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What are varicose veins?

Varicose veins are enlarged veins that can be flesh colored, dark purple or blue.  They often look like cords and appear twisted and bulging.  They are swollen and raised above the surface of the skin.  Varicose veins are commonly found on the backs of the calves or on the inside of the leg.

What causes varicose veins?

All leg veins contain one-way valves designed to direct the flow of blood to the heart.  If these valves fail to function correctly or “leak,” some blood is able to flow back down into the leg, in the wrong direction, and overfill branches of the superficial veins under the skin.  These malfunctioning valves within the venous system of the leg can occur at any site but the majority of them are located in the groin area or behind the knee, where there are major junctions between superficial and deep veins.  The pressure of the blood from the valve malfunction causes the veins to become distended or bulge – this results in varicose veins.  At the same time, tiny capillary branches of the veins are also overfilled with blood, producing multiple spider veins and purple discoloration.

Who gets varicose veins?

Heredity, obesity, common hormonal fluctuations, aging, standing occupations, pregnancy and leg injury can all be contributing factors to the causes and severity of varicose and spider veins, with heredity being the most prevalent.  Hormonal factors, include puberty, pregnancy, menopause and the use of birth control pills or estrogen replacement, play a role in the this disease.  As such, women are more likely to suffer from these abnormal leg veins than men.  Pregnancy, for example, causes increased hormone levels and blood volume and the enlarged uterus causes increased pressure on the veins.  Varicose veins due to pregnancy, however, often resolve or improve within 3 months after delivery.  A growing number of abnormal veins usually appear with each additional pregnancy.

What are spider veins?

Spider veins are similar to varicose veins, but they are smaller.  They are often red or blue and are closer to the surface of the skin than varicose veins.  They can look like tree branches or spider webs with their short jagged lines.  Spider veins can be found on the legs and face.  They can cover either a very small or very large area of skin.

How can I prevent varicose veins and spider veins?

Not all varicose and spider veins can be prevented.  But some things can reduce your chances of getting new varicose and spider veins.  These same suggestions can help ease discomfort from the ones you already have:

  • Wear sunscreen to protect your skin from the sun and to limit spider veins on the face.
  • Exercise regularly to improve your leg strength, circulation and vein strength.  Focus on exercises that work your legs, such as walking or running.
  • Control your weight to avoid placing too much pressure on your legs.
  • Do not cross your legs when sitting.
  • Elevate your legs when resting as much as possible.
  • Do not stand or sit for long periods of time.  If you must stand for a long time, shift your weight from one leg to the other every few minutes.  If you must sit for long periods of time, stand up and move around or take a short walk every 30 minutes.
  • Wear elastic support stockings and avoid tight clothing that constricts your waist, groin, or legs.
  • Eat a low-salt diet rich in high-fiber goods.  Eating fiber reduces the chances of constipation, which can contribute, to varicose veins.  High fiber foods include fresh fruits and vegetables and whole grains, like bran.  Eating too much salt can cause you to retain water or swell.

How are varicose and spider veins treated?

In addition to a physical exam, the lab at Willamette Vascular Specialists will take ultrasound pictures of the vein to find the cause and severity of the problem.

Sclerotherapy is the most common treatment for both spider veins and varicose veins.  Dr. Peterson injects a solution into the vein that causes the vein walls to swell, stick together, and seal shut.  This stops the flow of blood and the vein turns into scar tissue.  Later the scarred veins are reabsorbed by the body’s natural healing response.  Most patients can expect a 50% – 90% improvement.  Microsclerotherapy uses special solutions and injection techniques that increase the success rate for removal of spider veins.  Sclerotherapy does not require anesthesia and can be done in our office.

If sclerotherapy didn’t work for me in the past, does that mean it never will?

No.  We must first eliminate the underlying diseased veins that feed the bulging surface veins to obtain a durable test.  This can be done by repeat sclerotherapy, duplex-guided injection or duplex-guided radio frequency ablation.

Can varicose and spider veins return even after treatment?

Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments.  Over a period of years, however, more abnormal veins can develop.  The major reason for this is that there is no cure for weak vein valves.  So with time, pressure gradually builds up in the leg veins.  Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency).  Ongoing treatment can help keep this problem under control.

Should a woman wait to treat her varicose veins until after all planned pregnancies?

Experienced vein specialists agree that treatment for varicose veins is best done before or between pregnancies.  Just ask any woman who has suffered through pregnancy with painful varicose veins!

What is an aortic aneurysm?

