At Inovia Vein in Northwest Portland, we can help you address your vein care needs. Our clinic is part of a group of the only specialized vein clinics in Oregon that is staffed by leading vein care specialist. Our clinic in Northwest Portland, Oregon is led by Dr. Alexander D Nicoloff. Dr. Nicoloff is a board certified vascular surgeon who has practiced Vascular Surgery in Portland for over 20 years while on staff at Legacy Emanuel Medical Center, Legacy Good Samaritan Medical Center and Legacy Meridian Park Medical Center.
“I joined Inovia Vein to bring my expertise treating a wide variety of vascular disorders and focus on a special interest of mine — caring for patients with common venous disorders,” said Dr. Nicoloff.
“Here I can spend more time working directly with patients to figure out optimal treatment pathways and treat them over time in an efficient and convenient outpatient setting until their issues are resolved.”
What follows are very common questions we hear when helping patients through their vein care journey.
What Causes Varicose Veins?
Everyone has veins to carry blood back to the heart. Blood is pumped by the heart through arteries, out to tissues, through capillaries, then it collects in veins for the journey back to the heart. The veins in the legs have a unique challenge in that the blood must overcome gravity to get back to the heart. Water and other fluids will not run up hill without a pump, and likewise, blood will not go back up against gravity without a pump. In the leg veins there are one way valves in the veins that prevent back flow of blood as it works it ways against gravity back up to the heart. The calf muscles are the pump. As one walks or moves their legs, the contraction of the calf muscles serves as a pump to move the blood in the veins up toward the heart, and the valves keep the blood from coming back down.
Varicose veins occur when the valves in the leg veins become weak or damaged. This can be a result of injury (like a broken leg or getting hit with a fast ball in the calf), a result of some form of coagulation or blood clotting disorder, or most cases it is just genetic (which is why we often see this runs in families). Once the valves become damaged the blood can pool in the lower leg veins. When this happens the pressure in the veins goes up and the veins start to stretch and bulge out. Over time we see varicose veins appear on the legs, usually starting below the knee on the inside of the calf, and eventually working their way over the foot and up the thigh.
Why Do Varicose Veins Hurt Sometimes?
The reason varicose veins hurt is because of tissue stretch and inflammation. Any tissue in the body that stretches can hurt. This is because there are stretch receptors in tissues that signal pain when they are activated. Early on just the veins themselves stretch and hurt. With time fluid pressured within the veins weeps into the surrounding tissues. This is why varicose veins can lead to leg swelling, especially around the ankles and below the knees. This can be so severe in some cases, it can be difficult for some to put their shoes on. The swelling and discomfort from varicose veins tends to get worse as the day goes on, and better at night. This is because pressure builds up in the veins during the day when we walk and stand, and then gets better at night when we are sleeping as the pressure is relieved on the leg veins when we sleep.
Are Varicose Veins a Health Problem?
Varicose veins can become a health issue in some people. With time there is an inflammatory response to the vein and skin stretching in the lower legs, which is why the achy veins can appear red and feel warm and tender. Likewise, this is why swollen ankles can appear red as well, as the stretch leads to inflammation of the skin.
At times the veins can clot, known as superficial vein thrombophlebitis. This can be quite uncomfortable and can progress to deep vein thrombosis or pulmonary embolism and requires medical evaluation and treatment.
Over time the swelling and skin stretching can cause scarring of the skin, leading to a brown hard area above the ankles (known as lipodermatosclerosis). Many people have this brown discolored skin by their ankles and are unaware this is due to venous insufficiency. In some patients, wounds can open around the ankle (known as venous stasis ulcers). This can be quite painful, debilitating and can become infected. This can require hospitalization or extensive wound care. Once patients see redness, swelling, skin irritation or wounds that do not heal they should seek medical attention as many of these complications of venous insufficiency can be treated with great relief.
What Can You Do?
For starters, many patients with mild symptoms of swelling and ache find elevating their legs helps. This lessens the pressure in the veins and thus the stretch comes out of them. This also reverses the pressure gradient that leads to swelling, and fluid can return from the ankle tissues to the capillaries and back to the circulation. This is why in most vein patients, swelling goes away at night. But the next day, however, the swelling returns. During the day, a strategy of graded compression hose can help. Graded compression hose are tighter than traditional socks, and serve to put pressure on the skin and bulging veins, helping prevent swelling and the pain from the stretch of the tissue. They are generally only needed during the day. For patients with skin irritation and redness or itching, compression can help, but also a dermatologic care strategy can also contribute to relief with various topical medications to treat these symptoms.
What If This Doesn’t Work?
In most cases where the symptoms are advanced, the saphenous veins are the culprit. Both the great saphenous vein (GSV,) and small saphenous vein (SSV) run under the skin and are responsible for the vein return from the skin and underlying tissue. When the valves are bad, the veins dilate and stop working, leading to venous insufficiency and varicose veins. In the past this was treated with open surgery or vein stripping at the hospital. But not anymore. There now are numerous minimally invasive vein treatment options with interventions like endovenous ablation of the greater saphenous vein with methods such as ClosureFast RFA , VenaSeal, and Varithena Endovenous Microfoam. Most of these treatments can help reduce the pain and swelling from varicose veins significantly.
These procedures can be done in the office with a local anesthetic with little or no downtime. Patients walk in, have their treatments in less than an hour, then walk out. Most people can go back to work or normal activities the next day. Before any procedures are done, we sit down with you and help map out a personalized vein treatment plan that accounts for your specific vein care needs. This can involve staging the procedures over several treatments so we can treat both legs, as well as some of the branch vein with techniques like sclerotherapy, when indicated.
How to Start Your Vein Treatment Journey
At the Inovia Vein Specialty Clinic in Northwest Portland, we can assess your varicose veins and recommend the optimal treatment for your needs. This starts off with a first visit where we listen to you about your concerns and symptoms, and help map out a treatment plan to diagnose and treat your issues. Patients often ask if these treatment are covered by insurance?
The answer is that it depends. With most insurance plans when the patient has symptoms of swelling, ache, skin irritation and wounds the treatments are covered. We can help you assess your options and submit your case to your insurance company for their input when needed. For patients where insurance coverage is not offered by their insurance companies, we can help quote patient pay options to facilitate treatment.