anesthetic and makes a small incision of about one-quarter of an inch to insert a catheter into the damaged vein.

Ultrasound technology helps the doctor calculate exactly where the problem is, and a tiny laser is inserted into the vein. As the doctor slowly pulls out the laser, its heat energy closes up the vein. The body will subsequently use different routes to send blood back to the heart, and bumpy veins will disappear.

People want to know, is this really a problem? Yes. Can a doctor fix it? Yes. Is it covered? Most insurance plans consider varicose veins a medical problem now,” Sinha says. “Coverage varies, and sometimes people have to be patient with the process because there are strict criteria.”

Sinha just wishes more people would talk about their varicose veins with their medical providers. “Patients feel bad because they think they’re being vain. They don’t want to bother the doctors because they’re so busy,” she says. “But we’d love to encourage patients to partner with their physicians to treat varicose veins. We can significantly improve quality of life.”