There are two common myths about veins in the leg that become swollen and stretched, or varicose, and they sometimes keep people from getting necessary treatment: Treatment for varicose veins is mostly for cosmetic reasons, and sore, achy legs with bulging veins are the result of standing or sitting too long.
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The truth behind the first myth is that cosmetic treatments are primarily linked to spider veins, which often cover the legs and even the face. They are damaged veins that appear to be similar to varicose veins, only thinner, according Dr. Adam Keefer, a board-certified vascular surgeon and varicose vein expert at Coastal Vascular & Vein Center in Charleston.
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Though spider veins may be associated with varicose veins, the issue is seen as cosmetic, and treatment is elective.
“Sore, achy legs, bulging veins and even open wounds that won’t heal, in truth, are often signs of a more serious medical condition,” Dr. Keefer said.
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Veins can become varicose when the valves that control blood circulation are damaged or diseased; they weaken and no longer do their job. Instead of blood moving toward the heart like it should, blood stays in place and pools in the vein of the leg.
“A leaking vein could be a sign of chronic venous insufficiency, or CVI; liver disease; heart disease; or blockages,” Dr. Keefer explained.
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CVI is a progressive medical condition in which the valves that carry blood from the legs to the heart no longer function, causing blood to pool in the legs and veins to swell. There are several contributing factors to varicose veins and CVI, including pregnancy and heredity.
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Dr. Keefer and the Coastal Vascular & Vein Center team do a lot of arterial and venous work; treatments for varicose veins is one branch of that work. For Dr. Keefer, “one of the biggest rewards in varicose vein work is being able to give people a lot of relief in a relatively short amount of time.”
“There is also reward in being able to heal chronic wounds that have bothered a patient for more than a year,” Dr. Keefer added.
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Compression stockings often are the first option to manage symptoms, and there are a variety of other therapies.
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Many times, a problem can be fixed before a patient goes home.
“Patients can walk in and walk out. It’s that simple,” Dr. Keefer said.
Initially, one of Dr. Keefer’s patients felt anxious about her varicose veins and treatments, but she left CVVC giving the whole experience “an 11/10.”

Dr. Keefer offered several proactive measures that people can take to avoid vein issues, including:
• Exercise regularly to increase the blood flow in your legs;
• Maintain a healthy weight;
• Elevate your legs in the evening;
• Wear compression stockings if you are on your feet or
sitting a lot.

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THE SIGNS AND SYMPTOMS OF CVI
Without treatment, people with CVI may experience progressive symptoms that can be debilitating and signifi- cantly impact quality of life. People who suffer from CVI may experience:
• Leg heaviness or tiredness; • Leg or ankle swelling;
• Varicose veins;
• Itching, restless leg;
• Skin changes or rashes;
• Brown, colored skin on leg;
• Ulcers, open sores;
• Leg pain, aching or cramping.

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MINIMALLY INVASIVE TREATMENT OPTIONS
ENDOVENOUS THERMAL ABLATION
Endovenous thermal ablation is a minimally invasive treatment that involves the insertion of a thin, flexible tube called a catheter into a diseased vein to seal it shut using heat. Blood that would normally return to the heart through these veins will then travel through other veins instead, as is the intent with all treatments listed. The treated vein dries up, shrinks and is absorbed by the body. Two types of thermal energy may be used:
• Radiofrequency ablation uses radio frequency ener- gy to provide uniformly distributed heat to contract the collagen in the vein walls, causing them to collapse and seal off. An example of this treatment option is the ClosureFastTM RFA system.
• Laser ablation delivers laser energy to heat the blood, causing it to coagulate and close off the diseased vein.

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NONTHERMAL TREATMENTS
Endovenous nonthermal treatments use a minimally in- vasive approach that involves insertion of a catheter into the diseased vein. With nonthermal methods, tumescent anesthesia is not needed.
• Mechanochemical ablation uses a rotating catheter inserted into the vein to scar the vein walls as a scle-
rosant medication is injected through the catheter to
close the vein.
• Injectable foam sclerotherapy uses polidocanol in-
jectable microfoam through a catheter inserted into the diseased vein to fill and collapse the vessel.

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NONTHERMAL, NONTUMESCENT AND NONSCLEROSANT TREATMENT
The VenaSealTM closure system is the only approved treatment that is nonthermal, nontumescent and nonsclerosant. It uses a proprietary cyanoacrylate adhesive delivered through a catheter into the diseased vessel. The VenaSeal procedure closes the vein by sealing it with a combination of the adhesive and external compression.

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SCLEROTHERAPY
Sclerotherapy is a varicose and spider vein treatment in which a chemical solution is injected into problematic veins. This solution irritates the vein lining, causing it to undergo fibrosis and eventually disappear so abnormal veins can no longer fill with blood. In a few weeks, the diseased vein will be absorbed by the body. Multiple treatments may be needed to close the damaged vein. Vein specialists will often use sodium tetradecyl sulfate– SotradecolTM* – or polidocanol (AscleraTM*) treatments, which can be done in a doctor’s office without anesthesia.

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