What are varicose veins?
Varicose veins are enlarged, tortuous veins just beneath the skin of more than 3 mm in diameter. Most commonly they develop in the legs and near the ankles.

What causes varicose veins?
Varicose veins develop when you have faulty valves in your veins and weakened vein walls. Normally, the one-way valves in leg veins keep the blood flowing efficiently against gravity up toward the heart. When these valves do not function properly, blood pools, pressure builds up, and the veins become enlarged, tortuous and weakened. This leads to what is called as venous insufficiency.
Some people may be more likely than others to develop varicose veins because of inherited characteristics (genetics) and the aging process. Varicose veins may also result from conditions that increase pressure on the leg veins, such as being overweight or pregnant or having an occupation that requires standing for long periods of time.

What are the symptoms?
People with varicose veins often do not have symptoms but may be concerned about the appearance of the veins. Varicose veins are visible through the skin and appear dark blue, swollen, and tortuous. If you have varicose veins, your legs may feel heavy, tired, achy and painful. Symptoms may be worse after standing or sitting for long periods of time. Varicose veins can also cause skin color changes (stasis pigmentation), dry, thinned skin, skin inflammation, open sores (ulcerations), or bleeding after a minor injury.

What increases my risk for varicose veins?
Factors that increase your risk of developing varicose veins include:

• Being a female.
• Pregnancy (particularly repeated pregnancies).
• Being overweight (tends to be a stronger factor in women). Having low muscle mass and high body fat decreases the support for the veins.
• Advancing age.
• Family history of varicose veins.
• Jobs which require prolonged sitting or standing.
• Conditions that increase pressure in the abdomen, such as liver disease, fluid in the abdomen, previous groin surgery, or heart failure.
• Injury to the veins.

How can I prevent varicose veins in remaining veins or other leg?
Varicose veins may be prevented to some extent by:

• Wearing compression stockings. They improve circulation and are a mainstay of treatment for varicose veins that are causing symptoms.
• Regularly elevating the legs. Elevating your legs helps keep the blood from pooling in your lower legs and improves blood flow to the rest of your body.
• Avoiding long periods of standing or sitting. Sitting or standing still for long periods of time puts added stress on the veins in your legs.
• Exercising and controlling your weight. Walking, bicycling, and swimming are recommended for varicose veins.

These suggestions can relieve your symptoms, slow the progression of varicose veins, and prevent complications such as sores or bleeding. They are especially important if you have a family history of varicose veins. These measures may help you avoid surgery or other medical treatment for your varicose veins.

Who get affected?
Varicose veins are much more common in women than in men, affecting about 31% of women compared to 17% of men. Varicose veins often develop during pregnancy. They usually become less prominent after pregnancy and may disappear completely.
Varicose veins become more common as people age.

How are varicose veins diagnosed?
To diagnose varicose veins, your doctor will examine your legs and feet. Varicose veins are easy to see, especially when you are standing. The doctor will also check your legs for tender areas, swelling, skin color changes, ulcers, and other signs of skin breakdown.
Additional testing may also be needed if you are considering varicose vein surgery or other vein treatments.

How are they treated?
Self-care measures such as wearing compression stockings, elevating your legs, and exercising regularly may relieve symptoms and keep varicose veins from getting worse.
Sclerotherapy, endovenous laser or radiofrequency treatment (which uses heat to close off varicose veins), or surgery to treat varicose veins may be considered when symptoms persist. These procedures may also be used if you are concerned about the appearance of varicose veins.

Will my ulcer (wound) heal on its own after laser procedure?
Yes! It starts improving immediately after the laser procedure but you need to take of it by regular & proper dressings, preferably by or under supervision by a surgeon, crepe application & elevation of leg while resting & at night.

What are spider veins?
Spider veins (also called telangiectasia or venulectasias) are enlarged veins near the skin surface that appear purple, red or blue. They are commonly found on the legs, though they can also appear on the face and other parts of the body.

Typically, spider veins appear to have a diameters of 1 mm or less, but their actual diameters may be up to 3 mm under the surface. Small spider veins are usually pinkish red, whereas larger spider veins are blue or purple in color.

What factors contribute to spider veins?
There are several factors that cause some people, but not others, to develop spider veins:

• Genetics
Most women with spider veins have mothers and/or grandmothers who also have them. These women unfortunately inherit a tendency for weak vein walls and poorly functioning vein valves.

