Vein Disease

• Venous System
• Varicose Veins
• Spider Veins
• Glossary

Glossary

Artery
Arteries are vessels that carry oxygen-rich blood from the heart to the body.

Ambulatory (Stab) Phlebectomy
This term refers to being able to walk and go home right after varicose vein surgery. In the past, patients remained in bed in the hospital for days after vein surgery. With new techniques of removing varicose veins through tiny incisions, prescription fitted compression stockings, and tumescent local anesthesia, patients can walk and go home as soon as the procedure is complete. This is what is meant by ambulatory or stab phlebectomy.

Bruising (Purpura)
Bruising occurs when blood leaks out of the treated veins into the tissue plains. This results in purple color like any bruise that goes away over time. Bruising is blood that is evenly distributed through the tissue plains in contrast to a clot which is a localized collection of blood. Bruising results from blood leaking out through the needle puncture or when the laser puts a hole in the wall of the vein instead of destroying the entire vein.

Capillary
Capillaries are the tiniest arteries whose walls are a single cell thick and contain red (oxygenated) blood. The capillaries actually deliver oxygen and nutrients to the cells. They are responsible for the redness in the skin and when they dilate the skin turns bright red. Capillaries are the very fine, red vessels that appear on the face and legs from aging (thinning of the skin), sun damage, and injuries.

Catheter
In the context of the Closure procedure, a slender, 60-100 centimeters long device designed to move within the vein and shut--or close-- it by delivering radiofrequency energy through a group of specially designed electrodes.

Closure™
The Closure procedure is an outpatient (day surgery) treatment performed in hospitals, surgical centers and doctor's offices. Anesthesia is typically used to numb the treatment area. The Closure Catheter is inserted into the vein through a small opening, often using only a single needle stick. The catheter delivers radiofrequency (RF) energy to the vein wall, causing it to heat, collapse and seal shut as the doctor pulls the catheter from the vein. Like other venous procedures, the Closure procedure involves risks and potential complications. Patients should consult their doctors to determine whether or not they are candidates for this procedure, and if their conditions present any special risks.

ClosureRFS™ (Closure Radiofrequency Stylet)
Small catheter (Stylet) for treatment of incompetent perforator veins using RF energy.

Clot (Thrombus)
This is coagulated blood, i.e., a thick, viscous, clump of red blood cells held together by fibrin "glue". A clot is referred to as a thrombus. It is important to prevent clot in treated veins. Clot eventually liquefies releasing chemicals from the red blood cells. These chemicals cause inflammation—heat, pain, redness, and hardness. Clot can lead to the vein healing open rather than closed. The pigment that is released from the red blood cells is what causes brown spots. Compression with prescription fitted stockings prevents clot from forming in the treated veins resulting in the veins healing closed.

Collagen and Elastin
The two major proteins located in vein walls that gives them strength, support, and flexibility. These proteins are called connective tissue because they hold the vein walls together like the framework of a house. These two proteins shrink and thicken when heated by Radiofrequency or Laser heat thus destroying the diseased veins. The process is similar to what happens to the egg white when you cook an egg.

Conservative Therapy
Conservative therapy refers to the used of compression stockings, Aspirin, Motrin and other anti inflammatory drugs, exercise, and elevation to treat vein disease. Conservative therapy does not treat vein disease. Once the one-way valves are permanently injured and the vein walls stretched beyond their elastic point, they will not repair themselves.  Conservative is good for preventing vein disease and slowing the progression of already diseased veins; it does not treat diseased veins. Surgery is the only way to treat vein disease.

CoolTouch®
CoolTouch® is the corporation that makes the 1320nm laser fibers used for the EVLT™ procedure.

Compression therapy

Compression involves bandages or prescription stockings. The pressure is greatest at the ankles and less as you progress up the leg similar to standing in a swimming pool where the greatest pressure is at the bottom of the pool. Properly fitted compression stockings are very important in dealing with vein disease.

Compression stockings can be used to prevent varicose veins from forming. They provide support to the walls of the veins so that they do not get stretched beyond their elastic points from internal pressure. Once the walls are stretched too wide and the valves damaged, swelling, aching, varicose veins and ulcers will form.

