What is vein disease?
Veins carry blood back to the heart. Valves are located throughout veins to help keep blood flowing in the right direction – against gravity and back to the heart. Vein disease, or venous insufficiency occurs when valves become damaged, allowing the backward flow of blood in the legs. This pooling of blood can cause visible changes such as small blue or purple "spider veins" on the skin's surface, large lumpy varicose veins just under the skin, or a brown woody appearance to your lower legs. If left untreated, it can lead to a feeling of heaviness and/or pain, swelling, ulcers, and other health problems.
It is important to remember that vein disease symptoms often progress slowly, so that people don't always realize how much their life is inhibited by vein issues. Patients who receive any one of the modern minimally invasive treatment options for vein disease are often surprised to find how quickly their quality of life improves. Correcting vein problems early can mean more energy, better looking skin, and avoidance of future problems.
What are vein classifications & why are they important to know?
A six-stage severity score classifying vein disease by severity is known as a CEAP classification. The treatment of veins in patients who fall in the 2-6 range on the CEAP classification, is considered medically necessary and are often covered by insurance and Medicare. Although we treat spider veins, insurance and Medicare consider treatment of these veins as cosmetic and are not covered.
Six levels of severity include:
- C0 - No visible signs of venous disease
- C1 - Spider veins (known medically as telangiectases), which are less than 1 mm in diameter or reticular veins (also known as feeder veins), which are larger than spider veins, but not as large as varicose veins.
- C2 - Varicose veins (dilated veins larger than 3 mm in diameter)
- C3 - Swelling (known medically as edema) without skin changes
- C4 - Skin changes: A = Pigmentation or eczema; B = Lipodermatosclerosis (hardening of the skin) or atrophie blanche (a type of scar)
- C5 - Healed leg or ankle ulcer
- C6 - Active leg or ankle ulcer
However, whenever using the CEAP clinical score, it is essential to remember that it is only a clinical score. It is quite possible that if a venous duplex ultrasound scan is performed (which should always be the case when assessing any venous disease) then more often than not, worse venous diseases are found deeper inside the leg that cannot be seen by clinical examination alone.
Although some varicose veins are cosmetic, there is a very high proportion of varicose veins and associated venous disease that causes medical problems and therefore is "medical" not "cosmetic".
Are my varicose veins a health problem & how are they treated?
If you have varicose veins in your legs, it is a sign that blood is not being properly returned to the heart. In the past, the presence of varicose veins has been considered strictly a cosmetic issue. Today, we know that varicosity is a symptom of a progressive venous disorder. Untreated, varicose veins can cause pain and discomfort impacting exercise and activity schedules and overall quality of life. Eventually, venous insufficiency can cause serious medical conditions such as phlebitis, cellulitis or ulcers.
Even if you have no physical symptoms, the presence of varicose veins can be a source of embarrassment or self-consciousness. Varicose veins can erode self-esteem, lead to the avoidance of social situations where the legs will be exposed, and significantly affect the quality of life.
What is vein reflux?
Venous reflux refers to the abnormal backing up of blood in the veins. When blood flows backward in the veins, a person is then known to have venous insufficiency (also called chronic venous insufficiency or CVI to those for whom reflux is an ongoing concern). Venous insufficiency is a common medical condition that underlies most of the clinical presentations of venous diseases, such as varicose veins, swollen and achy legs, and venous ulcers.
Varicose veins on the surface are not always the reason patients request an appointment to see a Vascular Surgeon. The real concern is swollen achy legs when veins are allowing blood to reflux into them. A venous duplex ultrasound scan identifies the underlying cause. It is only by treating the underlying cause that good long-term results can be obtained for patients.
How are varicose veins treated?
Varicose veins are treated with lifestyle changes, compression therapy, and medical procedures. The goals of treatment are to relieve symptoms, prevent complications, and improve appearance.
Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn't cause problems with blood flow because the blood starts moving through other veins. Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis.
What is Compression Therapy?
Compression therapy is the most conservative option to treat vein disease and is often recommended as a first line of treatment. This consists of wearing socks or stockings that are specially designed to support your veins and increase circulation in your legs. The socks or stockings are normally worn in the morning upon arising, and removed at night. Throughout the day the compression they provide prevents blood from pooling in leg veins, thereby helping overall circulation and diminishing any leg swelling you may have.
Compression socks or stockings can be purchased anywhere, but they are not all created equal. Compression therapy should be prescribed based upon the compression strength your Vein Specialist finds to be the most beneficial to you upon examination.