They also tend to develop spider veins at a relatively young age (in their thirties or even in their twenties).

• Hormones
During pregnancy, and to a lesser degree also during their monthly cycles, fluctuations in the female sex hormone estrogen and progesterone cause the softening of the vein walls and valves. This makes a woman's veins more prone to stretching.

Increased blood volume, which is needed to provide circulation to the fetus, also causes increased pressure on the vein walls. The growing fetus also exerts pressure on the pelvis, which in turn, causes more pressure to build in the leg veins.

• Prolonged standing or sitting
Both prolonged standing and sitting cause a great amount of pressure to develop in leg veins. In both conditions, the calf muscles are inactive and therefore cannot help push venous blood to return to the heart. This causes blood to pool in the veins, thus resulting in increased pressure on the vein walls.
• Injury or trauma
In some people, spider veins appear after injury or trauma to the vein. These include broken ankle, surgery, car accident or sports injury. Bruising, which is pooled blood resulting from broken veins under the skin, can also lead to an inflammatory response, which in turn, can result in enlarged veins.
• Vein conditions
In men, spider veins are usually the result of blow-outs from nearby varicose veins. High pressure from these veins cause neighboring smaller veins to stretch and enlarge. These spider veins are usually darker and have larger diameters than the spider veins in women.

Spider vein matting, which resemble bruisings that do not fade, is often caused by the healing process of injuries and bruises, as well as complications from sclerotherapy.

• Causes of facial spider veins
For some, prominent facial veins are caused by rosacea. This condition is marked by numerous red spider veins in the nose, cheek, forehead, and chin, and is sometimes accompanied by acne breakouts. Although the cause of rosacea is not known, it seems that alcohol, spicy food, and stress may play a role.

Chronic sun exposure can also cause or exacerbate facial spider veins. In some people with chronic allergies, repetitive coughing and sneezing can lead to enlargement of veins around the nose and below the nostrils. Bouts of violent vomitings can also lead to spider veins on the cheeks.

What factors contribute to spider veins?
There are two main conventional treatments for spider veins: sclerotherapy or injection therapy, and laser treatment.                                                                                                                                                                                                                   Sclerotherapy or injection therapy
In this treatment, chemical irritants (or sclerosants) are injected at the general location of spider veins. This chemical irritates the lining of the vein and cause blood clots to form and the veins to collapse. Blood is prevented from entering these veins, and the body will slowly remove these spider veins. This process can take anywhere from two weeks to as long as a year.

Sclerotherapy is an outpatient procedure, and may require many repeat visits to your doctor's office. In most cases, your doctor may elect to use a salt water or saline solution as the sclerosant. In other cases, anesthetic or surfactants such as sodium tetradecyl sulfate (STS) are used. After the injection, a compression bandage is applied to make the vein collapse.

Although sclerotherapy is a safe procedure and is effective in treating minor vein problems, it does have several drawbacks:

• First, sclerotheraphy does not address the underlying cause of spider veins, therefore it is not a permanent cure - up to 70% of spider veins reappear after about three to four years, with some reappearing in as early as a couple of months.

• Second, sclerotherapy can be a painful procedure, especially if saline or a salt solution is used. For some, pain and tenderness can last for weeks.

• Third, sclerotherapy can leave temporary and permanent patches of yellor or brown discolored skin at the site of the injection, which can create a larger cosmetic problem.

Depending on the machine used, there are various forms of laser treatments. These include argon laser, pulsed dye laser, and intense pulsed light.

Laser theraphy is less painful than sclerotheraphy, laser is often the preferred treatment method for fine spider veins, especially the ones in the face. However, even this treatment has several drawbacks:

• First and foremost, the effect of laser is often temporary because it does not address the root cause of the vein conditions - most people see their spider veins come back after the procedure. The result is also variable - some people experience very good results, whereas others see virtually no changes.

• Laser therapy is often very expensive and is not covered by most insurance policies. A patient may also need several rounds of laser therapy to see the effects.

• Laser is less effective for spider veins in the leg and for larger spider veins.

• In people with darker skin, laser is usually not as effective as in people with lighter skin. This is because the skin pigment melanin also absorbs the laser's energy, thus diverting the laser's effect on spider veins.