Compression can help relieve the symptoms of swelling, aching, pain, pigment, and ulcers from distention once the veins are diseased; however, compression does not repair damaged veins once the valves and walls are damaged. The compression only helps relieve the symptoms and slow the progression of the disease. Surgery is required to treat diseased veins.

Compression stockings are an integral part of the surgical treatment of diseased veins. The compression forces the vein walls of the treated veins together so that clot does not form inside. When clot forms inside the treated veins, it prevents the vein wall from healing (scaring) closed. The compression stockings prevent the treated veins from healing open so that backflow continues and the symptoms continue to progress. 

CW Doppler
  Continuous Wave Doppler is an instrument that is used to determine the direction of flow in arteries and veins. It works on the same principle as the change in the sound of a train coming toward you and going away from you. It is a simple, quick, painless test that gives the physician a general idea if venous backflow is present in the superficial veins of the legs.

Dermatitis
As a result of the leakage of blood from over distended veins, particularly on the inner lower legs above the ankles, oxygen and nutrients cannot flow to the cells of the skin and waste products build up in the tissues. This results in redness, scaling, itching, and weeping of the skin referred to as dermatitis.

Duplex Doppler Ultrasound
An ultrasound system used to map the pathways of the veins. It uses ultrasound, color, and sound to determine the direction of flow in the veins. This is particularly helpful in visualizing and evaluating both the deep and superficial venous systems to pinpoint where the one-way valves are diseased and to determine the veins need to be treated.

 

Deep Veins
Deep veins are located along the bones and under the skeletal muscles of the body. Deep veins receive structural support from the adjacent bones and muscles unlike the superficial veins.  These veins contain the largest volume of blood and return deoxygenated blood directly to the heart.  Blood flows from the tiny spider veins into the superficial veins. Healthy superficial veins route blood into the deep veins which lead to the heart. This is why spider veins may be caused by disease in the deep or superficial systems.

Deep Vein Thrombosis (DVT)
A blood clot that forms in the deep venous system is called a DVT. Clots form as a result of injury to the lining of vessels, blood that is standing still, and genetic traits in the clotting system. Clots are one mechanism that leads to damaged valves in the venous system. Damage to the one-way valves in the deep system results in backflow of the blood—just like diseased valves in the superficial veins. However, the deep veins cannot be destroyed like the superficial veins can. The disease process in the deep system is called chronic venous insufficiency and prescription fitted compression is required in an attempt to prevent more clots from forming in the deep system.

Dilation
Enlargement of a vein due to increased internal pressure.

Edema
Swelling or inflammation caused by fluid buildup.  Frequently occurs in the legs and ankles of people with venous insufficiency.

Electrode
In this context, the Closure Catheter has multiple electrodes which emit radiofrequency energy to close - or occlude - the vein to be treated.

Endovenous
Endovenous refers to something done inside a vein.

EVLT™ (Endoluminal Venous Laser Treatment)
The procedure where a laser fiber is inserted inside a vein and laser (light) energy is used to destroy the diseased vein. In the case of EVLT™ from CoolTouch Corp., the wavelength is 1320 nm which is absorbed by water creating heat which destroys the vein.

Hematoma
A localized mass of clotted blood confined within an organ, tissue or space.

Incompetent Valves
Incompetent valves are one-way valves in the veins that don’t work. Incompetent valves allow gravity to push blood backward in the veins. Once the valves are damaged (incompetent) it is next to impossible to repair them. The veins that contain incompetent valves need to be destroyed with surgery. Incompetent or missing valves is the problem in vein disease.

Induration (Lipodermatosclerosis)
When blood leaks from distended veins around the ankles, it deposits proteins and hemosiderin into the tissues and the chemicals released from the red cells cause inflammation in the tissues. This process leads to “elephant” skin that is hard, rough, and tough. Oxygen and nutrients cannot flow through the hardened tissues which are normally above the ankle on the inside of the lower legs. The hardness is referred to as induration and feels like “wood”. The hardened skin breaks down easily and does not heal well resulting in recurrent oozing, ulcers, bleeding, and infections. These are essentially permanent changes in the skin that are very difficult to reverse with any type of treatment.

Laser Fiber
A laser fiber is a fiber optic catheter (glass fiber) that is inserted inside the diseased vein for the EVLT™ procedure. It directs the laser light to the tip of the fiber where the light energy is absorbed by the water in the vein and vein wall creating heat. The heat destroys the diseased vein.

