What Are Varicose Veins?A condition called venous insufficiency causesvaricose veins. This is an abnormal circulatorycondition with decreased return of blood from legveins up to the heart, with pooling of blood inthe veins. Varicose veins are prominent, superficialveins that have lost their valve effectiveness and asa result of dilation under pressure, have becomeelongated, bulged and thickened close to theskin’s surface. Any vein may become varicose,but the most commonly affected areas are thelegs and feet.

What Is Venous Insufficiency? As blood flowsthrough your veinsfrom your legs upto your heart,stop valves in yourveins are supposedto close to keepblood from flowingdownward withgravity. As you age,your veins can loseelasticity, causingthem to stretch. When the valves in the veinbecome weak and do not close properly, theyallow blood to flow backwards, or reflux, andpool in the veins. This forces the vein walls toenlarge and bulge out. This abnormal circulatorycondition is called venous insufficiency.

What Are the Symptoms?For many people, varicose veins and spider veins— a common, mild and medically insignificantvariation of varicose veins — are simply acosmetic concern.

For other people, varicose veins may cause any orall of the following symptoms:

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Inova Alexandria Hospital islocated 4 blocks east of I-395at 4320 Seminary Road.

Cardiovascular and Interventional Radiology at Inova Alexandria Hospital

VaricoseVeinswithout

Surgery or Scars

TreatingInova Health System is a not-for-profit health care system based inNorthern Virginia that consists of hospitals and other health servicesincluding emergency and urgentcare centers, home care, nursinghomes, mental health and blooddonor services, and wellness classes.Governed by a voluntary board of community members, Inova’smission is to provide quality careand improve the health of thediverse communities we serve.

www.inova.org

G22399/6-04/3,000

4320 Seminary RoadAlexandria, Virginia 22304

703-504-3000

Varicose Veins• aching pain, fatigue or heaviness in the leg• burning, throbbing, cramping or swelling in the leg• enlarged veins readily seen under the skin

of the leg• brownish-gray discoloration or ulceration on the

lower leg• itching around a vein

Some people may not have visible varicose veins butstill experience symptoms caused by dilated veins, aswell as spider veins, that place pressure on their nerves.Often symptoms of varicose veins worsen as the dayprogresses. Many people who experience thesesymptoms find they need to sit down in the afternoonand elevate their legs to relieve their discomfort.

Severe cases of venous insufficiency can cause skindiscoloration, ulceration or swelling, which requireimmediate medical attention.

Who Is at Risk for Varicose Veins?Risk factors include age, family history, femalegender and pregnancy. In women, pregnancy,especially multiple pregnancies, is one of the mostcommon factors that accelerates the worsening ofvaricose veins. Additional factors that do not causevaricose veins but may speed or worsen theirdevelopment include obesity, prolonged standing orphysical trauma to the lower limbs. Varicose veinsaffect one out of two people age 50 and older, and15 to 25 percent of all adults.

How Is Venous Insufficiency Diagnosed?An ultrasound test is used to painlessly map the veinsof the legs to assess vein anatomy, vein valve functionand blood flow changes.The saphenous veins and alldeep and superficial veins of the legs are examined todetermine if the veins are open and to identifyreflux. This test will help your interventionalradiologist determine the most appropriate treatmentoptions for you.

Image courtesy and copyright of Diomed Inc.

Excerpts in this brochure werereprinted with permission of theSociety of Interventional Radiology©2004, www.sirweb.org.

Is the Loss of this Vein a Problem?No. After treatment, the blood in the faulty veins is diverted to the many normal veins in the leg,re-establishing normal flow.

What Happens After the Procedure?After the procedure, your doctor may ask you to walk,wear compression stockings and refrain from rigorousactivity for a period of time. Many patients resumenormal activities within a day, with little or no pain.There is no scar because the procedure does notrequire a surgical incision.

What Are the Complications of thisProcedure?You may experience the discomfort of minor sorenessand bruising, which can be treated with over-the-counter, non-aspirin pain relievers as needed. Fewpatients also experience numbness, which passes quickly.You should talk with your doctor about the possiblecomplications if any procedure you may choose.

