At the Inovia® Vein Specialty Centers, our focus is exclusively on the treatment of varicose veins.
At our vein centers in Bend, and Tigard, Oregon, varicose veins are one of the most frequently treated venous diseases. Varicose veins are swollen bulging veins under the surface of the skin that can be dark purple or blue in color. Although varicose veins can occur anywhere in the legs, they most often occur in the calves and behind the knees. Varicose veins are often due to incompetent valves in the veins which allow the blood to pool and stretch out the veins below.
The function of veins is to bring blood back to the heart. Because the veins of the legs work against gravity, they contain one-way valves to prevent the blood from flowing backward as it travels back to the heart. If the one-way valve becomes weak, some of the blood can leak back down the vein, causing the veins to become pressurized in the veins. This causes what is known as vein reflux, or venous reflux. With venous reflux, veins start to bulge out on the legs.
Causes of Varicose Veins
Venous reflux is a condition that develops when the valves that usually keep blood flowing out of your legs become damaged or diseased. When this occurs in the superficial veins, the congestion will cause the veins to abnormally enlarge, which in turn leads to either varicose veins and/or spider veins. When this happens over the long term, complications such as thrombophlebitis, deep vein thrombosis, chronic venous stasis disease and venous stasis ulcers can occur.
While many varicose veins are asymptomatic, patients with bulging veins often complain that their legs feel heavy, or ache, and often their legs throb or feel more uncomfortable as the day goes on. Typically, these symptoms are worse at the end of the day and with prolonged standing. It is thought that these symptoms are due to a stretching of the veins as the blood abnormally pools in the leg vessels when the patient is standing.
For many patients, an office evaluation by a vein specialist is all that is needed to determine the extent of the varicose and spider veins. At our Oregon vein centers, this is the first step in developing an initial treatment plan.
In other patients, however, there is evidence that some of the larger superficial veins might be incompetent and contribute to the visible varicose veins. When this is suspected, a detailed examination using a sophisticated Duplex Doppler ultrasound scanner is done to ‘map’ the points of venous insufficiency and characterize the size and location of vessels.
This non-invasive test, performed in the office setting, allows the treating physician to better characterize the extent of the problem and develop a treatment plan that will minimize the chance of recurrence and maximize the potential to obtain the best results. Ultrasound is also used after treatments to monitor progress, rule out complications, and assure optimal results. All this is performed on site in our vascular laboratory.
Recurrent Varicosities After Surgery
At our practice, we frequently see patients who have had previous vein stripping or ligation. Unfortunately, recurrences of varicose veins in our Oregon patients are common after previous vein ligation stripping and avulsion.
Current theories of why varicose veins recur after previous vein ligation and stripping relate to the concept of neovascularization. This is especially common after a formal saphenofemoral junction (where the superficial and deep veins meet in the groin) dissection and ligation, a technique that was common until recently. Neovascularization occurs when the veins from the abdomen and pelvis are dilated with gravity and ultimately coalesce to form new, large varicose veins in the legs. While early studies suggest that the newer endovenous approaches to obliterating the saphenous vein lead to significantly less neovascularization because the saphenofemoral junction is left intact, long-term studies are not yet available to prove this assumption.
Vascular ultrasound is an excellent way to assess these often complex patterns, and both ambulatory phlebectomy and ultrasound-guided sclerotherapy can be very effective forms of treatment for recurrent veins.
Are these treatments covered by insurance?
This depends on your policy and specific coverage provided by your insurance carrier. In general, most insurance providers have two categories under which vein treatments may fall:
- Cosmetic Procedures
- Medically Necessary Procedures
Some vein treatments will fall under the category of cosmetic procedure, and as such, will not be covered by most insurance providers. This is commonly the case for asymptomatic spider veins.
In certain circumstances, however, insurance companies may deem varicose veins and other disorders medically necessary and thus will offer varying degrees of coverage depending on their contracts with the patient and the doctor. Insurance companies use varying criteria in order to determine if vein treatment is to be considered “medically necessary.” These criteria may include one or more of the following:
- Lifestyle Disruption: The daily activities of the patient must be disrupted significantly.
- Pain: The patient must be experiencing pain as a result of their vein disorder.
- Failure of Conservative Measures: Other methods of treatment, such as compression hose, have failed to provide adequate relief.
- Vein Size: Bulging veins larger than 4 mm are often considered medically significant.
- Complications: Complications, such as phlebitis, bleeding veins, leg swelling and leg ulceration make it more likely an insurance company will consider treatment medically necessary.
A trial of conservative management is sometimes required prior to providing coverage for varicose vein treatments. This includes a number of features, such as compression therapy, rest, elevation and other maneuvers. It is best to check with your insurance carrier if you have any questions about your coverage.
Schedule a Consultation
To learn more about varicose veins at our Bend or Tigard, Oregon vein centers, request a consultation today with one of our specialists.
More about Varicose Veins
To learn more about varicose veins and their treatment, visit the following pages: