Frequently Asked Questions

What is venous disease and how is it caused?

Venous disease is a problem with the flow of blood from the foot back to the heart. When blood flows from the foot to the heart in the veins, it has to flow against gravity. Due to gravity, as blood is a heavy liquid, its tendency is to flow backward towards the foot. There are valves in the veins designed by nature to prevent such backward flow of blood. However, if the valves do not work well, blood tends to pool in the legs after people are up and around for a while through the day. This leads to symptoms described above (under the question “What are the symptoms of venous disease”). Over a long period of time, the skin branches of the veins become engorged and show up as varicose veins due to increased pressure in these veins.

What is the difference between varicose veins and venous disease?

People use the terms venous disease and varicose veins interchangeably. Varicose veins are a symptom of venous disease. People may be able to recognize varicose veins themselves without the help of a doctor and may seek self-referral to a specialist for this. The other terms that are used interchangeably with Venous Disease for the purpose of this web-site include venous incompetence, venous reflux disease, and venous insufficiency.

What are the symptoms of venous disease?

Commonly people get achiness, heaviness, or tiredness of the legs after being up and about, swelling of the legs that is worse towards the later part of the day, varicose veins with itching and/or throbbing over varicose veins. Sometimes varicose veins also bleed spontaneously. People also get skin discoloration in the lower legs especially in the shins. On a long-term basis, if untreated, venous disease can lead to ulcerations in the legs that are difficult to heal.

Who is at risk of venous disease?

People who are in professions that involve a lot of walking and standing, people who have other family members with venous disease, women after pregnancies, people who have had a clot in the legs in the past, etc. Though the above sets of people are at risk, practically anybody can get venous disease as it is a consequence of the two-legged posture of the human species.

What is the difference between varicose veins and spider veins?

Varicose veins are the bigger enlarged veins whereas the spider veins typically appear pink or purple in color and are frequently seen in a small cluster.

How can I tell if I have venous disease?

f you have risk factors for vein disease and have symptoms of achiness, heaviness, or tiredness of legs, swelling of the legs that is worse towards later part of the day, varicose veins or spider veins, skin discoloration in the leg, etc, you may have venous disease. You can take our self-assessment test in the resources section of this website to determine if you potentially have venous disease.

How do I get consultation from a vein specialist?

You may self-refer yourself to a vein specialist, make an appointment and get a consultation. Alternatively you may ask your primary physician to refer you to a vein specialist. You may call this office (Tel number 248-243-3936) and make an appointment too.

What does consultation involve?

During the initial consultation, the vein specialist will see you, examine you and determine whether you have appropriate symptoms for venous insufficiency. If you have symptoms, usually you are first asked to undergo a compression-stocking trial period. This is followed by ultrasound testing and treatment if needed.

How is venous disease treated?

The first step in treating venous disease is a compression stocking trial. Most insurance companies require patients to use compression stockings for about three months before any further testing or treatment is approved. Certain symptoms exempt patients from the stocking trial requirement. These include; skin color or texture changes, bleeding from varicose veins, recurrent clots in the varicose veins, and current or healed ulcers of the leg. If stockings do not help ablation (Laser, Radiofrequency or VenaSeal ablation) of incompetent veins is the definitive procedure. 

How do compression stockings work?
Compression stockings have graded strength in such a way that they have more compression effect at the ankle and as the sock goes up the leg, the compression effect becomes lesser. This allows blood to flow from the foot towards the heart and prevents pooling of the blood, thus alleviating the symptoms.
How do I wear the compression stockings?

The compression stockings are usually recommended to be worn from morning to evening every day. It is not necessary to wear the stockings when you are in bed at night. If it is too hard to wear compression stockings you may buy the “Butler Device” from a medical supply store such as Binson’s or Wright and Fillipis to help wear the stockings.

What does ablation procedure involve?

The ablation procedure is a minimally invasive technologically advanced state-of-the-art procedure wherein the bad vein is closed through a needle hole. This is done under local anesthesia in the outpatient office setting. It is a minor procedure that most patients are easily able to undergo. 

How does ablation procedure help me?

By closing the bad vein that causes pooling of blood in the legs, the ablation procedure results in alleviation of symptoms such as achiness, heaviness, tiredness of legs, swelling of legs. In many patients, ablation procedure also results in varicose veins becoming less prominent.

If I undergo an ablation procedure, what is the recovery time?

Typically after the ablation procedure, the patient is sent home with an Ace-bandage wrapping of the leg. They are typically asked to rest for a few hours. After that, they can be up and about the same day. They can resume normal activities the next day. Some people may be even able to go back to work the next day if their work does not involve significant physical effort or long durations of standing.

Are varicose vein and venous disease treatments covered by insurance?

