by Andy C. Chiou, M.D., M.P.H., F.A.C.S.
Originally Appeared in Healthy Cells, December 2004

You’re a busy person, one who rarely slows down. Your legs have to keep up with your pace. Eventually, your legs begin to show all those miles. In fact, one in six women and one in ten men in the United States are affected by venous disease of the lower extremity – often in the form of varicose veins.

Today’s technology and the medical community’s commitment to women’s healthcare have made it affordable and efficient to take care of these unsightly – and often painful – veins. When considering the elimination of your varicose veins there are several things to keep in mind including:

• treatment options
• qualifications of the medical provider
• facility location and environment

Your choices

There are many different treatment options available, depending on your individual situation. That’s why it’s important to have your veins properly evaluated and your options clearly explained to you.

While some facilities only offer a few choices, a few facilities are able to offer the full range of comprehensive varicose vein treatment. Your choices for varicose and spider vein removal include topical laser treatment, sclerotherapy, vein ligation, vein stripping and the innovative VNUS® Closure®.

Your provider

As more individuals seek treatment for varicose veins, people have an increasing number of providers to choose from. These include plastic surgeons, radiologists and vascular surgeons who are vascular specialists.

When choosing a treatment provider, it’s important to be confident in his or her abilities to provide you with the best results in a caring environment. A comprehensive vein center staffed by knowledgeable physicians can provide an accurate diagnosis and recommend the right treatment for your underlying condition.

Your location

Although varicose veins can be a symptom of an underlying medical condition, more often it’s a matter of addressing the appearance of the veins or the pain they cause. Therefore, your veins can be treated in a variety of locations – in a physician’s office, a surgical center or a hospital. The key is to choose a convenient facility where you will feel comfortable and relaxed.

The Treatment Everyone’s Talking About

VNUS® Closure® uses radiofrequency ablation of the veins (in other words, a minimally invasive microwave procedure). This procedure has revolutionized the treatment of varicose veins and serves as a viable alternative to the more invasive option of vein stripping.

This treatment appeals to many people because it is done on an outpatient basis with a short recovery. A thin catheter is threaded into the vein and delivers radiofrequency energy to the vein wall. The vein heats up, collapses and seals shut.

After the diseased vein is closed, nearby healthy veins take over and empty the blood from your legs. Once normal blood flow is re-established, symptoms quickly improve. Most patients are able to resume their normal activities in one to two days.

by Andy C. Chiou, M.D., M.P.H., F.A.C.S.
Originally Appeared in The Peoria Woman, October 2004

If there was a simple way to remove your painful and unattractive varicose veins, would you consider it? Fortunately, this is now a very real possibility for many patients.

Before explaining how this is done, please allow me to provide some background.

Healthy veins defined

Your legs contain a network of veins. As you age, gain weight, endure pregnancy and spend excessive time on your feet, these veins can become damaged.

In a healthy vein, the valves open and close to aid in the return of blood to the heart. As these valves become damaged or diseased, they no longer work properly, resulting in the backward flow of blood in your legs – this is known as venous reflux. This causes blood to pool in the legs, leading to swelling, pain and varicose veins.

Consider your choices

There are many different treatment options available, depending on the individual patient’s situation. But today, I’ll be explaining a treatment that many people are interested in – VNUS® Closure® or radiofrequency ablation of the veins (in other words, a minimally invasive microwave procedure).

This treatment appeals to many women and men because it is done on an out-patient basis with a short recovery. The procedure is performed in a physician’s office, a surgical center or a hospital with local or regional anesthesia.

Once the area is numb, a thin catheter (a tube even smaller than a coffee stirrer) is threaded into the damaged or diseased vein using a single needlestick. The catheter delivers radiofrequency or microwave energy to the vein wall. This causes the vein to heat up, collapse and seal shut.

After the diseased vein is closed, nearby healthy veins take over and empty the blood from your legs. Once normal blood flow is re-established, symptoms quickly improve.

Short-term recovery

For this procedure, recovery truly is short-term. When the procedure is completed, the catheter is removed and a bandage is put over the insertion site. The bandage may remain for a full day.

Your physician will also provide you with guidance as to other recovery recommendations – these may include walking, wearing compression stockings and avoiding standing for extended periods of time. Most patients are able to resume their normal activities in one to two days.