An aortic aneurysm is dilation, bulging or ballooning of a weakened part of the aortic artery wall.  Aortic aneurysms are named according to their location:

  • Thoracic aortic aneurysms are those that form in the chest cavity.
  • Thoracoabdominal aneurysms extend from the chest into the abdomen.
  • Abdominal aortic aneurysms occur exclusively in the abdominal portion of the aorta.

Regardless of their location, aortic aneurysms are dangerous because of the risk that they will rupture, causing life-threatening hemorrhage.

What are the risk factors for aortic aneurysm?

Disorders such as emphysema, chronic hypertension or atherosclerosis, inherited diseases, such as Marfan’s syndrome or Ehlers-Danlos syndrome, and smoking can increase the risk of aortic aneurysm formation.  The children or siblings of people with aortic aneurysms are also at increased risk for aneurysm formation.

What are the symptoms of aortic aneurysm?

Often, individuals with aortic aneurysms do not have specific symptoms; rather, the main complaint can be vague pain in the chest or abdomen. The symptoms of a ruptured aneurysm include a sudden intense back or abdominal pain (or chest paint, in the case of thoracic aortic aneurysm), or signs of shock such as shaking, dizziness, fainting, sweating, rapid heartbeat, and sudden weakness.

How is an aortic aneurysm diagnosed?

Since aortic aneurysm often does not produce symptoms, it is important for people at increased risk for aortic aneurysm formation (for example, those with a family history or smoking history and over age 65) to undergo screening for the condition with noninvasive testing.  Aneurysms can also be discovered during a routine medical examination, during an abdominal surgery, or during a diagnostic imaging test.  The most common diagnostic tests for aortic aneurysm are ultrasound and computerized tomography (CT) scan. At the Willamette Vascular lab, we routinely conduct aortic aneurysm screenings for those patients with risk factors.

What are the treatment options for an aortic aneurysm?

Treatment for an aneurysm varies according to its severity and size.  If a rupture is not imminent, the physician may decide to monitor the growth of the aneurysm using ultrasound and CT scans, and attempt to lower the pressure on the aneurysm using medication to lower the blood pressure.  Aneurysms greater than 5.5 cm in diameter should be considered for surgical repair.  In some cases, a minimally invasive procedure called endovscular stent graft repair may be performed.

What is a Carotid Artery Disease?

The carotid arteries are the two major arteries in the neck that supply most of the blood to the brain.  Over time, these arteries may become narrowed or blocked due to a process called atherosclerosis or “hardening of the arteries”.  The buildup may obstruct the blood flow to the brain, leading to a stroke or a “mini” stroke (TIA).

What are risk factors for Carotid Artery Diseases?

Known risk factors, include family history, high blood pressure, high cholesterol, heart disease, diabetes, smoking and obesity.

How is Carotid Artery Disease diagnosed?

Diagnosis is usually made with an accurate and painless technique using imaging with ultrasound or duplex scanning conducted conveniently in the Willamette Vascular laboratory.  Occasionally, a magnetic resonance angiogram, CT scan or angiogram may be necessary.

What are symptoms of carotid stenosis?

  • Numbness or weakness in the arms or legs, especially when limited to one side of the body
  • Drooping of one side of the face
  • Difficulty speaking or understanding speech
  • Difficulty seeing from either one or both eyes

Blockage (stenosis) of the carotid arteries can also occur without any signs or symptoms.  This is called asymptomatic stenosis and it predisposes the patient to have a stroke.  Asymptomatic stenosis in the carotid arteries is sometimes discovered during a routine examination, when a “bruit,” – a swishing sound – is heard through a stethoscope placed on the neck in the area over the artery.  A bruit generally indicates a significant level of stenosis in the artery.

How is Carotid Artery Disease treated?

Mild carotid artery disease can sometimes by treated with medication and risk factor modification such as smoking cessation and reduction of cholesterol levels, and monitored for progression to a more severe form.

More severe disease is usually treated with an operation called carotid endarterectomy.  In certain individuals, a minimally invasive procedure called carotid stenting may be possible.

What is PAD?

Peripheral Arterial Disease is a condition where plaque builds up in arteries of the body leading to partial or complete blockage of blood flow.  This can cause weakness or pain in your legs, poor healing wounds or difficult walking.

What can be done if I have PAD?

Depending on the severity of blockage, a variety of things can be done ranging from medicine, angioplasty and stenting without any major surgery or bypass procedures.

The majority of patients do not require any intervention.  Instead, we focus on treating risk factors, like hypertension, diabetes, elevated cholesterol, and smoking cessation.  If intervention is required there are catheter techniques now that allow restoring of blood flow to the legs without having surgery.  In some cases bypass surgery may still be required.

Does insurance cover evaluation and treatment of PAD?