If compression therapy does not adequately address your vein disease, you might benefit from a medical procedure. In this event, insurance may require evidence that you have attempted formal compression therapy treatment to see if your symptoms improve without surgery.
For these reasons, it is important to consult with a Vein Specialist early in the process to ensure you are prescribed the most effective compression therapy that will be recognized your insurance if a procedure is required in the future.
How do I get compression stockings?
Talk to your Vein Specialist to find out if compression therapy is right for you. If it is, they will tell you what compression strength you should buy and provide education regarding effective compression therapy. Additionally, they will be able to recommend an authorized vendor that can measure and fit you for the stockings that will most effectively help manage your vein disease.
What medical procedures are available for vein disease treatment?
To determine whether insurance will cover your surgery, it's helpful to consider why you're pursuing treatment. Are you addressing your varicose veins because they're causing health issues – for example, do your varicose veins limit your daily activities, cause pain or result in further complications? Or are you looking to treat them because you don't like the way they look? Insurance is more likely to cover procedures that are medically necessary than procedures that are cosmetic, or intended to enhance your appearance.
Medical procedures are done either to remove varicose veins or to close them. Removing or closing varicose veins usually doesn't cause problems with blood flow because the blood starts moving through other veins. Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis. Click here for pre-surgery FAQ.
You may be treated with one or more of the procedures:
Sclerotherapy. (SKLER-o-ther-a-pe) uses a liquid chemical to close off small spider veins less than 1mm in size and can be done in your surgeon's office without anesthesia. The chemical is injected into the vein to cause irritation and scarring inside the vein. The irritation and scarring cause the vein to close off, and it fades away. You may need several treatments to completely close off a vein. Treatments are typically done every 4 to 6 weeks. Following treatments, you will wear prescribed compression stockings to help healing and decrease swelling. In a few weeks, treated varicose veins will fade.
Ambulatory phlebectomy (fluh-BEK-tuh-me). Your surgeon removes larger lumpy varicose veins through a series of tiny skin punctures. This procedure is usually done to remove the varicose veins closest to the surface of your skin. Your surgeon will numb the area around the vein. Following the procedure, a compression wrap is required for a couple of days, then compression stockings for a couple weeks.
Catheter-assisted procedures using laser energy. (Endovenous Laser Ablation Therapy) With this treatment, your surgeon inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter using either radiofrequency or laser energy. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. Afterwards, you will be required to wear a compression wrap and follow up in office in a couple days.
Will insurance cover my vein procedure?
To determine whether insurance will cover your surgery, it's helpful to consider why you're pursuing treatment. Are you addressing your varicose veins because they're causing health issues – for example, do your varicose veins limit your daily activities, cause pain or result in further complications? Or are you looking to treat them because you don't like the way they look? Insurance is more likely to cover procedures that are medically necessary than procedures that are cosmetic, or intended to enhance your appearance.
Even if your vein disease is causing health issues, some insurance might first require a formal trial of conservative management, such as compression therapy, to see if your symptoms improve without surgery. If there is no improvement, you can choose to move forward with surgical treatment provided that insurance requirements are addressed.
At the Vein Center of Mid-Missouri, located within Columbia Surgical Associates, our staff will help handle these requirements for you, including any prior authorizations and letters of medical necessity. If your insurance plan does not cover treatment we will review other methods of payment including financing options and self-pay.
Once varicose veins are removed what is going to happen to my overall health?
Most patients quickly find a higher quality of life; returning to normal activity and exercise free of fatigue, leg pain and heaviness. Since none of the treatment methods involve large incisions, there are no sutures to worry about. Patients may need to wear bandages and/or compression stockings for a few days following the treatment. Most people are back at work within a couple of days. Though there are few activity restrictions after varicose vein procedures, your board-certified vascular surgeon will give you specific instructions about how to care for yourself properly following treatment. Your physician may have short term lifting, exercise, or travel limitations based on your history and procedure(s) performed. Click here for post-surgery FAQ.
Next steps
Learn more about varicose veins and potential treatment from our Vascular Surgeons.
To schedule a consultation to meet our team, learn more about our services and find out which treatment options will best meet your needs, call Vein Center of Mid-Missouri at 573-256-1541. We look forward to meeting you!
Vein Center of Mid-Missouri is located at Columbia Surgical Associates, 3220 Bluff Creek Drive, Suite 100, Columbia, Missouri.