Ligation
Ligation refers to tying or suturing a vessel closed.

Lumen
The lumen of a vessel is the inner tunnel of the vessel.

Matting
When tissue and vessels are injured, the cells release chemicals that stimulate growth of new vessels (tiny red capillaries). These chemicals come from the red blood cells in clot that forms during the initial stages of the injury. This is one reason it is very important to wear prescription compression stockings after a vein treatment. Compression prevents clot from forming after the vein lining in injured thus preventing the release of these chemicals. Matting is the growth of a fine, network of very superficial red vessels after treatment of spider veins. Compression may prevent or decrease the growth of these fine red vessels that occasionally grow back after sclerotherapy and laser treatment of spider veins.

Minimally Invasive
Minimally invasive came about as a result of laparoscopic surgery. It refers to surgery done through small incisions in comparison to the larger incisions used for traditional surgical procedures.

Micro Phlebectomy (Ambulatory or Stab Phlebectomy)
The process of removing varicose veins through tiny (1-2mm) stab wounds using hooks to retrieve the varicose veins. The surgery is done using tumescent local anesthesia and the incisions are so small they do not require stitches. Paper tapes are all that are used to close the incisions. Prescription compression stockings are worn to compress the areas where the varicose veins are removed in order to prevent bleeding and clots.

Occlusion
Occlusion means to close or obstruct a vessel.

Paresthesia
Numbness or tingling often associated with damage to sensory nerves.

Perforator veins
Veins which serve as connections between the superficial veins and deep veins.

Phlebectomy
Developed in the 1950s, a phlebectomy involves removing diseased veins through a series of very small punctures or incisions with a variety of specialized hooks. It is typically used on varicose veins which are at, or near, the skin's surface, and is a complimentary treatment to the Closure procedure.

Paresthesia
Paresthesias are tingling or electrical sensations often associated with damage to sensory nerves.

Perforator Veins
Perforator veins connect the superficial veins to the deep veins. The one-way valves in the perforators route blood from the surface veins (spider veins, reticular veins, superficial tributaries, and superficial trucks) to the deep veins. The deep veins carry the blood to the heart. Missing or diseased one-way valves in the perforator veins allow the higher pressure deep vein blood to travel backwards into the superficial veins resulting in swelling, aching, heaviness, and varicose veins.

Phlebectomy
Phlebectomy is the removal of veins. Phlebectomy can be done by making incisions over veins and surgically removing the veins or it can be done by making tiny incisions and using hooks to pull veins out through the tiny incisions. At one time, phlebectomies were done as part of the surgical vein stripping of the superficial veins. Phlebectomies are now done along with the Closure® or EVLT® to remove varicose veins.

However, research is showing that many varicose veins will go away without performing phlebectomies once the superficial veins are treated with Closure® or EVLT®. As a result, many individuals are waiting six months to a year after these procedures to see whether or not they will need phlebectomies.

 

Phlebologist

A phlebologist is a physician who specializes in treatment of vein disease.

 

Pigmentation
When a clot forms outside the vein, the red blood cells break down releasing the red-brown pigment of hemoglobin. The pigment is called hemosiderin. It may cause brown spots after treatment of veins or leakage of blood from varicose veins. These brown spots will fade over time when the surrounding tissues are normal. Pigment that develops from leakage and permanent tissue damage around the ankle (venous stasis) does not fade as readily as the small brown spots from leakage after sclerotherapy

PIN (Perforate Invaginate) Stripping
Procedure where a wire rod is threaded through the vein, the end of the vein sutured in such a manner so that when the vein is stripped out it invaginates inside itself. It is much less traumatic than the previous method of attaching a large knob on the end of the wire rod and tearing the vein out on the back side of the knob. Although some surgeons still use stripping and PIN stripping, and PIN stripping is occasionally necessary, these methods have been replaced by Closure® and EVLT®.

Prolapse
Prolapse of one-way valves is a condition in which the leaflets of the valves fold backwards allowing blood to flow in the wrong direction. Prolapse occurs when the valve leaflets are not strong enough to hold the blood collecting above them or the pressure in so great within the lumen that it forces the leaflets backwards within the vein.