• Although laser therapies are less painful than sclerotherapy, it is not completely painless. Some feel stinging or burning sensation, which may last for several hours. Others may experience blisters and skin discoloration in the treated area.

What are Perforator Veins ?
The body has network of veins at two levels of depth from the skin in the arms and legs, the deep and superficial venous systems. The superficial veins close to the skin normally bring blood back to the heart by eventually connecting with the deep veins that lie close to nerves, arteries, and bones. In fact, the two systems run parallel to each other, resembling a ladder. The rungs of the ladder are the perforator veins that normally drain blood from superficial to deep. If the one-way valves in the perforator veins fail to work, blood may flow from deep to superficial, causing high pressure in the superficial venous system.

What are Symptoms of Perforator Veins ?
High superficial venous pressures from incompetent perforators may cause varicose veins or skin ulcers, particularly in the lower leg and ankle.

What Causes Perforator Veins ?
Contributing factors include:

• Heredity

• Pregnancy

• Hormonal changes

• Being Overweight

• Standing or sitting for prolonged period of time

• Advancing Age

• Trauma

How we perforating veins diagnosed?
The location and malfunction of perforator veins will be determined by duplex ultrasound. If a perforator vein is found to be feeding a large varicose vein or is underlying a skin ulcer, then treatment will be recommended.

How are Perforating veins Treated?
Usually the incompetent or dilated perforating veins treated during the treatment of refluxing GSV or SSV but they can be treated as isolated procedure and both SFJ &SPJ are found to be competent.

PEPLA Technique:
To treat perforators effectively & quickly with laser.we have developed a special technique which we have names as “PEPLA”. pre-cutaneous Endo-Perforators laser ablation. Under usg guidance pre-marked perforator is visualized in best possible ultrasound plane.A seven inch long 18 gause ( mm) needle is then inserted in perforating vein just above the deep fascia & steered till sub-facial level.needle tip position inside the perforator is conform by back flow of venous blood which usually pushes under pressure.A 0.6mm diameter optical fibre inserted through the needle so its tips lies inside the perforator.needle is withdrawn & perforator is closed with appropriate dose of laser energy.closure is conform immediately with color droppler.

What is Post Procedure Protocol ?
Once the procedure is complete, a compression stocking is placed on the treated leg for 7 days. Under normal conditions the patient may return to work the following day.

The following are common physician recommendations:

• Wear compression stockings for a period of one week all the time, then 3 more weeks during the day

• Abstain from high impact activities such as running or step aerobics for a period of 3 weeks

• Walking is encouraged, as it will aid in the healing process

A repeat ultrasound will be done in 3-7 days to check the deep leg veins, and again in 4 weeks to ensure that the treated veins are sealed. Occasionally, a treated vein will reopen, requiring either repeat injection of foam sclerotherapy or repeat laser treatment. The vast majority of treated veins are sealed shut at 1-year follow-up.

As with any procedure, some mild side-effects might occur. You may experience a slight redness to your skin tone in the treated area, which will fade away within a few days. You might also notice a slight swelling in the treated area.

What are Alternative Treatment Options ?
Sub-fascial Endoscopic Perforator Surgery (SEPS) – This surgical procedure is performed under general anesthesia in the hospital. Several small incisions are made in the leg, and a space is created between the muscle and the skin. The bridging perforator veins are visualized with a camera, and clips are applied to close them. There is more postoperative pain and bruising than with minimally invasive, office-based treatment.

What is Deep-Vein Thrombosis (DVT)?
Deep-vein thrombosis (DVT) is a serious medical condition. DVT occurs when a blood clot (thrombus) forms in one of the large veins, usually in the lower limbs, leading to either partially or completely blocked circulation. The condition may result in health complications, such as a serious pulmonary embolism (PE) and even death if not diagnosed early and treated effectively.

What is a Pulmonary Embolism (PE)?
A pulmonary embolism (PE) occurs when a blood clot is lodged in the artery that carries blood from the heart to the lungs (pulmonary artery), causing a severe dysfunction in respiratory function. PEs often come from the deep leg veins and travel to the lungs through blood circulation. Symptoms include sudden shortness of breath (that becomes worse with breathing), and rapid heart and respiratory rates.

