Frequently Asked Questions (FAQ)

In simplest terms, arteries take oxygen-rich blood FROM the heart; veins return oxygen-depleted blood TO the heart.

Venous reflux disease is a condition that develops in the superficial venous system when the valves in your veins that keeps blood flowing out of your legs and back to your heart becomes damaged or diseased. This causes blood to pool in your legs. Common symptoms of superficial venous reflux disease include leg restlessness, pain, swelling, and heaviness and fatigue as well as varicose veins.

The deep venous system returns blood directly to the heart and is in the center of the leg, near the bones. The superficial venous system is just beneath the skin; it has less support from surrounding muscles and bones than the deep venous system. Perforator veins serve as connectors between the superficial and the deep systems.

Varicose Vein Questions

Varicose veins are raised, ropey, enlarged veins. They usually appear on the legs and can cause the leg to swell, itch, ache, and in severe cases, can cause ulcers. Normal vein valves close after blood travels up the vein, preventing blood from moving backwards (refluxing) down the vein. Varicose veins form when valves in the vein fail (become incompetent). Valves become incompetent for a variety of reasons, including trauma and pregnancy. Once a valve becomes incompetent, the vein below the valve is exposed to higher pressure and becomes dilated. This causes other valves to fail and other veins to dilate.

Varicose veins are dark blue in color and commonly appear on the backs of the calves or on the inside of the legs. But they can form anywhere on your legs, from your groin to your ankle. They protrude or bulge from under the skin and feel ropey. Varicose veins cause an achy or heavy feeling in the legs, and burning, itching, throbbing, muscle cramping and swelling in your legs. Prolonged sitting or standing makes your legs feel worse, while elevating your legs makes them feel better. Varicose veins can also cause skin ulcers near your ankle.

Gravity is the culprit. The distance from the feet to the heart is the furthest blood has to travel in the body. Consequently, those vessels experience a great deal of pressure. If vein walls and valves weaken, the reflux of blood can cause superficial veins to become varicose.

Pregnancy does not cause varicose veins; rather, it can aggravate an existing tendency toward the condition. More blood circulates in the body during pregnancy to meet the demands of the developing baby. This increased blood flow can burden an already weakened venous system. The growing fetus can also press on the pelvic veins and hinder the passage of blood. Finally, some researchers speculate that hormones present during pregnancy may contribute to dilated vessels. Prominent, uncomfortable veins that do not diminish postpartum should be evaluated by a vascular surgeon; though, some insurance providers require a six-month waiting period postpartum be observed before treatment is a covered benefit.

It depends. Leg aching and/or throbbing can be symptoms of varicose veins and are most likely related to them. However, since there may be other conditions related to your leg discomfort, it is recommended that anyone experiencing leg pain should have an evaluation by a vein specialist. Temporary relief of these symptoms may be achieved by avoiding prolonged sitting and/ or standing If you have a standing profession or if you find yourself standing for an extended amount of time, shift your weight from leg to leg. When sitting for more than 30 minutes, try to elevate the legs above heart level. If that is not possible, stand up and walk around for a few minutes before sitting again. In either case, wearing compression hose is recommended.

Yes, there are a number of conditions that can mimic venous disease in one or more of its manifestations. Nerve compression from back problems as well as arterial disease are the most common. However, there are many other conditions that can cause swelling, pain, discoloration and ulceration etc. Your physician will be able to diagnose your condition and/or rule out many of the other conditions.

Both invasive and non-invasive methods are available to treat varicose veins.

Non-invasive methods include wearing compression stockings, exercising, leg elevation, losing weight, not wearing tight clothes, avoiding long periods of standing or sitting, and not crossing your legs while seated. ESES (pronounced SS) is an easy way to remember this conservative approach. It stands for Exercise Stockings Elevation and Still. Exercise, compression hose/stockings, elevation and rest will not make the veins go away or necessarily prevent them from worsening due to the underlying venous reflux disease not being addressed; however, it may provide temporary relief of the symptoms associated with varicose veins. Weight reduction is also helpful. If there are inflamed areas or an infection, topical and/or oral antibiotics may be prescribed.

Invasive treatments include endovenous therapy, ligation, and phlebectomy. Endovenous therapy is treatment from inside the vein using heat generated by lasers, radiofrequency devices or chemicals to irritate the vein walls and cause the vein to close and then be reabsorbed by the body. Ligation is tying off a vein to cause it to shrink. Phlebectomy is removal of varicose veins.

Patients report feeling little, if any, pain during and after our procedures. Tumescent solution is local anesthetic used to desensitize the treatment area.

