- The Washington Times - Sunday, December 10, 2000

Scores of people are plagued by painful, debilitating and unsightly veins. Patients looking for relief can choose from a veritable smorgasbord of specialists called phlebologists and treatment options.

The most common venous disorders, according to Drkoop.com, the Web site founded by former Surgeon General C. Everett Koop, are varicose and spider veins. Varicose veins, the large, ropy veins commonly seen in the legs, occur when the vein is not functioning correctly to help bring blood back up to the heart. Their contents are stagnant or refluxing (flowing backward). Spider veins, the threadlike vessels most often seen on the surface of the skin, appear to be induced hormonally and are associated with pregnancy and menstruation.

According to Veinsonline.com, a Web site that bills itself as the "varicose veins doctor finder" (www.veinsonline.com), some sufferers seek treatment for cosmetic purposes, others for medical benefits.

Untreated varicose and spider veins usually worsen with time and can lead to swelling and a tired feeling in the legs. In addition, enlarged veins can cause venous insufficiency, a congestion of the venous blood that restricts the flow and keeps blood from returning from the legs to the heart. Resulting ailments include blood clots, leg ulcers and bleeding infections.

Patients who want to zap their troublesome veins should shop around. Providers advertising their services include dermatologists and plastic and vascular surgeons even cosmetologists and specialists in obstetrics and gynecology. Treatments range in price from about $350 to many thousands of dollars, says one specialist, although sometimes "medical necessity" qualifies the treatment for insurance coverage.

According to Drkoop.com, varicose veins can be treated by removal (vein stripping) or by injecting them with a substance that causes veins to scar closed (sclerotherapy). Removing or treating varicose veins does not cause circulation problems because veins can reroute themselves around a blockage. Laser procedures frequently are used on spider veins.

Sclerotherapy is king at the 16 offices of Dr. Brian McDonagh's Vein Clinics of America (VCA), in business since 1981. VCA phlebologists practice a refined technique, the doctor explains from his Chicago office: The injected solution that irritates the vein wall "is analogous to the paint on an art brush, where the quality of the result is a function of the artist's training and experience and not merely the paint," he says.

He doesn't recommend vascular surgery. "It has all the sophistication of deboning a chicken. You cut the skin, and you yank the thing out, and you keep doing this until you don't see any more. By today's definition, that's unnecessary surgery."

He says his method of sclerotherapy is foolproof. "I've never seen a patient this has failed on. I introduced it formally in 1993, and we've done more treatments than anyone on the planet."

Dr. R.J. Castiello, a Chevy Chase dermatologist with 30 years of experience, says he sees about 40 to 50 patients per day and performs sclerotherapy about once a day.

He recommends that prospective patients explore their options before settling on a specialist and treatment plan.

"I'm not about to tell you one man's technique is better than another's," he says, "but get a reference from a physician you know. Talk to a dermatologist or something. You need someone to be your fiduciary."

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