Varicose Veins: What Men Need to Know

Contributed by Wake Radiology

About five years ago, Dr. Steven Taylor noticed that he was developing varicose veins in his legs. It didn’t surprise him, as nearly everyone on his mother’s side of the family has them.

While he didn’t have any discomfort at first, throughout time his legs began to feel heavy and tired. As a dentist with a new private practice in the Triangle, Dr. Taylor spends his day sitting, standing or walking around the office. He had one thought: “You’re not supposed to have bulging varicose veins at age 37!” He took action by undergoing an evaluation and ultrasound to confirm what he suspected. In August 2009, he had two procedures to ablate a malfunctioning vein and remove the larger resultant varicosities.

“It was a simple outpatient procedure at Wake Radiology Interventional Services in Cary, and now the symptoms are completely gone. My legs no longer feel tired, and that’s a good thing,” noted Dr. Taylor, who is also an active dad to two boys – ages 3 and 4.

Dr. Taylor is not alone. More than 80 million Americans have symptoms related to venous insufficiency. While most think that it’s a problem primarily for middle-to-older age women, about 25 percent of patients are men. Women are more likely to develop problematic veins due to multiple risk factors such as hormonal influences during pregnancy, puberty and menopause and use of oral contraception. Men usually have a family history of the condition. Other contributing factors may include high blood pressure, being overweight, lack of exercise and smoking.

Most patients will first notice a slight pain or burning in their legs, followed by swelling, aching, throbbing, itching and heaviness in the affected area.

“While these symptoms are the same for both sexes, men are more likely to come in for an evaluation after the condition has worsened,” according to Susan Weeks, MD, interventional radiologist, at Wake Radiology, who specializes in minimally invasive vein treatments.

Dr. Weeks says that men more often present with increased pain, swelling, skin changes and difficult to treat ulcers. “We don’t want men to wait until their symptoms are debilitating or affecting their lifestyle. There are many therapies now that are much easier for the patient with fewer complications that give them a quicker return to normal activities.”

Veins run throughout the body as part of the circulatory system. They have one-way valves to direct blood back toward the heart. When the veins malfunction, they become engorged with blood, causing spider or varicose veins. Spider veins are smaller and form on the surface of the skin, while varicose veins are larger, superficial veins that can result in greater pain and discomfort. They appear twisted and ropey and are usually located on the calves, on the inside of the leg or lateral thighs.

Physicians normally diagnose malfunctioning venous valves through a combination of physical examination and ultrasound testing. In many patients, the secondary varicosities are readily visible, but ultrasound is used to identify the underlying malfunctioning superficial vein. Using sound waves through Doppler ultrasound, physicians can locate the precise point of the valve malfunction.

“Some patients come in with minimal pain or fewer symptoms, so we can prescribe more conservative treatments, including the use of compression hose,” explained Dr. Weeks. “These stockings compress the superficial veins to promote blood flow through the leg veins and prevent fluid accumulation.”

Dr. Weeks noted, however, these stockings do not cure the problem. In cases where the symptoms are more severe or compression hose are not sufficient, other treatments are required.

“We treat chronic venous insufficiency or valvular dysfunction by ablating the underlying problem vein, removing secondary varicosities through tiny access sites, and sclerosing any smaller varicosities or spider veins as needed.”

Dr. Weeks is a vascular and interventional radiologist and vein specialist at Wake Radiology Interventional Services in Cary. She graduated from the University of North Carolina School of Medicine and completed a residency and fellowship in vascular/interventional radiology at the University of North Carolina Hospitals.
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Common Procedures to Treat Varicose and Spider Veins

Endovenous laser treatment (EVLT) — a minimally invasive procedure using imaging guidance and laser technology. Ablates the main superficial veins to allow decompression of secondary varicosities and allows healthier veins to take over.

Sclerotherapy — an injection that irritates the lining of the vein and causes it to fibrose and be absorbed by the body. Used to treat spider veins and small to medium-sized varicose veins.

Ambulatory phlebectomy — an in-office procedure where medium and large varicose veins are removed through tiny puncture holes in the skin. The vein is hooked through the small opening and gently removed one section at a time.

Cosmetic laser technology — a topical laser is directed on small spider veins, causing them to seal and be absorbed by the body.

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