Radiofrequency (RF) Energy
Radiofrequency is form of energy that generates heat by stimulating naturally-occurring molecules in and around tissues. The heat generated by "RF" waves is used to shrink, cut, or cauterize tissue. RF energy is used for the Closure® procedure.

Reflux
Reflux is the term used to describe backward flow of blood in veins.  Reflux contributes to the development of varicose veins when incompetent leg vein valves let blood flow towards the feet instead of the heart.

Reticular Vein
Reticular veins are the medium size, blue network of veins that backflow into the spider veins. They are located on the underside of the skin and carry the from the spider veins to the superficial tributaries and back to the heart. In some instances, the spider veins may be the result of backflow from the reticular veins into the spider veins causing the spider veins to be visible in the skin.

Saphenofemoral Junction

The Saphenofemoral junction (SFJ) is located near the groin where the Greater Saphenous vein dumps superficial venous blood into the (deep system) Femoral vein. This is most often the area where the one-way valves are incompetent when venous insufficiency is present. This is the key are that needs to be treated when varicose veins or venous signs and symptoms are present.

Saphenopopliteal Junction

The Saphenopopliteal junction (SPJ) is located near the back of the knee where the Lesser Saphenous vein dumps superficial venous blood into the (deep system) Popliteal vein. This is the second most common area that needs to be treated when veonous signs and symptoms or varicose veins are present.

Saphenous Veins (Long Saphenous and Short Saphenous Veins)

The Long and Short Saphenous veins are the major superficial vein trunks that collect venous blood from all of the superficial venous tributaries and deliver the blood directly into the deep veins via perforator veins or major junctions.

The Long Saphenous vein is a superficial vein trunk that runs from the ankle to the groin and collects blood from the thigh and inner lower leg; the Short Saphenous vein is the superficial vein trunk that runs up the back of the leg from the ankle to the knee and collects blood from the back and outside of the lower leg.

Although other venous tributaries may have to be treated, the Long and Short Saphenous veins are most often responsible for the signs and symptoms of vein disease. They are the most common veins treated by either Closure™ or EVLT™ in order to cure vein disease.

Sclerotherapy

Sclerotherapy is the “Standard of Care” for the treatment of spider veins and reticular veins on the legs. A chemical (scleroscant) is injected into the veins and damages the inner lining of the veins. Compression bandages are used to approximate the injured inner surfaces so that they heal (scar) together. If blood is allowed to flow after injury to the inner wall of the vein, clot will form, and the veins will heal open. This is why compression is a key part of sclerotherapy.

Liquid sclerosant is used for the tiny and medium vein. Many different sclerosants are used for sclerotherapy. The most common sclerosants are detergents (soaps) that disrupt the cell walls of the cells lining the veins.

Foam is used for larger reticular veins and varicose veins. Foam is made with detergent and air so that micro air bubbles form. The air bubbles displace the blood from the vein walls and keep the sclerosant in contact with the lining cells longer resulting in excellent results.

Sclerotherapy works well on larger varicose veins as well as spider and reticular veins; however, higher concentrations and larger volumes of the sclerosant has to be used increasing the risk of injury to the deep veins. The smaller volumes and concentrations of sclerosant are used to treat spider and reticular veins and the large volumes of blood in the deep system to dilute the sclerosant makes sclerotherapy of spider and reticular veins very safe.

Sclerotherapy Verses Laser

Sclerotherapy is the “Standard of Care” for leg veins because leg veins are many sizes, shapes, and colors and are located at many depths in the skin. Each laser wavelength penetrates to a specific depth and is absorbed by a particular color. Each size of vein also requires a different amount of light energy to be adequately treated. As a result, it is very difficult to consistently and effectively treat leg veins with lasers. This is why sclerotherapy is the “Standard of Care” for treating spider and reticular veins on the legs.

** Lasers actually cause more discomfort than the tiny, superficial needle sticks of sclerotherapy.

Spider Veins
Small blood vessels near the skin's surface which appear as tiny, twisted, purple lines.

Stripping
Surgical removal of an incompetent vessel, historically considered the standard of care for removing incompetent saphenous veins. Stripping of a saphenous vein typically involves making an incision in the groin region and surgically tying off the top of the vein.  An instrument resembling a thin rod with a bulbous end is then inserted into the saphenous vein and passed through to the knee.  Another incision is made at the upper calf.  The stripping device is then tied to the vein and pulled out through the second incision.

