Varicose Veins
VEIN Atlanta
Louis G. Prevosti, MD, FACS Louis G. Prevosti, MD, FACS

Q and A with Louis G. Prevosti, MD, FACS

What are varicose veins?
Varicose veins are distended or stretched and distorted veins which are frequently visible on the leg. They can appear virtually anywhere on the leg and are often accompanied by painful itching and/or burning, swelling, and tenderness of the veins themselves.

What causes varicose veins?
Varicose veins, like the smaller spider veins, are caused primarily by one thing: blood moving the wrong direction in the vein. This happens because the valves that are inside leg veins to prevent that backward flow can fail, and when they do, a condition known as venous reflux occurs. This reflux leads to the condition of chronic venous insufficiency, which is what causes the varicose veins as well as a host of other problems such as leg swelling, cramping, and skin discoloration

Are varicose veins dangerous?
The veins are not only unattractive, but they can create some definite health hazards as well. The veins themselves can develop clots, creating a potentially dangerous situation should the clots migrate to the deeper veins of the leg, creating a deep vein thrombosis or DVT. These clots can then travel to lung where they can cause serious injury or even death. The veins may also spontaneously bleed. This type of bleeding is often difficult to control, and may actually require a suture to stop. But the real problem comes from the condition of chronic venous insufficiency; the cause of the varicose veins. This is a dangerous situation which can cause chronic pain, swelling, skin changes and even large non-healing sores on the legs called venous stasis ulcers.

How are these problems treated?
Once the problem has been properly identified, treatment is directed at the source of the venous reflux. For varicose veins, the modern treatments represent tremendous advances over the old procedures. The old surgical treatment, vein stripping, called for surgical removal of the problem vein(s). This method is quite painful and only about 80% effective, meaning that the varicose veins recur in about 20% of patients. The new treatments are catheter based and are extremely effective with recurrence less than 4% after 10 years. These procedures, which can be done in the office, involve the placement of a special catheter in the vein via a small needle, and the application of thermal energy designed to cause the vein to simply close. This halts the backward flow of blood, and alleviates the problem without surgery. New, healthy veins are formed to handle the blood, and the old, closed vein is simply absorbed into the body. Spider veins are generally treated with special medicines injected directly into the veins using tiny needles in a procedure known as sclerotherapy. Lasers may also be used in this treatment, and special lights employed to precisely illuminate the veins

Are these procedures covered by insurance?
Treatment for varicose veins is almost always covered by insurance, while treatment of the smaller spider veins is generally not covered.

VEIN Atlanta
1100 Johnson Ferry Road, Suite 165
Atlanta, GA 30342
(404) 446-2800