- The Washington Times - Tuesday, April 9, 2002

The beach and pool season is approaching fast, and many people are sweating in the gym in order to look their best in swim trunks and bikinis. The 25 to 50 million Americans with swollen, twisted varicose veins, however, can't exercise away a condition that can be both an eyesore and a pain.
Varicose veins are abnormally swollen and bulging veins, most often found in the legs. Faulty valves in the veins or weak vein walls cause the bulging.
"A large segment of the population wants to go to the beach or wear shorts during the summer, and they may feel embarrassed about varicose veins," says Dr. Kenneth Moresco, an interventional radiologist who treats varicose veins at Inova Alexandria Hospital. "It's like a skin deformity."
However, very few patients with varicose veins decide to have their faulty veins removed, Dr. Moresco says.
Some people don't have them removed because they think it's only natural to have aching legs at the end of the day. Others say they elect not to have them removed because they have heard horror stories about stripping, the traditional vein-removal method, which is known to be painful and requires weeks of recovery, Dr. Moresco says.
He and a few other local doctors now offer a less invasive treatment that takes 30 minutes and uses a combination of ultrasound, a catheter and radio frequency to disable the faulty varicose vein.
The patient, who receives only local anesthesia, can walk out of the hospital on foot right after the procedure.
"They go home with a little Band-Aid on their knee," Dr. Moresco says. The procedure, called endovenous saphenous vein obliteration, disables the faulty vein by heating up the vein walls to about 185 degrees Fahrenheit using high radio frequencies. The radio frequencies are emitted from a 13- to 20-inch catheter that the doctor inserts through a small puncture in the faulty vein at the level of the knee.
The heat makes the vein wall collapse. As it shrinks, the vein becomes disabled.
The procedure costs between $2,500 and $5,000 and normally is covered by insurance unless the reasons for treatment are purely cosmetic, Dr. Moresco says.
On an ultrasound, used by the radiologist during the procedure, it looks as if the sides of the swollen vein are zipped up tightly as they are heated by the catheter.
The disabled vein which consists of dead cells is later absorbed into the body, as if it had never existed. Other surface veins take over the function of the disabled vein.
"You can barely see remnants of it a few months after the procedure," Dr. Moresco says.
He hopes the new treatment will encourage more patients to do something about their condition, which can lead to severe skin ulcers and possible amputation of a leg.
In a study published in the May-June 2000 issue of the medical trade publication Vascular Surgery, researchers said the success rate for the procedure is more than 90 percent.
Healthy veins, whose primary function it is to pump blood back to the heart, are full of valves that help push the blood upward and prevent it from becoming stagnant or even flowing back down toward the feet.
When the valves are faulty, the blood flows backward (refluxes) or pools and creates that bulgy, rope-looking vein called a varicose vein.
Some people with varicose veins have no pains or aches. They simply don't like the look of the swollen veins. Others experience swelling, throbbing, achiness and leg cramps.

Helen Hunyady, 52, a meat wrapper at a grocery store in Falls Church, has had aching and cramping legs for many years. She stands most of the day and is very overweight.
She thought all her discomfort was linked to her arthritic knees until a sonogram showed that she had varicose veins.
"I found out that my blood was going down into my legs, but not coming back up," Ms. Hunyady says, "and it was just hurting and hurting."
Women are more likely candidates for varicose veins than men. The reason for women's predisposition is that progesterone, a steroid hormone produced in the ovary, can cause a relaxation in the vein valves.
However, the condition is caused by a combination of factors, including family history and being overweight, which increases pressure on the veins.
Other conditions and lifestyle factors include frequent weight changes, which can occur when someone gains and loses weight often, pregnancy and prolonged sitting or standing.
After consulting with Dr. Moresco, Ms. Hunyady decided to have the procedure performed at Alexandria Hospital in late February. In the weeks after the treatment, she still has some pain, which may be because of the arthritis, but her muscle spasms and cramps are gone.
The swollen vein, which used to be noticeable on her left leg just above the knee, is no longer visible.
"It just faded away," Ms. Hunyady says.
Though it is minimally invasive and applauded by some patients, endovenous obliteration is not for everyone.
If a patient has a very "contortioned," or twisted, varicose vein, it can be difficult to thread the catheter through it, Dr. Moresco says. Stripping might be recommended in those cases.
Also, if a doctor suspects that a patient might need heart-bypass surgery in the future, treatment of the vein may not be recommended. The vein in this case, though unsightly and perhaps painful, might be used for lifesaving surgery to restore blood to the heart.
Another reason to hold off on the new treatment is if the swollen vein has blood clots, which can be detected with a diagnostic ultrasound.
Risks of the procedure include skin burns, infection, bleeding and possibly life-threatening blood clotting (if a clot goes undetected).

Though women are more common among varicose vein patients, men can get the condition, too. Alexandria resident Owen Jones, 65, who works as an accountant, had pain in his legs for decades. A few months ago, a malfunctioning valve was found in a vein close to his knee.
After talking to Dr. Moresco about the new procedure, he decided to have it done. If stripping had been the only alternative, Mr. Jones says he would have continued wearing compression stockings, a way to treat the symptoms of varicose veins but not the causes.
"I had heard it's terribly painful and you are laid up for so long too," Mr. Jones says of stripping.
A third method, sclerotherapy, is also available, but it is more appropriate for treatment of spider veins, which are more superficial veins.
People who have the symptoms of varicose veins may do well taking a five- to 10-minute walk every couple of hours and wearing compression stockings, Dr. Moresco says.
Varicose veins do no go away by themselves, however. The walks and compression stockings just take away the symptoms, not the causes.
Mr. Jones went in for the radio-frequency procedure about a month ago. He still has some swelling in his leg, and the vein is sore to the touch, but he no longer has chronic pain in his leg. That is a great relief, he says.
During the procedure, he was given local anesthesia and was able to follow along on the ultrasound screen as Dr. Moresco threaded the catheter through his faulty vein.
The doctor uses the ultrasound to help guide him or her through the vein.
"It was pretty neat watching it And when it was all over, I just walked out of there," Mr. Jones says.

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