Superficial veins
Veins which are just beneath the skin.  Because they enjoy less support from adjacent muscles and bones, they can develop areas of weakness in their walls and are more likely to become varicose than deep veins.

Thermocouple
A temperature measurement component on the Closure® catheter that lets the physician know the precise temperature of tissue being treated.

Tumescent Anesthesia
A solution of saline (salt water), Lidocaine (local anesthetic), Epinephrine (vasoconstrictor), and Bicarbonate (reduces stinging from medicines) is injected around the veins prior to destroying or surgically removing veins. It is responsible for vein procedures being safe and essentially pain free so that they can be done outpatient procedures in the office rather than hospital procedures with days spent in the hospital prior to going home.

Ulceration (Venous Stasis Ulcer)
These ulcers form on the inner, lower leg just above the ankle. They are formed by the pooling of venous blood in the lower leg and leaking out of the overly distended veins preventing oxygen and nutrients from reaching the tissue surrounding the lower leg. Once venous stasis ulcers have formed, there is so much permanent injury to the skin that it is very difficult to get the ulcers to heal. The ulcers ooze serum, bleed, and become infected. The Long Saphenous vein is a superficial vein trunk that runs from the ankle to the groin and collects blood from the thigh and inner lower leg; the Short Saphenous vein is the superficial vein trunk that runs up the back of the leg from the ankle to the knee and collects blood from the back and outside of the lower leg.

Valves
One-way valves in veins prevent gravity from causing backflow in the veins. Skeletal muscle squeezes the veins pushing the blood toward the heart and when the muscles relax, the valves prevent the blood from flowing backward. The one-way valves are the key to return of blood to the heart and missing or malfunctioning valves are the cause of vein disease.

Valvuloplasty
Valvuloplasty is the surgical placement of a series of sutures along the base of the valve.  This can tighten valve components called "leaflets", reduce the vein diameter, and prevent prolapse. General anesthesia is required, plus 3-6 days post-operative hospitalization and long-term therapy with anticoagulant drugs. The risks of the procedure includes deep vein thrombosis, infection, and bruising. Success rates of 10%-80% have been reported for patients suffering from primary, deep venous insufficiency. However, these procedures are very difficult and very few surgeons perform these procedures.

Varicose Veins
Varicose veins are veins that have been stretched beyond their elastic point. Varicose veins result from faulty one-way valves that permit backflow of blood causing over distention of the veins. The vein walls of varicose veins are unable to contract (shrink) back to normal size. Their large diameters result in very slow or no flow in the veins, leaking of blood into the tissues, aching, pigmentation, heaviness, blood clots, and ulcers. Effected veins elongated, dilated, tortuous, pouched, and thickened and will never function normally to return venous blood back to the heart.  It is estimated that 10%-20% of the general population has varicose veins.  Varicose veins are present more frequently among women and all adults after the age of 50.

Veins (Venous Vessels)
Veins carry oxygen-depleted blood back to the heart. They have very thin walls with minimal muscle, collagen, and elastin to support their internal pressures. Veins also function to hold blood until larger volumes of blood are needed for exercise, etc. The venous vessels function sort of like a dam or reservoir to hold water until it is needed on short notice, i.e., they provide “capacitance” to the vascular system.

Venous Insufficiency
Poor or impaired flow of venous blood from the legs and feet to the heart, often characterized by symptoms such as varicose veins, swelling, aching, skin changes and/or venous ulcers. Caused by over-dilation of venous vessels or damaged valves, resulting in pooling of blood. Deep vein thrombosis can also create this condition. Over time, this damages other valves in the veins and speeds progression of venous reflux.

Venous Reflux
Venous reflux is backflow of blood in the veins from gravity. The skeletal muscles squeeze the blood in the veins toward the heart and when the muscles relax the blood is prevented from flowing backwards by the one-way valves. When the valves are missing, malformed, or damaged, gravity causes the blood to flow backwards in the veins. This is referred to a venous reflux and is the hallmark of vein disease.

VNUS®
VNUS® is the corporation that makes the Closure™ and ClosureRFS™ catheters that use RF energy to create heat that destroys the diseased veins.