Frequently Asked Questions
The venous system is composed of pipes, pumps, and valves. The leg veins are the pipes that carry the blood. The motion of walking and the contraction of the calf muscles are the pump that propel the blood up the leg veins. The leg vein one-way check valves maintain unidirectional blood flow toward the heart when exposed to the effects of gravity.
If the pumps or check valves do not function properly, when exposed to gravity the blood does not flow efficiently. If the valves do not close properly then blood falls back down the leg vein when the patient is in the sitting and standing position. This reversal of blood flow, or reflux, causes the signs and symptoms of venous disease.
Visible signs may include spider veins, varicose veins, venous ulcers, and leg swelling. Spider veins (< 1mm) are small red, blue, or purple veins on the surface of the skin. Varicose veins (> 3mm) are larger distended superficial veins.
Common physical symptoms are leg pain, fatigue, heaviness, aching, burning, throbbing, itching, restless legs, and night cramps. More advanced symptoms include leg swelling, skin discoloration, and skin ulceration.
Predisposing factors include genetics, gender, age, obesity, trauma, and occupation. Heredity is the number one factor in the development of varicosities. Varicose veins are more common in women because of hormonal factors including pregnancy, puberty, menopause, and birth control or hormone replacement therapy. Varicosities from pregnancy often improve within 3 months of delivery but may not resolve after successive pregnancies. The incidence of vein disease increases with age and by age 65 over 60% of women and 45% of men will have venous disease. Occupations that require prolonged standing and sitting increase ones risk of vein disease.
Although procedures may correct venous reflux, long-term success requires you to comply with the following conservative care guidelines: Healthy Leg Principles
- Treat your varicose and spider veins and prevent progression of venous disease by wearing compression hose
- Exercise your calf muscle to compress your veins and massage blood towards your heart
- Elevate your legs daily and avoid prolonged standing
- Avoid high heel shoes except on special occasions
- Maintain a healthy weight
- Avoid or minimize heavy weight lifting, pounding exercises, local trauma, hot baths, sun bathing, or the tanning bed
Corrective procedures may be indicated for venous disease. Treatment results are best when corrective procedures are paired with the Healthy Leg Principles listed above. Treatments include cosmetic and medically necessary procedures. A mapping ultrasound of your legs will identify which veins have reflux. The results of the mapping ultrasound and your symptoms of venous disease aid Dr. Harper in making your treatment recommendations. Though vein procedures are elective, delaying treatment will allow your chronic condition to worsen with time. Thankfully with the evaluation and treatment methods available today, spider veins and varicose veins can be treated at a level of effectiveness and safety previously unattainable.
Phlebology is the medical specialty devoted to the evaluation and treatment of patients with venous disease. This includes spider veins, varicose veins, venous ulcers, and leg swelling. Phlebology has been an established medical specialty in Europe for over 50 years. In the United States, serious interest in Phlebology developed over the last 20 years. Dr. Harper has been a board certified surgeon with the American Board of Surgery since 1986. Dr. Harper established his Phlebology practice in 1997. He was in the first class to be recognized as a diplomat of the American Board of Phlebology and is an active member of the American College of Phlebology. He regularly lectures at American College of Phlebology meetings and was recognized in 2007 with the Platinum Abstract award for research on compression hose and venous disease. In 2009, Dr. Harper attained certification for vascular lab interpretation as a Registered Physician for Vascular Interpretation. The vascular lab at Vein Specialists of the South has earned added accreditation by the ARDMS.
Sclerotherapy is the premier spider vein treatment. The treatment is an office-based procedure at Spa Medical in which a micro needle is used to inject the vein with a medication that irritates the lining of the vein wall. In response to a series of treatments, the vein collapses and disappears. Normal activities are resumed immediately and compression hose are worn after each treatment to assist in healing. Maintenance Sclerotherapy sessions every 6 – 18 months may be necessary to treat new spider veins.
Some centers offer surface laser treatment for spider veins. At VSS and Spa Medical, we reserve laser treatments for facial spider veins and leg veins that do not respond to sclerotherapy. As specialists in the treatment of vein disease you can trust us to recommend the best treatment for you.
