– May 4, 2007

Like 30 percent of the American population, many Central Texans suffer from varicose veins – ropy, distended sometimes discolored veins that are close to the skin’s surface. Generally they are the result of aging, a family history of the condition or obesity. Women suffer more often than men because it is believed that hormonal changes, birth control pills, hormone replacement therapy and pregnancy increase their likelihood.

“Varicose veins are twisted or enlarged veins that result from weakness in the valves that are supposed to prevent blood from pooling in the extremities due to gravity. When the valves or the walls of the veins lose their elasticity, they tend to deform and are often visible on the surface of the skin. Although they can occur in many parts of the body, they usually are most noticeable on the legs around the ankles and calves and may appear lumpy or ropy,” says Emery W. Dilling, M.D., an Austin cardiothoracic surgeon.

The condition afflicts as many as 30-to-40 million people, some of them with few symptoms but others with major problems. Initial treatment usually is recommended by a primary care physician and often includes lifestyle changes such as regular exercise like walking, jogging or cycling to help increase overall muscle strength, improve circulation and maintain good vein health. Wearing support hose and avoiding standing or sitting for in one place for long periods of time also is advised.

Many people are concerned about appearance because surface veins can be unsightly, they don’t usually cause serious problems. A far more difficult challenge arises from deterioration of deeper veins that can result in decreased delivery of oxygen and nutrients to tissues, often causing pain and discomfort. If that happens, sufferers are usually referred to a vein specialist.

“The first thing patients tell me is that their legs hurt,” continues Dr. Dilling. “Sometimes they will describe the symptoms as aching, fatigue, burning, or numbness. Although they have a sense the varicose veins are causing the problem, they don’t understand why.”

Significant problems with varicose veins can occur if the leaking valves are creating high venous pressures in the legs so that blood flowing through tissues is slowed. The result is decreased oxygen and nutrient delivery to the tissues. In some cases, fluid leaks out of the capillaries, resulting in swelling. Occasionally the condition progresses to discoloration of the skin and eventually large ulcers.

The first step is diagnosing the problem areas to determine where valves are leaking. If lifestyle changes alone can no longer manage the condition, some patients move to a more complete and definitive treatment that closes off and removes the vein containing the leaking valves. This eliminates the channels through which the blood is flowing backwards.

“Vein surgery has advanced in recent years, making it a minimally invasive procedure with little pain or recovery time. Stripping removes the vein in its entirety. It is usually done in a hospital under general anesthesia and requires a small incision in the groin and at the knee. An alternative, laser ablation, closes the vein by using heat,” adds Dr. Dilling. “Both are outpatient procedures that allow the patient to go home the same day and go back to work within two days.”

With these treatments, most patients get relief from symptoms caused by the leaking vein. In addition, the procedures often are accompanied by removing the visible varicose veins under the skin by puncturing the vein with a needle, inserting a tiny hook under the skin, grabbing the vein and pulling it out. Cosmetic results with this in-office procedure, called phlebectomy, also tend to be good.

These newer treatment options are highly effective; however, new varicose veins may develop later in life. Up to 60 to 70 percent of people are considered cured after 30 years of observation.

“There’s good news and bad news about these procedures,” comments Dr. Dilling. “The bad news is that you can never be certain that you are forever cured. The good news is that it is never life threatening and we can always deal with new varicose veins if they arise.”

Emery W. Dilling, MD
Cardiothoracic Surgeon
VeinSolutions, a division of Cardiothoracic and Vascular Surgeons

Dr. Dilling received his medical degree from the University of Oklahoma where he also completed an internship and two residencies. He completed a fellowship at the Veterans’ Administration Hospital followed by General Surgery and Thoracic Surgery residencies at the University of Oklahoma Health Sciences Center where he served as chief resident of surgery. He is a Fellow of the American College of Surgeons and the American College of Cardiology and a Diplomate of the American Board of Thoracic Surgery. Formerly President of the American Heart Association, he is also an active member of the American Medical Association, Society of Thoracic Surgeons, Texas Medical Society, Travis County Medical Society, Southern Thoracic Surgical Association, and the Texas Transplant Society.