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Superficial Vein Disease De-mystified

Superficial Vein Disease De-Mystified

I still remember that night as a medicine intern in the ER when a surgical resident casually commented, “It’s really ironic that three of the most common things we see are never taught in medical school – back pain, hemorrhoids, and varicose veins.”  What was also ironic was that, unbeknownst to me, I would spend nearly 30 years treating patients with varicose veins and trying to counteract this lack of medical education among my non-vein specialist colleagues.

So let me take these next few minutes to debunk some of the myths I’ve heard and share some of what I’ve learned over the past 3 decades taking care of thousands of patients with vein disease. My goal is for every patient with varicose veins (and you, as their doctor) to know how to help them have the healthiest legs possible.

First of all, varicose and spider veins are frequently symptomatic.  They commonly cause heaviness and aching in the legs, but burning, throbbing, itching, numbness and restless legs can also indicate the presence of superficial vein disease.  Although treating the veins is the most effective way to relieve these symptoms, graduated compression stockings (frequently just knee highs) and regular exercise will diminish the symptoms in most people.  Bio-flavenoids (grapefruit skins, horse chestnut seed supplements, etc.) can also help with the aching and swelling that result from vein disease.

The newer treatments are incredibly effective and are personalized, based on the patient’s anatomy, symptoms and goals.  Some combination of endovenous thermal ablation techniques, surgical removal of veins through 2mm incisions, ultrasound-guided injections, and visually-guided injections is recommended for most patients.  All of the treatments can be performed in the outpatient setting.  A great public education website is and vein specialists can be found at

Most leg ulcers are venous in etiology.  While most of us know this, it’s also crucial to understand that many ulcers occur in patients who only have superficial vein disease.  That means they are CURABLE and the patient doesn’t have to suffer from recurrent ulcers – if the vein disease is appropriately diagnosed and treated.  Nowadays, every patient with varicose veins and especially those with venous ulcers should undergo ultrasound examination of their venous system.  The deep venous system can be examined while the patient is supine, but the superficial system must be examined with the patient standing – otherwise, a great deal of disease can be missed.

One final myth to bust is that superficial venous thrombosis (a superficial vein that becomes red, hard and tender) is benign and should be treated with bed rest and moist heat.  In fact, up to 40% of these have concomitant DVT, so every patient with SVT should undergo ultrasound examination to rule out DVT.  In addition, to encourage greater blood flow (and decrease the propagation of more clot), the patient should wear graduated compression stockings and ambulate frequently.  NSAIDs can be useful for pain relief.  Thrombophilia workup is indicated if the SVT is extensive, unprovoked, or if there is a personal of family history of venous thromboembolism.

We all see many people with venous disease.  With this information, you can now provide your patients with accurate information to help them make the best choices possible for their health.

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Helane Fronek

Helane Fronek MD, FACP, FACPh initially trained in and practiced internal medicine and entered the field of phlebology, the treatment of venous disorders, in 1985. Since then, she has been an integral part of the development of this new medical specialty. As the Director of the Varicose Vein Clinic at Scripps Clinic in La Jolla, California, she provided cutting edge treatment for the entire spectrum of superficial venous disorders and conducted research on venous leg ulceration, compression therapy, and emerging therapies for varicose veins. Dr. Fronek is a past president of the American College of Phlebology, the largest medical organization devoted to vein care. Dr. Fronek was the first recipient of the American College of Phlebology’s prestigious Leadership Award and was recently honored as its Honorary Member. Board-certified in both Internal Medicine and Phlebology, she is also Assistant Clinical Professor of Medicine at UC-San Diego School of Medicine. She writes regular columns on physician coaching for both Vein Magazine and San Diego Physician magazine and is passionate about helping her clients find greater enjoyment and balance in their lives.

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