How Successful Is Vein Ablation?More than nine people out of ten who have had veinablation remain reflux free for nearly two years.This isa higher efficacy rate than surgical vein ligation orstripping.

Does Insurance Cover EVLT® and VNUS® Closure®?Many insurance carriers cover EVLT® and VNUS® Closure®, based on medical necessity andsymptom relief.

Treatment Options

How Are Varicose Veins Treated?People who experience mild symptoms can easetheir discomfort by following a few simple lifestylerecommendations. These include exercisingregularly, maintaining a healthy weight, wearingloose-fitting clothes, elevating the legs during rest,wearing elastic support stockings and avoidinglong periods of standing or sitting.

However, if you experience severe symptoms,it may be necessary to medically treat yourvaricose veins. Your physician can help youdecide which treatment is best for you based on the size and type of veins affected and theseverity of your symptoms. Your options mayinclude the following:

• Vein ligation or stripping are surgicalprocedures that remove or “strip” faulty veins from the leg.These procedures can bepainful, have a long recovery time, and canresult in the recurrence of varicose veins.

• Ambulatory phlebectomy is a minimallyinvasive surgical technique used to treat varicoseveins that are not caused by saphenous veinreflux. The varicose veins are removed througha series of tiny skin punctures.

• Sclerotherapy is the injection of a vein-shrinking solution that is used to treat spiderveins and very small varicose veins.

• Vein ablation (Endovenous Laser Treatment(EVLT®) and VNUS® Closure®) is a minimallyinvasive alternative to surgery that uses laser orradiofrequency energy to close faulty veins toeliminate bulging and symptoms while leaving thevein in its place. This causes much less trauma tothe leg and fewer side effects than surgery.

Vein Ablation

How Is Vein Ablation Performed?This minimally invasive treatment is an outpatientprocedure performed by an interventional radiologist - a doctor specializing in the use of imaging techniques tosee inside the bodyand treat conditionswithout surgery.

During vein ablation,the interventionalradiologist applies alocal anesthetic to theskin, then inserts a thincatheter, about the sizeof a strand of spaghetti,into the vein.Thecatheter is insertedthrough a tiny entrypoint, usually near theknee. Using imagingguidance, the catheteris guided up thegreater saphenous vein in the thigh.Then laser orradiofrequency energy is applied to the inside of thevein, heating and shrinking the vein walls, causing themto seal the faulty vein so blood cannot flow through it.By closing the greater saphenous vein, the varicose veinsshrink and improve in appearance.The treatment takesless than one hour.

Inova Alexandria Hospital’s interventional radiologistsperform both Endovenous Laser Treatment (EVLT®) and VNUS® Closure® radiofrequency vein ablationprocedures to treat varicose veins.

Targeted Treatment

Cardiovascular andInterventional Radiology atInova Alexandria Hospital

Inova Alexandria Hospital’s Cardiovascular andInterventional Radiology program treats avariety of medical conditions withouttraditional surgery.

Our nationally recognized, board-certifiedinterventional radiologists perform minimallyinvasive procedures using small incisions, tinyinstruments and imaging techniques.Theseprocedures are generally less traumatic topatients than surgery, and result in less painand shorter hospital stays.

Our interventional radiologists performedthe first peripheral and renal angioplasty andstent placement in Northern Virginia. Ourteam also performed the first abdominalaortic stent graft in Northern Virginia.They were some of the first doctors in theMid-Atlantic Region to perform uterinefibroid embolization (UFE), and have one ofthe largest and most successful UFE programsin the country.

Our interventional radiologists are experts attreating varicose veins, peripheral vasculardisease (PVD), spinal bone fractures, abdominalaortic aneurysms and stroke. Each year theyperform thousands of procedures. For moreinformation, call 703-504-7950 or visitwww.inova.org.

For more information or to make an appointment, call

703-504-7950.

Image courtesy and copyright of Diomed Inc.

Saphenofemoraljunction

Femoralartery

Femoralvein

Greatersaphenous

vein

Posteriormedial tributary

Laser fibre