James Lin, Jr., M.d.
Total vein care clinic

600 N. Garfield Ave., Suite #303, Monterey Park, CA 91754
(626) 572 - 7431
 What Are Varicose Veins?
Varicose veins are tortuous, enlarged veins.  Any vein may become varicose, but the veins most commonly affected are those in your legs and feet.  This is because standing and walking upright increase the pressure within your leg veins.  The picture above right shows a good example of a varicose vein in the right leg, before and after EndoVenous Laser Therapy, or EVLT.
For many people, varicose veins and spider veins are simply a cosmetic concern.  For other people, varicose veins can cause aching pain, itchiness, heaviness, numbness and discomfort in the legs.  Sometimes the condition leads to more serious problems such as “browning” or discoloration of the skin, leg swelling, skin ulcers, and even bleeding.
Varicose veins are a common condition in the United States, affecting up to 25 percent of men and up to 45 percent of women.  Treatment may involve self-help measures, such as wearing compression stockings, or procedures by your doctor to close or remove the veins.
                                                What Causes Varicose Veins?
Your veins carry blood from your capillaries back to the heart.  In your legs, this means that the blood must flow upward, against gravity.  Consequently, all of your leg veins contain one-way valves which prevent the blood from backflowing.  Over time, these valves can fail to close tightly, allowing blood to pool in your lower legs and feet, and causing the characteristic bulging and twisting of varicose veins.  Once these valves are damaged, they cannot be repaired.  Nobody really knows why these valves are damaged in the first place, but many doctors believe there are certain risk factors which increase your likelihood of developing varicose veins.  Risk factors include:  family history of varicose veins, multiple pregnancies for a woman, and prior trauma to the affected leg.  Contrary to popular belief, jobs which require standing for long periods of time do not seem to “cause” varicose veins, although it may make the symptoms worse if you already have vein problems.  
The damaged vein and valves will slowly worsen with time.  The diagrams below illustrate the pathology associated with these damaged valves and how they relate to poor blood flow and the formation of varicose veins.
                                                        In this diagram, the green arrows indicate normal
                                                        blood flow.  The one-way valves inside the vein only
                                                        allow the blood to flow upward, back to the heart.
                                                        These normal valves will close when standing or when
                                                        there is increased pressure, thus preventing the
                                                        backflow of blood downward toward the feet.  This is
                                                        a normal diagram of venous blood flow in the leg.
                                                            In this diagram, the red arrows indicate abnormal
                                                            blood flow.  The valves in the superficial vein are
                                                            broken and no longer function properly.
                                                            This allows blood to flow in the wrong direction,
                                                            downward toward the feet, when standing or
                                                            with increased pressure.  Notice also that the vein
                                                            containing the broken valves has now increased in
                                                            size and become “varicose” due to the increased
                                        What Are The Symptoms?
Some people with varicose veins do not experience any symptoms at all.  When painful signs and symptoms do occur, they may include some of the following:
    *    Aching, cramping, or throbbing
    *    Heaviness in the affected leg
    *    Burning, numbness, or tingling
    *    Itching
    *    Night cramps and soreness after laying down for bed
    *     Skin ulcers around your ankles
    *    Worsening symptoms with prolonged standing or sitting
    *    Improved symptoms with walking
Varicose veins vary in color and may appear skin color, dark purple, or blue.  They commonly appear on the lower legs and thigh, but can form anywhere from your groin to your ankle.  
Spider veins are similar to varicose veins, but they are smaller and appear like spider webs.  Spider veins are found closer to the skin’s surface and are often red or blue.  They occur on the legs, but can also be found on the face.
                          How Do You Treat Varicose Veins?  Is It Painful?
The good news is that there is a new, minimally invasive method for treating varicose veins that is significantly better than the old method.  
The old method for treating varicose veins was to have surgery.  Surgery involves considerable preparation, general anesthesia, pain in the affected areas, and a lengthy recovery period.  The medical laser technology that we use eliminates all of those factors.
First, our treatment is minimally invasive, which means that our entry point into your vein is extremely small, not even requiring stitches.  Second, there is no “recovery” to speak of.  In fact, you will be up and walking as soon as the treatment is completed and able to return immediately to full normal activity.
The procedure itself only lasts approximately 60 minutes, and it is performed right in our office.  We use local anesthesia to numb your leg, insert the laser fiber into the target vein, and then turn the laser on.  Within minutes, your varicose veins will be eliminated.  The only uncomfortable part of the procedure is the local anesthesia injections that we need to give you in order to numb your leg.  The rest is easy!
You may feel some discomfort in your leg for about 1-2 weeks, but it is manageable and usually does not require any medication.  Bruising will also be present in the leg for about 3-4 weeks.  The diagrams below illustrate how the laser fiber is placed inside the vein, and how it closes the vein after it is turned on.
                                                           The laser fiber is inserted into the varicose vein
                                                           through a very small entry point in your leg, usually
                                                           somewhere near the knee.
                                                        The laser fiber is activated and is pulled back out of the
                                                        vein.  As it is pulled back, the laser fiber “closes” the
                                                        vein.  This vein has now permanently been closed and
                                                        will no longer cause the symptoms associated with
                                                        varicose veins.  The body will heal this “burned” vein
                                                        over the next few weeks.
There are also other methods for treating varicose veins, and these can be discussed at the time of your consultation.  Another commonly performed procedure for varicose veins is called Ambulatory Phlebectomy.  In short, it involves using a small hook to pull out smaller varicose veins from a small entry point in the skin.  Commonly, a combination of Laser therapy and Ambulatory Phlebectomy is employed for optimal results.  
                                       What Are The Side Effects?
All medical procedures have risks.  While this laser treatment and other associated treatments for varicose veins are exceedingly safe, there are some risks that potential candidates should be aware of.  Although rare, one cosmetic concern is mild darkening of the skin in the treated areas.  In most cases, this skin darkening will lighten with time, but it may occasionally take up to 4-6 months.  Other risks that should be discussed with your physician include bleeding, nerve damage, thrombophlebitis, skin ulceration, leg swelling, deep venous clots, or pulmonary embolism.  Overall, the benefits of this procedure far outweigh the risks, and Dr. Lin will be happy to discuss any concerns you may have about the procedure, or vein care in general.
                                       Will My Insurance Cover Treatment?
If you have clinical symptoms arising from venous disease, Medicare and almost all private insurance will cover the cost for treatment.  As always, you will need to check with your insurance provider to determine exact coverage based on your health plan.  We also offer cash price discounts in the event that you do not have insurance.  Please call our office for more information.