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VARICOSE VEIN DISEASE by Ihor Magun, M.D., F.A.C.P. Nearly forty percent of people in America have varicose vein disease. Of this forty percent, half experience significant discomfort and require multiple interventions. To discover what causes this common malady we need to examine the physiology of the venous system. Arteries carry blood away from the heart by an active pumping mechanism; veins, on the other hand, passively transport blood back to the heart. Veins contain internal one-way valves, which liter ally prevent blood from flowing backwards. Vari cose veins form when there is a breakdown of the valves in one or more of the connections between the deep and superficial venous systems. This loss of valve function allows blood to leak into superfi cial veins, which distend and produce varicose veins. Common causes of varicose vein disease are genetics, hormones (especially during puberty, pregnancy, and menopause), aging, prolonged standing, obesity, and a history of leg injuries or surgical interventions. Varicose vein disease can be asymptomatic or painful. The disease symptoms do not correlate to the size of the affected vein. In fact, patients may have symptoms of varicose vein disease and have no visible signs. A normal-looking leg does not mean vein disease is not present. Treatment of varicose vein disease has changed dramatically over the past ten years. In the past, the procedure of choice was vein stripping. Today, ultrasound has become the gold standard for diagnosis and management. Other treatment options currently exist and are used depending on the nature of each individual case. Obviously these interven tion methods are done only when conservative therapies are not successful. Conservative methods include use of compression stockings (worn only during the day), analgesics, and avoiding hot baths. Most surgical interventions are performed as ambu latory procedures. Endovenous ablation therapy uses thermal energy that produces vein collapse. For bulging veins, a procedure called ambulatory phle- bectomy is used (commonly in conjunction with endovenous ablation). During ambulatory phlebec- tomy, the varicose veins are removed through 2- millimeter incisions. The procedure leaves no scar ring. Sclerotherapy is also used for bulging veins. In this procedure, foamed medications are instilled into the veins to produce the desired effect. Spider veins, which are similar to varicose veins but are more superficial in location, are often blue or red and can be found on the legs as well as other parts of the body. Facial spider veins are fre quently the result of prolonged sun exposure in fair skinned individuals. Spider veins are treated by su perficial lasers. Varicose vein disease can be prevented (or minimized) by controlling your weight, exercising regularly, avoiding prolonged standing, and shifting your weight from one leg to the other when stand ing. Wearing support hose is also helpful. Do not cross your legs while sitting and elevate them as needed. Watch your salt intake as salt consumption may produce water retention and overwhelm an al ready compromised venous system. If all efforts and precautionary measures fail, do not be timid about seeking advice and treat ment from a vascular surgeon. The newer tech niques and outpatient procedures can literally get you back on your feet. НАШЕ ЖИТТЯ”, ЖОВТЕНЬ 2005 15
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