Why do blood clots form? (PE)?
Blood clots form to help heal the body after an injury. For example, clots are what stop the bleeding in a cut or wound. In most situations, blood clots are a natural part of the healing process. They enable the injured tissue to begin to repair itself without excessive blood loss. In the case of DVT, however, the body signals the clotting process to occur unnecessarily at the wrong time and in the wrong place.

Does DVT always occur in the legs?
Blood clots can occur anywhere in the body. However, DVT occurs only in deep veins. Most often it occurs in the legs, thighs, and pelvis.

How do I know if my patient is at risk for DVT?
Although some people may be at risk for developing DVT, DVT can occur in almost anyone. Some risk factors or triggering events to discuss with your patient include, but are not limited to:

• Congestive heart failure or respiratory failure

• Restricted mobility

• Cancer

• Obesity

• Age over 40 years

• Recent surgery

• Smoking

• Prior or family history of venous thromboembolism (VTE)

What age group is at risk for DVT?
DVT occurs most commonly in adults over 40, but anyone at risk can develop it.

What are the symptoms of DVT?
Symptoms of DVT may include pain, swelling, tenderness, discoloration or redness of the affected area, and skin that is warm to the touch. However, as many as half of all DVT episodes produce minimal symptoms or are completely "silent." Because a number of other conditions — including muscle strains, skin infections, and phlebitis (inflammation of veins) — display symptoms similar to those of DVT, the condition may be difficult to diagnose without specific tests. Advise your patients to see you immediately if they have any of the symptoms listed above.

Is long-distance travel safe if I am at risk for DVT?
If you are at risk for DVT, or have experienced a prior DVT or PE, you can still make long-distance trips, as long as you take some simple precautions. Recommend that before patients leave for a long trip, they practice calf and leg exercises they can do while sitting, and that during their trip; they stretch their legs as much as possible. They may also want to wear compression stockings to help the circulation of blood in the legs. Remind them to stay hydrated; dehydration can increase the concentration of clotting factors in the blood. If patients will be traveling for more than four hours, you may consider recommending treatment with an anticoagulant, or "blood thinner," before they leave.

How is DVT diagnosed?
In the diagnosis of DVT, you will take into account the patient’s specific risk factors, the patient’s symptoms, and the results of objective tests, such as some method of imaging the clot. Possible tests include: duplex ultrasound, venography and magnetic resonance imaging (MRI), and the d-Dimer test.

How is DVT/PE treated?
The initial treatment of both DVT and PE is anticoagulants, also known as "blood thinners." These medications do not actually thin blood; instead, they block the action of various clotting factors and prevent blood clots from growing in order to allow the body’s own nature processes to destroy clots over time.

After being diagnosed with DVT or PE, what limitations will my patient experience?
DVT and PE usually resolve successfully, allowing patients to return to their previous activities. Advise your patient to listen to his or her body while exercising, but recognize that immobility is an important risk factor for DVT and PE, so activity is important in helping to prevent future blood clots.

What is the chance that my patient will have another DVT or PE?
A patient’s chance of having another DVT or PE depends on the specifics surrounding his or her first DVT or PE. If the blood clot occurred as a result of surgery or trauma, and the risk factor was considered temporary, then the risk of having another DVT or PE may be very low. If the blood clot occurred spontaneously, without any risk factors being present, the risk of another clot is 30 percent over the next 10 years. Obviously, a patient’s risk of having another DVT or PE will be higher if he or she is in a high-risk category (e.g., has cancer).

I'm in good physical condition, so do I need to worry about deep vein thrombosis?
Most healthy people may be at low risk of developing DVT, but it can happen. Be aware of the risk factor and that over time your risk factors can change. Access your risk on a regular basis, and if you observe anything suspicious, speak with your healthcare provider right away.

I'm taking oral contraceptives. Does that mean my risk is higher?
Yes. Both oral contraceptives and hormone replacement therapy may increase the tendency of the blood to clot. Keep in mind, however, that millions of women have taken oral contraceptives without encountering this problem; the affected population is relatively small.

Does being overweight affect my risk of developing deep vein thrombosis?
Obesity is a risk factor for both cardiovascular disease and DVT. It makes it more difficult for blood to circulate throughout the body and often results in low activity levels, both of which can increase your risk of DVT.

