Southern NH Health Vein Clinic Care for Spider and Varicose Veins

Spider and Varicose Veins: Signs, Symptoms, and Solutions

In this episode of On Call with Southern New Hampshire Health, Dr. Luis Suarez of Mass General Vascular and Endovascular Surgery and Foundation Vascular Surgery discusses varicose and spider veins, plus the expanded minimally invasive services at Southern New Hampshire Health’s Vein Clinic that are making treatment easier than ever.

Complete Transcript: 

Scott Webb (Host): Veins serve important functions in our bodies, mainly to return blood to the heart. And when they aren't operating properly, we may experience pain, heaviness, or achiness, not to mention varicose or spider veins. Vascular surgeon, Dr. Luis Suarez, is here today to tell us about the Southern New Hampshire Health Vein Clinic and how he and the team there can help with venous disorders.

 This is On Call with Southern New Hampshire Health. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to get some information from you, and an update from you about the vein clinic. Tell us about the work that the vein clinic is doing, your work there, paint a picture for folks.

Dr. Luis Suarez: At the vein clinic, what we do is that we provide evaluation, diagnosis, and treatment for all venous disorders, with special focus on chronic venous insufficiency, varicose veins, and venous ulcers. But also, we see patients with venous obstructions or pelvic venous disorders. So basically, the whole range of venous disease.

Host: Yeah. And you touched on varicose there, but let's break this down. What are varicose veins? What are spider veins? Maybe you can tell us what they are and maybe what they're caused by.

Dr. Luis Suarez: Varicose veins and spider veins are unsightly dilated superficial veins that you can see under the skin of your legs, mostly below the knee, but also it can be on your thighs. And again, they range from thin and kind of blue-looking spider veins that look more like a sunburst appearance when they coalesce. Or you can have these large ropey veins or what we usually call varicose veins. They're very tortuous, kind of twisty-turny. And they can be accompanied by symptoms like pain, heaviness, achiness. Some patients can have itchiness too. And in the most severe cases, they can have wounds on their ankles or what we call venous ulcers.

And the reason why this is because most of them are secondary to something called venous insufficiency or venous reflux. What that means is that your veins are meant to bring the blood from your toes all the way inside your body and back to your heart. And in order to do that, they have little valves that open and close really fast within your veins. And in some patients, in about 10 to 30% of the population, these valves don't work very well, what they call a leaky valve. And what happens is that some of the blood that should be going up, it stays on your leg. And because of gravity, it kind of pulls down. When it pulls down, it increases the pressure on your legs, and the pressure kind of has to go somewhere. And that somewhere can present like leg swelling, but it can also present like dilated varicose veins.

Host: Yeah. And you mentioned there that they're unsightly, sure. So, some folks really don't like the way that they look, but it doesn't necessarily mean, right, Doctor, that there's any health implications, right? That anything needs to be done. But what I want to get a sense from you is, like, when would you recommend treatment for folks if they have some of these things like varicose veins?

Dr. Luis Suarez: There's a different range of symptoms that can present. And the treatment is recommended mostly for patients who have symptoms associated with these varicose veins. We also offer cosmetic treatments, and we can talk a little bit about that in the future. But the main indications for treatment is symptoms, right? So, those patients whose symptoms are interfering with their day-to-day activities, especially heaviness, achiness, and swelling, will benefit from treatment. It can range all the way up to these venous ulcerations, which are very detrimental to quality of life. Their wounds are very difficult to heal. So, we also treat those, but again, most of our patients present most of the time with just the varicose veins with the pain, heaviness, and achiness.

Host: And then I'm sure there's probably a range of treatment options, right? So, maybe you can give us an overview of the treatment options that are available, and maybe what the recovery time is. Like, how long are folks really off their feet, if that's even a thing?

Dr. Luis Suarez: Yeah. So, that's the good thing about the management of venous disease that have changed greatly in the past, you know, 15 years. And most of the treatments that we do now are minimally invasive, and they're office-based, so we don't even need to go to the operating room.

These treatments have different components. The most common treatments are what we call ablations. And what the ablations do is that they close the veins that are not working, to decrease that pressure that I was talking about before. So, when we identify veins that have these valves that are not working, we can close them with these ablation treatments.

