Connecticut Image Guided Surgery

501 Kings Highway East, Suite 110, Fairfield, CT 06825
Tel  203.330.0248 | Fax  203.330.9730 | Email



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Venous Disease

General Questions

What is the main difference between arteries and veins?
In the simplest terms, arteries pump oxygen-rich blood FROM the heart, while veins return oxygen-depleted blood TO the heart.

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What are the three main categories of veins?
The three main categories are deep leg veins, superficial leg veins, and perforator veins. Deep leg veins return blood directly to the heart and are in the center of the leg, near the bones. Superficial leg veins are just beneath the skin. They have less support from surrounding muscles and bones than the deep veins and may thus develop an area of weakness in the wall. When ballooning of the vein occurs, the vein becomes varicose. Perforator veins serve as connections between the superficial system and the deep system of leg veins.

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What are varicose veins?
Varicose veins afflict 10% to 20% of all adults. They are swollen, twisted, blue veins that are close to the surface of the skin. Because valves in them are damaged, they hold more blood at higher pressure than normal. As a result, fluid may be forced into the surrounding tissue, resulting in pain, leg swelling and heaviness in the leg.

Unsightly and uncomfortable, varicose leg veins can promote swelling in the ankles and feet and itching of the skin. They may occur in almost any part of the body but are most often seen in the back of the calf or on the inside of the leg between the groin and the ankle. Left untreated, symptoms are likely to worsen with some possibly leading to venous ulceration.

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What causes varicose veins?
The normal function of leg veins is to carry blood back to the heart. This is true of both the deep veins in the leg and the superficial veins which feed them. For example, during walking, the calf muscle acts as a pump, contracting veins and forcing blood back to the heart.

To prevent blood from flowing in the wrong direction, veins have numerous valves. If the valves fail (a cause of venous reflux), blood flows back into superficial veins and back down the leg. This results in veins enlarging and becoming varicose. The process is like blowing air into a balloon without letting the air flow out again -- the balloon swells.

To succeed, treatment must stop this reverse flow at the highest site or sites of valve failure. In the legs, veins close to the surface of the skin drain into larger veins, such as the saphenous vein, which runs up to the groin. Damaged valves in the saphenous vein are often the cause of reversed blood flow back down into the surface veins.

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Why do they occur more in the legs?
Gravity is the culprit. The distance from the feet to the heart is the farthest blood has to travel in the body. Consequently, the vessels in the leg, especially the lower leg, experience a great deal of pressure. If vein valves can't handle it, the backflow of blood can cause the surface veins to become swollen and distorted.

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Who is at risk for varicose veins?
Conditions contributing to varicose veins include genetics, obesity, pregnancy, hormonal changes at menopause, work or hobbies requiring extended standing, and past vein diseases such as thrombophlebitis (i.e. inflammation of a vein as a blood clot forms). People tend to develop varicose veins

  • Between the ages of 30 and 70
  • During pregnancy
  • If a close family member has a history of varicose veins

Varicose veins developed during pregnancy often disappear within a year after giving birth; however, multiple pregnancies may increase a woman's risk of developing varicose veins. Additionally, women suffer from varicose veins more than men, and in people over age 50, the incidence of varicose veins increases to 50%.

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What are the symptoms of varicose veins?
Some of the symptoms of varicose veins may include:

  • A change in the appearance of the skin on the calf or leg
  • The appearance of small clusters of veins on the leg
  • An ache or heavy feeling in the affected leg
  • A burning sensation in the affected leg
  • A restless feeling in the affected leg
  • Night cramps

People with significant varicose veins may be at a slightly increased risk of deep venous thrombosis (DVT). DVT may cause unusual and sudden leg swelling, which requires immediate medical attention.

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What are venous leg ulcers?
Venous ulcers are areas of the lower leg where the skin has died and exposed the flesh beneath. Ulcers can range from the size of a penny to completely encircling the leg. They are painful, odorous open wounds, which weep fluid and can last for months or even years. Most leg ulcers occur when vein disease is left untreated. They are most common among older people but can also affect individuals as young as 18.

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What is the short term treatment for varicose veins?
ESES (pronounced SS) is an easy way to remember the conservative approach. It stands for Exercise, Stockings, Elevation, and Still. Exercising, wearing compression hose, and elevating and resting the legs will not make the veins go away or necessarily prevent them from worsening because the underlying disease (venous reflux) has not been addressed. However, it may provide some symptomatic relief. Weight reduction is also helpful.

If there are inflamed areas or an infection, topical antibiotics may be prescribed. If ulcers develop, medication and dressings should be changed regularly.

There are also potentially longer-term treatment alternatives for visible varicose veins, such as sclerotherapy and phlebectomy.

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What is sclerotherapy?
A chemical injection, such as a saline or detergent solution, is injected into a vein causing it to "spasm" or close up. Other veins then take over its work. This may bring only temporary success and varicose veins frequently recur. It is most effective on smaller surface veins, less than 1-2mm in diameter.

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What is ambulatory phlebectomy?
As with sclerotherapy, ambulatory phlebectomy is a surgical procedure for treating surface veins in which multiple small incisions are made along a varicose vein and it is "fished out" of the leg using surgical hooks or forceps. The procedure is done under local or regional anesthesia, in an operating room or an office "procedure room."

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How can I prepare for my appointment?
Please assist us by remembering to bring the following to your appointment:

  • Patient registration form, if requested by our office.
  • Referral form (for HMO insurance, if required).
  • Insurance cards and a means of identification such as a driver's license or social security card.
  • List of current medications you are taking including prescriptions, over the counter medications, and any herbs.
  • Relevant information about your medical and surgical history. Bring any pertinent x-rays or records you may have.
  • Important questions you would like to ask the doctor.

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How do I make an appointment?
Our office hours are 8:30 am to 5:30 pm, Monday through Friday. We have the utmost respect for everyone's time, and we do everything we can to make the best use of both your time and our physician's time.

If you ever feel that you are experiencing a medical emergency, do not hesitate to call our office, regardless of the day or hour. We have in place a system of physician coverage that ensures that urgent medical needs will be met.

Please call (203) 330-0248 to request an appointment. When you call, the scheduler will ask for the following information:

  • Your name
  • Your date of birth
  • Brief description of the reason for the appointment
  • Your Address
  • Home and alternate (work) phone numbers
  • Your primary physician or health care provider, and whether or not you would like us to send a report of your child's visit to that provider
  • Your Insurance or HMO information

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How do I reschedule or cancel an appointment?
Usually you must give us 48 hours notice so that we may allow other patients the opportunity to take your appointment and, if necessary, reschedule your visit. However, it is most courteous to call as soon as you realize you must reschedule or cancel. Please try to be on time for your appointment. If you are running late, call ahead and let us know your estimated time of arrival.

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