If I develop DVT, how long will it take to medically treat?
In patients with an easily identified and reversible cause of a deep vein thrombosis, 4 to 6 weeks of therapy may be sufficient. For cases in which the risk of developing new thromboses remains high (such as in patients with certain cancers or genetic abnormalities), therapy may need to be continued for months to years. Some patients remain on oral medication for life.

How does endovenous laser treatment work?
Previously, treatment of painful, swollen varicose veins required a surgical procedure called vein stripping, where the vein was completely removed from the leg. More recently, endovenous laser treatment has been developed to treat chronic venous insufficiency by delivering laser through a small puncture in the leg to close the diseased vein.
With endovenous laser treatment, no surgery is required, and the entire procedure can be performed in less than one hour as a day care procedure. During the procedure, you are awake and your leg is anesthetized. A thin laser fiber is inserted into the great saphenous vein in your thigh. Your physician then will deliver laser energy through the fiber and into the vein, causing the vein to close

If the vein is closed by the treatment, where does the blood go?
Because there are many veins in the leg at superficial and deep levels and many short veins which connect these two system of veins, called perforators, the blood that would have flown through the closed vein now simply flows through other healthy veins after the procedure. The loss of the diseased vein is not a problem for circulatory system as otherwise also these veins were not performing their destined work of draining the blood in upward direction, rather they were bringing down some of the blood flown upwards by the normal veins, thereby increasing the load on healthy veins and making them weak and varicose.

What are the complications of laser treatment?
Fortunately, endovenous laser treatment has rarely been associated with serious complications when properly performed. Common minor complications of this procedure include bruising, mild itching, tingling, tenderness and tightness in the treated leg for up to two weeks after the treatment.

Is Endovenous Laser treatment painful?
Although individual responses vary, most people report little to no pain associated with endovenous laser treatment. Often the only sensation is felt during the delivery of anesthetic to the leg. After the procedure you may feel some tenderness, tingling, itching or tightness in the treated leg, which should disappear within a month.

How successful is endovenous laser treatment?
Clinical results have been published which document the success of endovenous laser treatment to the tune of 97%. Like any medical treatment, however, endovenous laser treatment has certain risks, which your physician will explain to you as they apply to your individual case.

Who should not be treated?
Patients should wait at least three months after pregnancy or major surgery before being treated for vein disease. Persons with deep vein thrombosis or incompetence, and patients who cannot ambulate for other reasons are NOT good candidates for treatment.

What is Ambulatory Microphlebectomy?
Ambulatory Microphlebectomies are used to remove smaller varicose veins. This procedure should not be confused with vein stripping. Microphlebectomies can be done as the only treatment for your varicose veins or to remove residual varicose veins after an ablation procedure.

What is the recovery rate, side effects and is there anything I should know about after having the procedure?
After your ambulatory microphlebectomy, you will be able to walk normally after a short recovery period. If you had anesthesia and/or a sedative for the procedure, you may need someone to drive you home. You will have to wear compression stockings or an Ace bandage on your leg for about two weeks after the procedure to help speed healing. You should also avoid vigorous exercise, but aside from that, you can continue to work and go about your life normally while recovering from the process.

Since ambulatory microphlebectomy is only minimally invasive and does not require heavy anesthesia, the risk of side effects is low. You may have bruises on the affected area, but these should go away normally. If you notice swelling, excessive pain, numbness, or fever, please call us or a physician right away.

What is Microphlebectomy (Ambulatory Phlebectomy)?
For most patients endovenous laser ablation greatly reduces the size of the varicose veins. On those rare occasions when the varicose veins are unusually extensive and persistently large, an ambulatory phlebectomy (microphlebectomy) may also be necessary. Microphlebectomy is an in-office, minimally invasive procedure that requires only local anesthetic and no sutures. Bulging veins are carefully removed through tiny incisions in the skin. No sutures are required; simply a series of steri-strip bandages.You can resume your normal activities immediately after the procedure. Since bandages are on your leg you must temporarily limit certain activities such as swimming for a week. Patients also wear compression stockings and visit the doctor a week after the procedure for a follow-up examination.

Does laser vein treatment hurt?
Even though no needles or incisions are involved, some patients experience a stinging sensation during treatment. While the cooling get is normally all that is required to reduce any discomfort to an acceptable level, some patients choose to apply a numbing cream prior to treatment. Following the treatment, the pain is minimal to nonexistent.