Long-term results

The majority of patients report good results including reduced (or eliminated) leg pain, reduced (or eliminated) leg fatigue and the absence of edema or swelling. In addition, most patients indicate that there is very little, if any, scarring or bruising following the procedure. Of course, every patient is different, but these are the typical results.

Varicose vein prevention

Although some degree of vein degeneration is inevitable, there are steps you can take to reduce your chances of getting varicose veins. They include:

• Maintaining a healthy weight
• Exercising moderately
• Avoiding prolonged sitting or standing
• Avoiding crossing your legs
• Elevating your legs periodically

The right treatment for YOU

If you already have varicose veins or even spider veins, it may be time to explore your treatment options. As with any other medical condition, it is important to make sure you are evaluated and treated by a qualified physician – or team of physicians.

Although some people consider varicose veins to be simply a cosmetic issue, in rare cases they can be an indicator of a more serious vascular condition, such as a life-threatening clot in your deep veins. A comprehensive vein center staffed by knowledgeable physicians can provide an accurate diagnosis and recommend the right treatment for your underlying condition.

Up to 25 million men and women may be affected by venous reflux – for many of them, a minimally invasive treatment such as the VNUS Closure procedure may be the right choice. The only way to know for sure is be evaluated.

by Andy C. Chiou, M.D., M.P.H., F.A.C.S.
Originally Appeared in The Peoria Woman, July 2004

With the recent publicity surrounding the Race For The Cure, the important topic of breast cancer has been brought to the forefront once again. And while breast cancer kills thousands of women a year, there is another deadly condition that women need to be aware of – not just for themselves, but also for their loved ones.

It’s called an Abdominal Aortic Aneurysm (AAA). And it can be a silent killer. Look at these startling statistics: About half of the people with ruptured aneurysms never make it to the hospital. Of the half that do make it, many die before or immediately after emergency surgery. In all, 75-85% of people that rupture an aneurysm outside of the hospital will die. Most didn’t even know they had an aneurysm.

In fact, 15,000-30,000 people die each year from ruptured aneurysms – compare this to approximately 32,000 people that die annually from prostate cancer and about 42,000 women who die each year of breast cancer.

What is an abdominal aortic aneurysm?

It is a weakening of the aorta, the largest blood vessel leading out of the heart. Most of these aneurysms occur in the abdomen rather than the chest because of the differences in the chemical and tissue matrix that makes up the blood vessels in the different locations. Compared to the aorta in the abdomen, the aorta in the chest has a lot more of a substance called “elastin.” We think that aneurysms in the abdomen are caused by an imbalance of enzymes in the blood vessel wall that essentially causes a “self-digestion” and weakening of the wall. This eventually results in a ballooning out of the blood vessel, and like a helium balloon, the wall gets thinner as the balloon enlarges. Unfortunately, this ends a lot times in the rupture of the blood vessel and severe internal bleeding that leads to death.What are the symptoms?A lot of times, there are no symptoms. Occasionally, people may experience severe, tearing back pain or abdominal pain. Other times, this disease can shoot clots down into the legs and cause a blue toe or foot. You may also notice a throbbing or pulsing in your abdomen.What are the risk factors?
The biggest risk factor is having a close family member who has been diagnosed with an aneurysm. Other risk factors include age over 55, high blood pressure, heart disease, smoking and a history of blood vessel hardening or atherosclerosis.

What can I do?

Early recognition and diagnosis is the key. If you have any risk factor, get screened with an ultrasound. It is painless, harmless and very accurate.

What are the treatments?

If you have a very small aneurysm, you may not need treatment, but just close and careful watching by your primary care doctor or internist. If you have a larger aneurysm – usually over 4.5 centimeters or a little over 2 inches in width – you should be seen by a vascular surgeon. Vascular surgeons are specially trained surgeons in the treatment of blood vessel diseases. They will confirm the actual size of your aneurysm with another study, and, if it is over 2.5 inches or over 5 centimeters, you will likely be recommended for repair of the blood vessel. This can be done two ways:

One way is to repair the blood vessel from the inside out, with only small cuts in the groins to access the major blood vessels. This technique is called endovascular repair of the aorta. There is usually less pain with this procedure and you typically go home from the hospital within a day or two. This way of fixing aneurysms is limited to the types of devices that are currently manufactured and also limited by your own anatomy. It is certainly not “one size fits all” and many people will not qualify for this technique of repair because of the shape of their aneurysm.