Procedures may be indicated for the underlying causes of venous disease as well as the more visual results of venous disease – your bulging varicose veins. Traditional surgery was limited to vein stripping. New minimally invasive Endovenous thermal ablation procedures like Venefit are an alternative to vein stripping that treat the underlying cause of venous disease, which is usually reflux in the saphenous veins. In the Venefit procedure, a small catheter is inserted into the damaged vein and radiofrequency energy (heat) is delivered to the vein wall. As the heat is introduced, the vein collapses and is sealed shut, eliminating the source of the underlying reflux.
The veins that connect the deep veins to the superficial veins are the perforator veins. If unhealthy perforators are detected, recommendations may include treating these veins with the Venefit device, open ligation, or ultrasound guided Sclerotherapy. If the perforator vein is ligated you may have an inch long incision to the specified site.
The superficial varicosities close to the skin are removed through tiny Phlebectomy (incisions 2- 3 mm in size). These micro-incisions leave nearly imperceptible scars.
Your procedure will be an outpatient procedure in our office, located at 556 Third Street in Macon, Georgia (31210).
We use a gentle numbing solution of Lidocaine to keep you comfortable during the procedure. You may have mild discomfort while the numbing solution is infused and after the numbing wears off in 4 – 6 hours. Tylenol is recommended to improve post-op discomfort. To ease your nerves and make your experience more pleasant, Dr. Harper may prescribe an oral relaxation medication for you to bring to the office on the day of your procedure. If so you should not drive until the following morning.
Is there a problem with treating the varicose veins in the leg in relationship to future heart bypass surgery?
No, we treat the bad vein and leave the good ones. The veins treated are diseased and therefore not good for use in a bypass operation. In fact, correcting the poorly functioning veins can preserve healthy veins for future bypass operations. Other viable vessels (apart from Saphenous Veins) for cardiac bypass include the internal mammary artery and the radial artery.
Success is dependent upon your initial assessment, an accurate treatment recommendation, the skill of your provider, and your compliance to the treatment and maintenance plan. It is important for you and Dr. Harper to discuss your primary concerns and expectations prior to scheduling any procedures. When seeking improvement from physical symptoms it is important to know that your venous disease may not be the only source of your symptoms. That being said, if you have symptoms arising from another etiology you are likely to still have these symptoms post procedure. If your main desire is cosmetic improvement, it is important for you to know that until your underlying reflux is treated you may not have satisfactory cosmetic results.
If you are proactive in treatments your end results are expected to be better than a patient who is not compliant. Our hope is that after treating your venous reflux you will have improvement in your pre-op symptoms and visual varicosities. It is important to note that if your venous disease is advanced, some of your symptoms (swelling, skin changes, etc) may be chronic in nature.
Insurance companies most often consider the treatment of symptomatic varicose veins medically necessary. Over the years many plans have become more restrictive in approval of vein treatments. Your insurance carrier may require that you meet certain standards prior to approving your procedure. Our patient care coordinator will supply this information at the time of your consultation when you schedule your procedure. The insurance prior determination process will be directed by our business and insurance staff.
When you are ready for cosmetic spider vein treatment, this will not be covered under your insurance plan. Sclerotherapy will be scheduled at Spa Medical, a division of Vein Specialists of the South.
The risks associated with these office-based procedures are minimal. However, no procedure or treatment is completely risk free. After your procedure you may experience bruising, mild to moderate discomfort, skin discoloration, numbness, tingling, burning, and increased swelling. The risk of infection and blood clots is low. If you have a history of blood clots, poor wound healing after surgery, or a history of skin infection (i.e. staph infection) it is important to discuss this information with Dr. Harper.
After the procedure you may have increased swelling related to administration of the local numbing fluid. This post-op swelling may last from 24 hours to several weeks. If you experienced numbness, burning, or tingling post-procedure, these symptoms may take longer to gradually improve. The risk of these post-op complaints increases if Dr. Harper works in your shin or ankle area where there is very little fat to separate the nerves from the veins. Risk of blood clot and allergic reaction from the procedure are rare.
One of the best compliments our practice can ever receive is you sharing your experience here with your friends and family. Please tell your friends and family to contact our office for a new patient appointment. Call 478-743-2472 or ask them to visit our website. It is helpful if you pass on your conservative care guidelines so your friends and family may start managing symptoms prior to their first visit.