How long does laser vein treatment take?
Laser treatments generally last for 15 to 20 minutes per session depending on the size of the vein and the extent of the area being treated.

How many laser vein treatments are required?
One or two Laser treatments are usually sufficient to effectively treat spider veins and 2 to5 laser treatments for small varicose veins in the legs. Laser therapy usually isn’t effective for varicose veins larger than 5 mm which may require Endo-Venous Laser treatment. You will receive advice on your own requirements during your consultation

How quickly will I see results?
The majority of the veins treated with laser therapy show significant improvement within 2 to 6 weeks of each treatment. Final results may not be apparent for a few months.

How long does recovery take?
Most patients generally return to normal activity immediately although it is recommended that you avoid strenuous exercise for the first 24 hours after laser vein treatment.

Are there any side effects?
Most patients report few, if any, side effects following laser vein treatment. Some patients may experience some redness or localized skin swelling that usually disappears within 24 hours. Where larger veins are treated some pigmented discoloration may persist for a few weeks.

How does Laser Vein Therapy work?
The laser delivers pulses of light energy that cause the blood within the vein to coagulate. This eventually destroys the vessel which is later reabsorbed by your body. Whilst this process is happening, blood flow is redirected to veins deeper below your skin’s surface, where it should be.

Can varicose and spider veins return even after treatment?
Non-surgical laser treatment for spider veins and small varicose veins has a very high success rate in comparison with traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Periodic “top-up” treatment can help keep a recurrence of spider and varicose veins under control.

What is sclerotherapy?
Sclerotherapy is the treatment of varicose veins by injection of the veins with chemicals that cause destruction of the veins. Many patients who select this treatment option for cosmetic reasons notice improvement in the way that their legs feel better after treatment.

Is the CoolTouch procedure performed under general anesthesia? 
No, the CoolTouch procedure for varicose veins only requires a local or regional anesthetic like epidural.

Why do doctors recommend gradient compression stockings?
The properly fitted gradient compression stocking can temporarily reverse the effects of vein disease and lessen the discomfort as well as skin damage. Many insurance companies require a trial of stocking use before approving definitive therapy.

There is no cure for varicose veins. Treatment falls into two classes; relief of symptoms and removal of the affected veins. Symptom relief includes such measures as wearing support stockings, which compress the veins and hold them in place. This keeps the veins from stretching and limits pain. Other measures are sitting down, using a footstool when sitting, avoiding standing for long periods of time, and raising the legs whenever possible. These measures work by reducing the blood pressure in leg veins. Prolonged standing allows the blood to collect under high pressure in the varicose veins. Exercise such as walking, biking, and swimming, is beneficial. When the legs are active, the legs muscles help pump the blood in the veins. This limits the amount of blood that collects in the varicose veins and reduces some of the symptoms. These measures reduce symptoms, but do not stop the disease.

Surgery is used to remove varicose veins from the body. It is recommended for varicose veins that are causing pain or are very unsightly, and when hemorrhaging or recurrent thrombosis appear. Surgery involves making an incision through the skin at both ends of the section of vein being removed. A flexible wire is inserted through one end and extended to the other. The wire is then withdrawn, pulling the vein out with it. This is called "stripping" and is the most common method to remove superficial varicose veins. As long as the deeper veins are still functioning properly, a person can live without some of the superficial veins.

Because of this, stripped varicose veins are not replaced.
Injection therapy is an alternate therapy used to seal varicose veins. This prevents blood from entering the sealed sections of the vein. The veins remain in the body, but no longer carry blood. This procedure can be performed on an out-patient basis and does not require anesthesia. It is frequently used if people develop more varicose veins after surgery to remove the larger varicose veins and to seal spider-burst veins for people concerned about cosmetic appearance. Injection therapy is also called sclerotherapy. At one time, a method of injection therapy was used that did not have a good success rate. Veins did not seal properly and blood clots formed. Modern injection therapy is improved and has a much higher success rate.

Untreated varicose veins become increasingly large and more obvious with time. Surgical stripping of varicose veins is successful for most patients. Most do not develop new, large varicose veins following surgery. Surgery does not decrease a person's tendency to develop varicose veins. Varicose veins may develop in other locations after stripping.