Melanie Nukala, MD, vascular surgeon, discusses varicose veins.
What are varicose veins?
Varicose veins are caused by incompetency of the valves of the veins. Arteries have high blood pressure to allow blood to go all the way down to your feet, but veins are a very low pressure system, so they rely on valves throughout the entire course of the vein to get blood back up to your heart. As we walk or move around, our muscles squeeze, which causes the blood to move through the veins and then the valves shut, which through a stepladder kind of pattern is able to get back up to the heart. When there’s incompetency of the valves for many different reasons—familial, high levels of progesterone during pregnancy, standing on your feet all day for your job—the pressure that’s on the valves ends up causing the veins to dilate. The valves are no longer able to completely shut, which then causes them to be leaky. It allows the blood to go back toward your foot, which is where it never should go. It should always be headed toward your heart. What that ends up doing is causing the vein to dilate even more and even more valves become incompetent. Then you can end up getting the varicose veins, the ropey veins that you see on some people’s legs.
What is a venous system?
Our legs have two sets of venous systems. We have a superficial venous system and a deep venous system. The deep venous system is involved when people have a blood clot in their legs which are the ones we’re concerned about after going on a long flight, for example. The superficial system is the one where you can see the varicose veins. So as long as the deep system is open and competent, you can shut down the superficial one without any concerns or problems.
How can varicose veins be repaired?
The first thing that we start off with is compression stockings. We always want our patients who have varicose veins or who are on their feet for a constant period of time to be wearing compression stockings. That pressure always pushes on the veins and doesn’t allow them to fully dilate or become incompetent if you’re trying to prevent varicose veins. If you already have varicose veins, then we can offer endovenous laser ablation. We puncture the vein and take a laser fiber up to the area of the groin where the vein starts and cause it to clot off from the inside. Then, over time, it usually just shrinks down and goes away, and all those ropey veins that you see on the legs are gone.