Varicose Veins in Calf Area? (photo)

Question

I have a few varicose veins on inside calf area of right leg. Should I be looking specifically for vascular surgeons to effectively treat this? What treatment would be most effective? What treatment should I definitely stay away from?

Sabrina Fabi, MD · Answer

You should see a dermatologic surgeon or vascular surgeon who specializes in endovenous vascular closure, which essentially uses a small laser fiber to close off the great saphenous vein. They will need to first ultrasound your leg to confirm reflux and then provide you with a plan. I personally would avoid stripping. Good luck.

Mitchel Goldman, MD · Answer

The treatment of leg veins should always be administered by a board certified dermatologist with a specific knowledge in the treatment of varicose veins. As a board certified dermatologist. Diplomat of the American Board of Cosmetic Surgery, and pioneer of sclerotherapy, I would recommend seeking the services of an expert. Depending on the size of the veins on your leg, effective treatments could be either sclerotherapy injections or a minimally invasive phlebectomy, in which the vein/veins will be surgically removed. First and foremost, I provide my patients with an ultrasound to determine the best course of action for them.

Sam Naficy, MD, FACS · Answer

I would recommend that you see a vascular surgeon for an evaluation and possible treatment.  You may need to first get an ultrasound of your leg prior to any treatment.

John Landi, MD · Answer

Your picture shows varicose veins. These veins are usually a result of leaking valves in the saphenous system. Think of your veins like a tree with the saphenous vein being the trunk and the varicose veins the branches. If the problem is in the trunk of the tree(saphenous vein valves), then treating the branches(varicose veins) will not solve the problem and only result in recurrence of the varicose veins. What you require is a venous reflux ultrasound which will evaluate the saphenous vein valves and both make the diagnosis and determine treatment. You should see either a vein specialist(Diplomate of the Am. Board of Phlebology) or a vascular surgeon with interest in vein problems.

Marilyn Pelias, MD · Answer

A cosmetic surgeon, vascular surgeon or dermatologist would all be appropriate to handle your problem as long as their training and experience was plentiful. If this vein is isolated, I wouldn't require an ultrasound of the veins. If the varsities extended above the knees, I would. This vein could be treated with microphlebectomy or injection in the office. I am not very satesfied with the laser for this size vein at the present.

Joel Gotvald, MD, FACS · Answer

These photograph show typical varicose vein disease of the lower leg.  Yes, I would suggest that you look specifically for a vascular surgeon who specializes in varicose vein treatments.   The reason that you have developed varicose veins in your leg is that you have a condition called venous reflux disease . . . this means that the valves inside the veins that normally control the direction of blood flow have begun to fail in particular veins in your leg.  The best way to confirm this diagnosis and to "map out" the anatomy of your abnormal veins is with a special type of ultrasound known as a venous reflux ultrasound.  This should ALWAYS be done before you proceed with treatment.  Most vascular surgeon offices offer this study within their offices, often times at the time of your visit. 

	Likely the most effective treatment for your condition would be either Endovenous Laser Treatment (known as EVLT) or radiofrequency vein closure (also known as Venefit or VNUS procedures).  This is the least invasive method of treating the condition.  You will likely need some injections, known as sclerotherapy, depending upon your response from the other treatment.

	 

	In the past, phlebectomy  and/ or vein stripping surgery was the most common treatment for your problem.  With less invasive methods, this is not offerred very often anymore.  Vascular surgeons rarely have to perform strippings due to the new laser catheters and radiofrequency catheters, which allow removal without the need for the surgery.

	 

	Since vein spas and plastic surgeons RARELY offer all of the various treatment options for varicose veins, you are best served by going to see a vascular surgeon who specializes in varicose vein treatments.

	 

	I hope this information is helpful.

Hratch Karamanoukian, MD, FACS · Answer

These are varicose veins. You need a Duplex vein scan to exclude venous insufficiency and that is treated with EVLT, ClariVein rocedure or Venefit procedure (VNUS Closure). Once that catheter procedure is done, you can be treated with foam sclerotherapy for these varicose veins. No cuts No sutures. No down time for these procedures. back to work the same day Seek a Board Certified Phlebologist (vein specialist) or vascular surgeon who has expertise in these procedures and at all cost avoid vein stripping which 'old time' vascular and general surgeons love to do. You have 2 diagnoses : 1) venous insufficiency (reflux) and 2) varicose veins.

Susan Goodlerner, MD (retired) · Answer

The first step in treatment is diagnosis. It is important for you to have an ultrasound of the veins looking for a leaky valve in the larger veins of the legs or "reflux." This test is usually done by a vascular surgeon or in a hospital radiology center. If itthe ultasound is positive for reflux, the first step would be a procedure called radiofrequency ablation done by a vascular surgeon. The doctor threads a small catheter into the large vein to close off the leaky valve. The superficial varicose vein may improve with treatment to the underlying problem. If not, it could be removed by a procedure called phlebectomy , a minor office procedure, done under local anesthetic to remove the dilated vein.

F. Victor Rueckl, MD (in memoriam) · Answer

You need to seek a vascular surgeon who performs EVLT. Many patients have both vascular veins (like these) and small reticular veins (that can be treated with sclerotherapy). Sometimes it's a combination of treatments that work best.

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