Another way to fix this problem is by opening up the abdomen and fixing the blood vessel by replacing it with an artificial tube. This is the traditional approach for repair. It is more involved and the recovery time is longer, but the results have been proven over four decades, while the new endovascular technique has only been approved by the Food and Drug Administration since October of 1999. Both ways are effective and relatively safe if performed electively or scheduled in advance by an experienced vascular surgeon. Emergency surgery always carries a much higher risk.

Who do I talk to about getting screened for this disease?

Ask your family doctor or internist to look at your risk factors. The doctor may then send you for an ultrasound screening. Otherwise, there are several vascular labs in the area that would perform this screen for you at low cost or for free and prepare a brief screening report for you to discuss with your doctor.

by J. Kevin Paulsen, M.D., F.A.C.S.
Originally Appeared in The Peoria Woman, January 2004

If you are a woman – especially one who has experienced several pregnancies, spends extensive time on your feet or is overweight – you already may be experiencing varicose or spider veins.

If you aren’t dealing with them yet, you may eventually become one of the many adults who have varicose or spider veins. In fact, approximately one in six women and one in ten men in the United States are affected by venous disease of the lower extremity. While varicose and spider veins are more likely to occur as you get older, individuals as young as thirty may begin to notice them.

Varicose veins are swollen, twisted veins near the surface of the skin. Spider veins are small, bluish lines that resemble a spider’s web or branches of a tree. Both are most often found on the legs, but spider veins can also be present on the face. Varicose and spider veins on the legs can be the result of extended periods of sitting or standing, pregnancy, obesity, increasing age, heredity and conditions that cause increased pressure in the abdomen.

The symptoms of varicose veins include pain, burning, throbbing, swelling and heaviness in the legs. Varicose and spider veins most often aren’t a cause for alarm – but are instead a matter of appearance and varying degrees of discomfort.

However, in rare cases, varicose veins can be an indicator of an underlying medical condition. Because of this, it’s important to have your varicose veins evaluated. If your physician diagnoses varicose or spider veins, there are several treatment options.

In some situations, lifestyle changes and at-home treatments can help control minor cases of spider veins and varicose veins. Treatments may include wearing support stockings, losing weight (if weight is deemed to be a factor), variation in daily activities (i.e. taking a break from long periods of standing or taking a break from prolonged sitting with a short walk) and elevating the legs.

For more pronounced cases, patients may benefit from outpatient services such as topical laser treatment, sclerotherapy, vein ligation or stripping.

Utilizing laser technology, spider veins of the face can often be treated with minimal or no bruising at all. The underlying spider veins are effectively removed in one or two brief sessions while the overlying skin is left undamaged, avoiding the need for any recovery time. In most cases, people are able to return to either work or their usual activities immediately following the treatment.

Small varicose veins and spider veins of the legs are treated by sclerotherapy. This rather simple procedure involves injecting a solution into the veins using a very fine gauge needle. This solution causes the veins to collapse and fade. In addition to the cosmetic benefit, sclerotherapy may also remedy the uncomfortable symptoms associated with spider or varicose veins, including aching, burning, swelling and night cramps.

For larger veins, or those with medical ramifications of leaving them untreated, vein ligation or stripping may be the best option. These procedures can also be done on an outpatient basis using regional or general anesthetic.

Vein ligation is accomplished using several small incisions that allow the surgeon to tie off the vein at a point close to the source of the blood flow. The blood is then rerouted to another vein. Vein stripping is completed in a similar manner – however, the affected vein is actually removed.

Of course, prevention is the best way to have legs that are free of varicose veins. Many of the lifestyle changes that are recommended to control the effects of varicose and spider veins can be used to prevent them. They include:
• Maintaining a healthy weight
• Exercising moderately
• Avoiding prolonged sitting or standing
• Avoiding crossing your legs
• Elevating your legs periodically

As already mentioned, in most cases, spider veins and varicose veins are a matter of appearance and varying degrees of discomfort. However, in some rare instances, they can be a sign of an underlying medical problem or can lead to complications. If you experience any of the following symptoms, you should contact your physician:

• Change in skin color around the ankles and lower legs
• Open sores, especially near the ankles
• Bleeding from a varicose vein
• Tender lump in your leg
• Sudden swelling in your leg, accompanied by pain

In order to determine your most effective treatment – and to ensure there are no underlying medical issues – it’s best to have a thorough evaluation by a qualified vascular surgeon, plastic surgeon or dermatologist. When selecting your treatment provider, it is best to choose one with significant experience, a caring support staff and a commitment to quality patient care.