Varicose Veins - Stephen Hopkins, MD

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Stephen Hopkins, MD FACS
Varicose Veins

Q: What is venous disease?
A: Diseases of the veins are varied. There can be problems with clotting in the veins, such as deep vein thrombosis, a serious medical condition. Another condition is venous reflux disease, a problem with the valves within the superficial veins. When working properly, the valves keep blood moving up the legs and towards the heart. When the valves are not functioning properly, blood will reflux back towards the feet causing swelling, aching, heaviness, itching and burning, and eventually can develop into varicose veins.

Q: What is the difference between venous disease and arterial disease?
A: Peripheral arterial disease (PAD), in contrast to venous reflux disease, is caused by blockages in the arteries that prevent proper blood flow to the legs. Left untreated, PAD can lead to gangrene and loss of toes and is also an indicator for other serious blockages that can affect the heart and brain. PAD requires a totally different treatment than venous disease, a problem with blood flow from the legs due to diseased valves, not blockages.

Q: Aside form the cosmetic symptoms of venous disease, what are the dangers of living with this condition?
A: People with venous disease often develop large varicose veins but also suffer symptoms such as aching pain, swelling, and burning. As the disease progresses, some patients develop venous stasis ulcers, open sores which can lead to infection. In extreme cases the infection from venous stasis ulcers can lead to lymphedema, a disturbance in the lymphatic system that is very difficult to treat.

Q: Both my mother and father have varicose veins. Am I doomed?
A: Venous reflux disease is definitely hereditary; it is an autosomal dominant trait. With one parent having venous reflux disease, there is a 50 percent chance for developing varicose veins. With both parents having the disease, the chance for developing varicose veins is even greater.
Genetics are the greatest factor contributing to venous reflux disease but not the only factor. Standing for prolonged periods on hard surfaces can also lead to the development of varicose veins.

Q: Are there any measures I can take to avoid developing venous disease?
A: Since choosing parents without venous reflux disease is not an option, if you feel are at risk for developing the disease, wearing compression stockings can help slow the progression by keeping blood from pooling where varicose veins might develop.
 

Q: Can venous disease develop during pregnancy? After pregnancy, will I continue to develop more varicose veins?
A: During pregnancy, women experience a surge of estrogen and progesterone, hormones that contribute to dilation of the venous valves. So many women start vein problems after they have had children.
Since venous reflux disease is a progressive condition, it is common for other vein problems to develop.

Q: What treatments are available for venous disease? Will my condition worsen without treatment?
A: There are many treatments available. Most commonly we use endovenous thermal ablation, using a laser or radio frequency to shrink and seal the vein wall. Blood is then redirected to healthy veins.

Other treatments include microphlebectomy, removal of the vein following ablation and sclerotherapy, an injection of a chemical to obliterate the vein from the inside out.

Venous disease is a progressive disease and there is no cure but we can control its progression. However, even once diseased veins have been treated, more diseased veins can develop.

Q: What kind of complications might develop following endovenous ablation? If you’ve closed off my veins, how will blood get back to my heart?
A: Complications are rare but bleeding, infection, superficial or deep vein thrombosis (clotting), and paresthesia (numbness) can occur. Thankfully all are very uncommon.

There are literally thousands of superficial veins in the legs. Following endovenous ablation, blood simply returns to the deep vein and back to the heart, resulting in much healthier circulation. There is much less pressure on the deep vein because the total volume of blood in the legs is less without the reflux and pooling caused by diseased superficial veins.

Q: I had a vein stripping procedure several years ago and now I have even more varicose veins. Why did they come back? Do veins have a tendency to re-grow?
A: When you strip superficial veins, you only strip a small amount of the veins, not all of them. The remaining veins can develop reflux and eventually new varicose veins. In addition, it is common for vein stripping to lead to neovascularization – growth of new veins where the previously diseased vein had been removed.

Bio:
Stephen Hopkins, MD, grew up in the Sacramento area. Inspired by his father’s career in medicine, Dr. Hopkins attended the Tulane School of Medicine, completed his residency in general surgery at the Ochsner Foundation Hospital in Louisiana and received further training at San Joaquin General Hospital and UC Davis Medical Center.

Following his training, Dr. Hopkins practiced in Georgia for a few years before returning to California. He has been in Sonora for 11 years. Dr. Hopkins works with his wife Anne, who is both office manager and nurse at their practice. Away from work Dr. Hopkins and his wife enjoy boating and many of the other outdoor activities the foothills provide.