By KATHY RICKETTS
The Daily Gazette

Tuesday, March 13, 2007

Bea Girard was tired of the constant throbbing pain in her legs.

"For the past few years, one vein in particular was really burning and sore," said Girard, 63 who lives in Stillwater. "I am very active and enjoy walking and jogging, and I had to do something."

Girard decided to have a consultation with Dr. Frank G. Fort of the Capital Region Vein Centre on Union Street in Schenectady.

Fort, a vascular surgeon for some 20 years, said that varicose veins are the most common vascular problem of the leg affecting more than 40 million people in the United States. Varicose veins are a chronic progressive disease that causes veins to weaken, bulge and balloon up with blood.

"The valves inside these veins no longer close, allowing blood to leak back down the leg, producing a distention of the vein," said Fort.

This is known as reflux.

Fort will discuss "It's Not All in Vein," at 7 p.m. Wednesday, Mar! ch 21, at Bellevue Woman's Hospital. The program is free.

While varicose veins are primarily a cosmetic concern, they can cause pain, leg heaviness, fatigue, itching, night cramps, restless legs and leg swelling. In addition, varicose veins increase the risk for phlebitis, an inflammation that can lead to a potentially fatal blood clot.

Pressure builds

Most often found below the knee, varicose veins range from tiny red spider veins to large blue, bulging and twisted varicosities close to an inch in diameter. The exact cause is not known, but heredity is the No. 1 contributing factor.

Varicose veins result from weakness of the vein wall and nonworking vein valves called leaky valves. Other factors include prolonged standing or sitting, pregnancy and aging.

"The reason we see them more often below the knee is because the vein is like a tube," Fort explained. "So there is always more pressure at the bottom part of the leg than the top."

There is no complete cure for spider or varicose veins, said Fort.

"If you don't treat the problem right to begin with, on top of progression of the disease, you will get recurrence," he explained.

Fort said varicose veins are often caused by an underlying problem leg vein -- often the saphenous vein, which ! starts at the foot and runs up the inside of the leg to the groin area. A painless noninvasive ultrasound test is usually done to determine if an underlying source exists.

While normal veins have one-way valves that allow blood to flow only upward to return to the heart and lungs, a varicose vein has valves that are not functioning properly. The blood can flow upward but tends to pool in the vein because of valve dysfunction. The varicose veins bulge because they are filled with the pooled blood.

"What you treat should be gone within three to four months, and you should have no immediate recurrence of the problem," Fort explained. "

That doesn't mean the disease won't progress. I tell people whether you treat them or don't treat them, you will get more as time goes on but it is a very slow process. Vein disease does not happen overnight. It is a cumulative effect of many years."

Fort said treatment of vein disease has advanced considerably in th! is country during the past 10 years.

"What doctors u! sed to d o in the past is make an incision, tie the saphenous vein just before it met the femoral vein and remove it through a bunch of large incisions leading up the leg into the groin region, leaving scars that left the leg looking worse."

Closure procedure

Fort said one of the newest and most patient-friendly, nonsurgical procedures is called the Closure procedure. That treatment, which is covered by some health insurers, is appropriate for people whose large varicose veins are caused by backflow of blood in the saphenous vein.

Using ultrasound and performed on an outpatient basis under local anesthesia, the surgeon positions a tiny catheter into the nonworking saphenous vein through a small nick in the skin.

The tiny catheter is advanced up the leg into the groin region. It then delivers radio-frequency energy to the vein wall.

As the energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is rerouted to other healthy veins.

Patients do not need bulky bandages or to wear heavy compression stockings. A simple bandage is placed over the! insertion site and the patient leaves the hospital in less than an hour with no pain, bruising or swelling. One can resume all activities including exercising and work the next day.

"Over a period of six months to a year, the vein disappears as if you had stripped it but without all that tissue trauma that causes pain and disability," said Fort.

Sclerotherapy

Fort said another procedure is called sclerotherapy. That involves injecting a solution into an abnormal vein. This damages the lining of the unhealthy vein, causing it to scar down and collapse. The varicose vein, over time is absorbed by the body's own healing mechanism and is removed from the circulation. Blood is automatically rerouted through normal, healthy veins.

Blue varicose veins take 10 to 12 weeks to disappear, and red spider veins take about 12 to 16 weeks to go away.

Following sclerotherapy, which is usually not covered by insurance, patients may experience redness and swelling of the skin and itching, which takes several hours to disappear.

In each session, a multiple number of veins can be safely injected. The sessions are done at weekly intervals.

People who had varicose veins removed are asked to wear compression stockings for several days. Spider veins do not require compression stockings.

Patients predisposed to forming varicose or spider veins will continue to form new ones over time, and further injections may be required in the future.

Ultrasound guided sclerotherapy and YAG laser treatment are also used for appropriate candidates.

"What I want to make clear is that varicose veins are not just what you see," said Fort. "It's a network. If the source of the problem is either in the saphenous vein or elsewhere, you have to treat the source. In other words, you have to get rid of the leak in the roof before you treat the carpet so it won't be ruined with the downfall of water. That is very important."

Pleased with results

Girard, who recently started working as a classroom aide in Stillwater, had the Closure therapy and sclerotherapy done on both her legs three weeks apart in January and early February.

"I was amazed," said Girard, who may need to have more work done in the future. "I had no pain. The next day I was walking. Visually, it looks much better now, but in three months it will look even better, and I am much more comfortable now. I don't have a lot of pain in my legs any more."