Yes, varicose veins and venous disease treatment that is symptomatic is covered by insurance. Our office applies for prior authorization from insurance companies so that patients are not liable for any of the covered costs. However, if you have a deductible that is not met, you may be liable to the deductibles.
Also note, that if you have no symptoms and you seek treatment for cosmetic reasons only, then, treatment may not be covered.

How do I prevent venous disease?

Venous disease is a consequence of the two-legged posture of human beings leading to valve dysfunction from standing and walking on two legs. The best way to prevent venous disease is to use compression stockings during waking hours when you are up and about on the legs. It can be used as a regular pair of socks. 

If I had treatment for vein disease, am I at risk of getting vein disease again in future?
Yes, if you have had venous disease in your life, it may mean that you may have inherited weak valves, and hence, you are at risk of developing venous disease again in future in your life. The best way to prevent venous disease is to wear compression stockings when you are up and about.
Are there any special instructions to arrive for ultrasound test?

Yes, when you come for the ultrasound test, it is important that you hydrate yourself well through the day prior to and the day of the test. We also recommend that you avoid coffee and cigarettes on the day of the test so that your veins are larger in size and are easily visible. 

If I have vein disease in both the legs, may I undergo the procedure on both sides at the same time?

Typically, we do not do procedures on both sides at the same time. We typically give a gap of at least two weeks between the two sides. Also, from a patient perspective, if you happen to be one of the occasional people who has higher post-procedure pain, it is preferable that you do not have pain in both legs at the same time.

What do I do if the stockings are very difficult to wear?

Some people find it difficult to wear stockings because they may not be able to bend down or they may have arthritis in the hands. For such people, medical supply stores have a device called the “Donning Device” or the “Butler device” which can be very helpful in wearing the socks. Please see resources section for a video of how the device may be used.

How is venous disease definitively diagnosed?
After a compression stocking trial, an ultrasound test is done to evaluate the function of the valves. This is done in our office by a specially trained board certified ultrasonographer. The ultrasound test will determine the presence or absence of valve dysfunction and the distribution of valve dysfunction in the leg.
How does ablation procedure work?

Typically venous disease is treated with ablation of the bad vein that is causing pooling of the blood. By ablation, the vein is closed by either Laser, Radiofrequency or Venaseal equipment. The closure of the bad vein that is allowing backward flow of blood prevents pooling of the blood in legs and allows the good veins in the leg to take blood smoothly back to the heart.

Can the varicose veins stay engorged even after the ablation procedure?

Yes, after the ablation procedure, even if your symptoms become better, the varicose veins might stay engorged in some people. As the veins are made of elastic tissue, once engorged, they may not completely go down. In such people, insurance companies, do cover a secondary procedure called Micro-phlebectomies to remove the residual varicose veins.

Can something be done to alleviate residual varicose veins?

Yes, if the varicose veins do not go down even after the ablation procedure, a second office-based procedure called Micro-phlebectomies, is performed to take out the residual engorged varicose veins. This procedure is also an office-based procedure done under Valium and local anesthesia. It involves removing the varicose veins after making small cuts in the skin directly over the prominent veins.

How are spider veins treated?

Spider veins are treated with injection therapy which is called sclerotherapy. This is also an office-based procedure.

Is there significant pain after the ablation procedure?
The ablation procedure usually causes very little postoperative pain in most patients. Most patients report that they have a pulling sensation in the thigh. This settles down on its own in a few days. Some patients do have significant pain that is treated with Motrin and warm compresses.
Are there any complications to ablation procedure?
Yes, ablation procedure can lead to Deep Vein Thrombosis or clot in the Deep veins of the leg. This occurs rarely, only in about 1-2% of patients. As a precaution, in our practice, we bring all the 100% of patients for an ultrasound test the week after ablation procedure to make sure they do not have a clot. Even though this appears like an over-kill, we take this precaution so that if a patient has a clot, it is recognized and treated.
If I have vein disease in both the legs, may I undergo the procedure on both sides at the same time?

Typically, we do not do procedures on both sides at the same time. We usually give a gap of at least two weeks between the two sides. Also, from a patient perspective, if you happen to be one of the occasional people who have significant post-procedure pain, it is preferable that you do not have pain in both legs at the same time.

May I have treatment for vein disease during pregnancy?

No, we do not treat pregnant women with any kind of vein procedures. However, you should wear compression stockings during pregnancy to prevent excessive stress on your veins. We will be able to treat your vein problem after the pregnancy.

Where can I buy compression stockings?

We typically recommend that you buy compression stockings from a medical supply store such as Binson’s or Wright and Filippis . Though for most people, the standard available sizes do fit well, some people may need a measurement of their legs and custom stockings. Custom stockings do need measurements of your leg to be taken by a qualified individual. Therefore, it is better to go to a medical supply store. We typically recommend against buying compression stockings from regular department stores, grocery stores, etc.