Below are actual patients of Montana Vein Clinic presented to show some of the more common problems people have with varicose veins. The pictures are untouched and, of course, personal information has been withheld to protect patient privacy.
Symptoms & Treatments for:
Patient 1: Male, Age 47
Varicose Veins with Leg Discomfort
Description: Construction worker. Has aching and heaviness particularly after standing on his feet all day.
Results: In 3 days he was back on the job site at light-duty. In 2 weeks was back at full activity with almost complete resolution of leg discomfort.
What was done: Treated with combined greater saphenous radiofrequency ablation and phlebectomy.
Dr. Grace commentary: This is one of the most common presentations we see: middle-aged, full-time worker, progressive visible varicosities and bothersome, but not disabling, leg discomfort. After treatment of the underlying cause (saphenous reflux) and removal of the large superficial veins most get significant relief. Also important for maintaining healthy legs is regular use of graduated compression stockings particularly during times of prolonged sitting or standing.
Patient 2: Female, Age 33
Varicose Veins and Pregnancy
Description: Mother of 3. Active runner, training for a marathon. Last pregnancy 3 years ago.
Varicosities appeared during her second pregnancy and got significantly worse with her third pregnancy. Symptoms are exacerbated by standing and running and include warmth, pain, and a pulsing sensation where the veins bulge under the skin.
Results: Started short runs in 10 days and distance training in 3 weeks.
What was done: Treated with endovenous laser ablation and phlebectomy.
Dr. Grace commentary: Pregnancy is the second biggest risk factor for varicose veins behind genetics. Each additional pregnancy increases the risk for developing varicosities. Although varicosities associated with pregnancy can improve, if veins are still present 6 months after delivery it's unlikely they will resolve. Treatment after all pregnancies are complete is a common approach; however, treatment between pregnancies can also be done and lowers the severity of vein problems with additional pregnancies.
Dr. Grace commentary: Phlebitis is common complication of varicose veins and a frequent reason people are referred to Montana Vein Clinic. Initial management is conservative with graduated compression and over the counter analgesics. Ultrasound documents the extent of the blood clot and identifies other poorly functioning veins. Phlebitis often causes localized discomfort, but the blood clot eventually gets absorbed by the body. Treatment is indicated to help to prevent recurrent episodes.
Patient 3: Female, Age 55
Phlebitis - A Complication of Varicose Veins
Description: Enlarging lower leg varicose veins present for many years. Superficial blood clot happened after sitting for a 2 day car trip, and the same thing happened 5 years ago.
Results: Phlebitis resolved with conservative treatment. After vein treatment no additional episodes of phlebitis (7 years to date).
What was done: Ultrasound showed localized clot in superficial varicosities, no deep vein blood clots (DVT), and saphenous insufficiency. The phlebitis improved with graduated compression and ibuprofen and she was subsequently treated with radiofrequency ablation and phlebectomy.
Patient 4: Female, Age 69
Early Treatments with Endovenous Ablation Only
Description: Long-standing varicose veins in the left lower leg, veins seemed to get worse after knee replacement surgery.
Her primary complaints were itching and burning around the visible veins and mild ankle swelling.
Results: Excellent relief of symptoms and very good improvement in visible varicosities.
Patient 5: Male, Age 61
Early Treatments with Endovenous Ablation Only
Description: Enlarging large superficial veins, minimal symptoms except for mild leg heaviness with standing.
Results: excellent relief of symptoms and very good improvement in visible varicosities.
What was done: Both were treated with greater saphenous laser ablation only.
Dr. Grace commentary: These two cases, each almost 10 years old, are included to show the evolution of technique and the results using only endovenous ablation. Years ago a ‘staged’ treatment approach was common, with ablation done first and phlebectomy done weeks or months later. As seen here saphenous ablation alone often gives partial improvement of visible varicosities. Staged phlebectomy was declined by these patients as they were happy with their symptom relief. Today, a combined endovenous ablation and phlebectomy would be done giving both symptom relief and a superior aesthetic result.
Patient 6: Female, Age 81
Skin Changes from Venous Hypertension
Description: skin darkening around the ankle and a recurrent skin ulcer. Has been able to get the ulcer to heal but it comes back every year or two. No prior varicose vein treatments.
Results: Within 4 weeks of treatment the ulcer healed, no recurrence at 6 years.
What was done: Greater and short saphenous vein insufficiency treated with laser ablation
Dr. Grace commentary: Advanced venous disease only happens in a small percentage of people with venous insufficiency. Findings include skin thickening, a brownish discoloration, and ulcers which most commonly occur around the inner ankle. Regular use of a graduated compression stocking is most important to help healing, but varicose vein treatment can help prevent the ulcer from coming back.
Patient 7: Female Age 50
Spider vein ‘clean up’ after large vein treatment
Description: Finished large vein treatment and has residual small varicose veins in both legs. Desires treatment of residual spider veins.
Results: Near complete resolution of small veins in the areas treated.
What was done: One session of visual sclerotherapy
Dr. Grace commentary: Many people present with a combination of large veins and smaller spider veins. Treatment of the larger veins is always completed first and sometimes the spider veins will decrease in size. After large vein treatment small veins respond better to treatment with sclerotherapy. Spider veins treatment is optional and it is often done to improve leg aesthetics. Spider veins can get more numerous over time but they do not turn into large veins.
Patient 8: Female, Age 55
Leg Pain, Prior Vein Treatment, & No Visible Varicose Veins
Description: has had lower leg and thigh pain recurring after varicose vein treatment at an outside facility 3 years ago
Results: successfully re-treated using laser ablation, this gave 80% relief of symptoms.
What was done: Ultrasound showed old clot in the saphenous veins - most consistent with opening of previously treated veins. Both veins were able to be successfully re-treated using laser ablation.
Dr. Grace commentary: Only one picture here since there isn’t much to see on exam. The key is the patient’s symptoms and the ultrasound findings. Vein ablation is highly successful however occasionally previously treated veins can open. Re-treatment can be technically difficult because of changes in the vein from prior treatment. The important point here is that the symptoms can sometimes be the only signal of underlying vein problems.
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