These ablation treatments are done with just a small puncture somewhere around your knee area and with a catheter in a procedure that takes about half an hour to 45 minutes. And when we do ablations, the patient really doesn't need much time off. You know, usually, we tell them the time off is only the day of the procedure. But they can go back to their normal activities the same day, and they can go back to work the day after.

Host: That's amazing.

Dr. Luis Suarez: Sometimes we combine them with what we call phlebectomies, which is when we make small cuts to remove the varicosities themselves, when the varicosities are too large. These are very small cuts. They're about one to two millimeters in diameter. And we just basically pull the veins out. Like, I tell the patients, we like pluck them out, you know? And this treatment is also minimally invasive. It sounds like it's more, and it may hurt a little bit more in the recovery time. But usually, the time off from that procedure is about two days, two to three days tops.

Host: Sticking with the ablations, give us a sense, like thermal versus non-thermal. Like, take us inside there a little bit. How does all that work?

Dr. Luis Suarez: So, either you use heat or no heat, okay? The traditional treatments are done with heat. Those were the first ones that were designed. And there are two types with heat. You can either do radiofrequency, which is basically the technique you use to provide heat, okay? So, radiofrequency is a catheter that heats up a probe. And the probe is the one that burns the vein. You can use a laser, which is called endovenous laser treatment, where laser is a technique to provide heat.

The one that we offer in our clinic is radiofrequency ablation, which is one of the more widely used. The advantage of the thermal ablations is that they're very reliable and we're very good at them. We've been using it for many years, and they have a really high success rate of about 95-100%.

The disadvantage is that we can only use the procedure for the veins above your knee, okay? For the leaky veins above the knee, all right? But most of the times, that's enough treatment to improve your veins below the knee, okay? Now, because we're using heat around the veins, there are a lot of other structures, right?

As you can imagine, if you look at your legs, there's fat, there's skin, there's nerves, right? Those sorts of things. So, if we just burn the vein without protecting those tissues, then you can cause a lot of problems like nerve pains and skin burns. So, to prevent that, we use a medication called tumescent, which is like a liquid mix with numbing medications that we put around the vein to isolate it, to compress around the catheter. So basically, a patient doesn't feel any of that, and there are no consequences to burn the vein.

In those rare occasions where we need to treat the vein below the knee, so let's say a patient has, for example, a venous ulcer. So, we have to treat the whole leg. We cannot use heat because below the knee, the nerves get really close to the vein, so there's no way to separate them. So, in those occasions, we use the non-thermal techniques, which the two main two that we have is something called foam sclerotherapy or a glue. Basically, it's a crazy glue. It is a glue called cyanoacrylate, which is, if you look at the ingredients of the crazy glue, it's basically the same. And what we do is that these treatments, because they don't use heat, we can use them from below the knee. The disadvantage is that the results are a little bit less predictable and sometimes require multiple sessions.

Host: Okay. I just want to finish up today and get a sense from you about cosmetic venous procedures, right? I'm assuming you do those there. So, for some folks, obviously, they have signs and symptoms, things that affect their lives, but for others, or either way, you know, what can you do when people just don't like the way these things look. What do you do to help them?

Dr. Luis Suarez: So, we do offer that. The main treatment is mostly for what we call spider veins or reticular veins, which are the fine blue veins that you have under your skin. And we do something called sclerotherapy, which is a small injection. It basically feels like mosquito bites where we can inject the veins and the veins disappear.

It's a treatment that's very straightforward. You know, depending on the extent of what we do, it can take anywhere from 25 to 30 minutes. There's no downtime from work. It does most of the time require multiple sessions. Most patients will need two or three sessions to get the results that they like.

Host: Yeah. Yeah, well, it's always great to learn, Doctor, from experts. And you know, as we're saying here, like sometimes you'll have pain and achiness and heaviness. Sometimes it'll just be, "I don't like the way these things look." But either way, the Vein Clinic can help. So, thank you so much for your time today. I appreciate it.

Dr. Luis Suarez: Of course.

Host: And for more information, go to snhhealth.org/vascular. And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is On Call with Southern New Hampshire Health. I'm Scott Webb. Stay well, and we'll talk again next time.