All varicose vein procedures are performed in our office using only local anesthesia allowing patients to literally walk out of their procedure; thus, avoiding the need for extended recovery and the side effects associated with general anesthesia.

Patients may experience some bruising or swelling following varicose vein procedures. Long term, our patients report little to no scarring.

Patients are walking immediately following the procedure; they typically resume normal activities within one day. Strenuous activities should be avoided for 7-10 days.

Most patients report a noticeable improvement in their symptoms within 1-2 weeks following the procedure.

No serious complications (e.g. need for hospitalization, blood transfusion, or other surgery) have been reported in our hands in well over 7000 cases. A small number of treated patients have had transient paresthesia (numbness) and even fewer have had superficial clotting or DVT.

No. You will be given a special pair of glasses to protect your eyes in case of accidental firing of the equipment outside the body.

Sclerotherapy is commonly used for treating spider veins and small varicose veins. It involves the injection of a FDA-approved foamed sclerosing solution (a mixture of saline and Sotradecol®), which causes chemical endovenous ablation of the vein, which collapses and diminishes in appearance.

Venous ulcers are areas of the lower leg where the skin has broken down exposing the tissue. Typically, skin discoloration as well as itching will occur around the ankle before a venous ulcer will form. Ulcers can range from the size of a penny to completely encircling the leg. They are painful, open wounds, which weep fluid and can last for months or even years if left untreated.

The vein simply becomes fibrous tissue after treatment. Over time, the vein will gradually incorporate into surrounding tissue. One study reported that 89% of treated veins are indistinguishable from other body tissue one year after the Closure procedure was performed.

Endovenous laser therapy (EVLT) is a relatively new technique that uses a laser to destroy the vein. It is an outpatient procedure and may be done under local anesthesia. It takes about 45 minutes. A laser fiber is inserted into the vein under ultrasound guidance. Next, the vein is anesthetized using local anesthesia. The fiber is then connected to the laser generator and slowly withdrawn from the vein, sealing it and stopping the venous reflux. Possible adverse reactions are numbness and tingling, and venous thrombosis (blood clots) in the legs. Patients may have bruising and mild pain for up to 4 weeks.

Radiofrequency ablation – the Closure Procedure – is similar to endovenous laser therapy. A radiofrequency probe is placed in the vein under ultrasound guidance. Then the vein is anesthetized using local anesthesia. Next, the vein is heated along its entire length by slowly withdrawing the probe from the vein. This causes the vein to clot and close, stopping the reflux. Radiofrequency ablation is an outpatient procedure, can be performed under local anesthesia, and takes about 45 minutes. Possible complications are numbness, tingling, and blood clots in the legs. Patients may have bruising and mild pain for up to 4 weeks.

Radio-frequency energy delivers heat to the vein walls causing them to collapse and seal closed so that blood can no longer flow through the diseased vein.

EVLT delivers heat to the vein walls with laser energy where Closure® uses radio-frequency energy. It is typically based on the physician’s preference, as both are highly effective procedures.

These are either knee-high or thigh-high elastic stockings, which are designed to compress most at the feet and ankles and least at the top. The lessening of compression from the ankle to the upper end of the stocking happens gradually. This maintains the flow of blood upwards towards the heart. These stockings come in 4 compression grades, depending on requirement of the patient, guided by the physician.

Compression stockings are essential to a successful recovery and prevent adverse side effects after surgery. You must wear compression stockings for the first 24 hours after the procedure. After that time, you should continue to wear them for the next 7 – 10 days at all times, except when sleeping.

One of the questions I am most often asked when doing screenings for vein disease is “Is treatment covered by insurance?” As usual, most medical questions are not easily answered and so the answer is yes, and no. All insurance companies consider varicose vein disease treatments medically necessary, and will therefore cover it, if there are complications such as bleeding or ulceration. Most consider treatment medically necessary if there are symptoms and reflux can be demonstrated on a Doppler exam.

Some of the newer treatments are considered “experimental” and therefore not covered. Spider vein treatments are considered cosmetic and no longer covered by any insurance plans of which we are aware.

Lastly, not only does each insurance company have its own requirements, but each individual policy can vary within the general guidelines of the company. Sounds confusing, and it is. The best way to find out if your particular situation meets the requirements necessary for insurance coverage is to come in for an evaluation.

“I found Dr. Kokinos to be excellent at explaining, assessing, and treating. It is wonderful to find an excellent doctor who is also a friendly and compassionate person.”

– SBVC patient

“For over 12 months I went between UCSF and Stanford Clinics trying to get diagnosed because I was so one could ever find a cause to any of my turns out it was a blood flow problem that was making me so sick. I am very thankful I found Dr. Kokinos!”

– SBVC patient