Varicose veins aren’t just unsightly, says vein doctor David Engleman.   They’re an inherited, progressive condition that can become serious over time.   We asked Dr. Engleman to answer some of the questions you might be asking yourself if you have varicose veins.   Dr. Engleman graciously spent time with us to share his expertise and talk about what a good vein doctor can do to help with venous diseases.

1.    What are the main reasons a person with varicose veins should speak to a qualified vein doctor?

Varicose veins don’t get better by themselves.  Conservative approaches such as wearing compression stockings and making correct lifestyle choices can slow the progression.  But without treatment, the veins will continue to worsen—frequently to the point where they become symptomatic and more difficult to address.  Worst cases can lead to irreversible changes to the skin and the veins, and to some degree to the lymphatic system.

Besides potentially leading to leg ulcers and hyperpigmentation (discoloration), some cases may lead to superficial thrombophlebitis—clotting off of the veins.  That condition is associated with an increased risk of deep vein thrombosis (DVT), a potentially life threatening condition.  A recent study scanned the deep vein systems of people with the condition and revealed they had a substantial risk of DVT.  This can be true even if you are feeling no symptoms.  Because every person is unique, only a qualified vein doctor can give you an accurate diagnosis.

2.    How do people know if a vein center is reputable?

To evaluate the work of a vein center, first ask if they are able to perform a complete vein-mapping study.  That means it should be done with the legs down, while you’re standing up.  I don’t recommend having an ultrasound while you’re lying flat.  Your vein doctor should do a full mapping study with ultrasound to detect venous insufficiency.  It may also be helpful to do a flow augmentation maneuver, which means manually compressing your legs or using cuffs to check for backflow.

It’s also important to make sure whoever is performing the venous treatment is also able to treat the whole problem completely.  That is, the clinic shouldn’t just do EVLT or radiofrequency ablation on the greater saphenous vein (the vein most often afflicted).  The clinic should be able to perform follow-up treatments on smaller tributaries, procedures such as microphlebectomy or ultrasound-guided foam sclerotherapy.  These can take care of smaller branches that can’t be treated with laser.  Seventy percent of cases of varicose veins come from leaking of the greater saphenous vein, but there can be other veins leaking as well.  It’s important to treat all the vein issues.

3.    Many people with varicose veins hate the way these veins look.  How do you help?

Treating varicose veins for cosmetic reasons often ends up surprising people.  They may not have been having symptoms or may have had vague symptoms—heavy feelings, legs tired at the end of the day—and they didn’t realize the varicose veins were the cause.  Then after they treat the appearance of the veins, their legs suddenly feel much better—they’re more energetic and don’t tire as easily.  The primary goal in all vein treatments is to lower the pressure in the veins by closing off the incompetent veins.  Cosmetic improvement is a side effect.

4.    What do you recommend if a person has large varicose veins but they don’t hurt?

It is always a good idea to have varicose veins evaluated with an ultrasound and a full exam.  Meet with the vein doctor to talk about how severe the insufficiency is.  If it’s not very serious, your doctor may recommend therapy and observation to help slow the process of degradation.  Your condition may not need treatment, or you may want to treat one leg and watch the other.  Once we fix a bad leg, sometimes patients feel so much better that they notice symptoms in the other leg they hadn’t noticed before.

5.    What do you advise for people over 50 who have large varicose veins?

Evaluation is always valuable.  You may have minimal symptoms, but your skin could be changing.  Skin changes can lead to significant medical problems.  And even without symptoms, some situations may call for treatment if the reflux is severe.  Only a qualified vein doctor can tell you the right thing to do for your unique situation.

6.    How hard is it to find certified vein specialists in Dallas/Fort Worth?

It can be confusing for patients.  Treatment options have improved in the last 5 to 10 years, and a lot of patients aren’t aware of newer procedures.  In fact, most primary care physicians are not aware of the new options, let alone where to send people.  Frequently I have patients finding me through the Internet when their family doctor doesn’t know where to send them.  Sometimes patients get sent to someone who tells them the only option is to get surgical stripping—which is not true.  Even the medical community is not that well educated.  Patients themselves are savvier these days.  They’re getting online and finding vein centers like mine.  I’ve even had doctors find me through the Internet.  I’m treating a doctor who’s been wrapping his legs with ace bandages for 15 years.  He thought his only option was vein stripping, a difficult surgical approach that isn’t required for most cases today.

I am a board certified interventional cardiologist who also holds board certification in the interventional treatment of peripheral vascular disease.  Many people would not know to look for those types of qualifications.

7.    Which Dallas/Fort Worth and surrounding area hospitals are you affiliated with?

Baylor Plano (The Heart Hospital), Baylor Carrolton.  But all my venous work is done in my clinic, Bella MD Laser Vein and Aesthetic Center in Dallas.

8.    What’s endovenous laser treatment, and how long should people plan to be out of work after receiving it?

Endovenous laser treatment is a minimally invasive treatment done through an IV access site with local anesthetic.  Using laser energy we’re able to close the bad vein in an outpatient setting with minimal downtime for the patient.  The type of work you do will determine how soon you can go back to work, but almost everyone can resume normal daily activities immediately with only mild to moderate discomfort for 3 to 5 days.

9.    Does sclerotherapy really get rid of spider veins?

Yes, we use it for cosmetic spider veins, and we also use transcutaneous YAG laser treatment for small spider veins.  Which treatment we recommend depends on the size and the depth of the vessels.  Both are effective, and results improve with multiple treatments in a series of two to three, spaced about a month apart.  Most patients experience a 50 to 80 percent improvement.

10.    What advice do you give women who develop varicose veins during their pregnancies?

The most important goal is to have a safe pregnancy.  What we usually recommend is conservative treatment during the pregnancy—elevating your legs and wearing graded compression stockings for support.  Then three to four months after delivery, we re-ultrasound to see if there is a continued insufficiency and then decide whether something should be done.   Most of the time veins worsen during pregnancy.  Then they improve within a month or two after delivery but are usually worse than before the pregnancy.  Subsequent pregnancies will lead to continuing gradual deterioration.  But for most women, there’s no need to wait until childbearing is past to have their veins fixed.  Once they’re repaired, at the next pregnancy the varicose veins either won’t be there at all or will be less likely to become serious.

To learn more about Dr. Engleman and his practice, visit Bella MD Laser Vein & Aesthetic Center.

Barbara Payne
Vein-Treatment.com Blogging Team

Image credit: Bella MD, Laser Vein & Aesthetic Center