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Dr. Christiane Werneck is a vascular surgeon with Trillium Health Partners in Mississauga, Ont., and an associate professor in the Department of Surgery, Faculty of Medicine, University of Toronto.
Question: What causes varicose veins?
Dr. Werneck: The condition is caused by defective valves that can no longer push blood through the affected veins. As a result, blood collects causing the veins to swell. Left untreated, varicose veins may grow in size and can eventually result in inflammation, skin breakdown and ulceration
Question: How common are varicose veins in Canada?
Dr. Werneck: Varicose veins affect more people than you might think. Approximately 20 per cent of Canadian adults are affected, with women being four to five times more likely to have the condition. Typical symptoms include swelling and pain, which can be severe. The diseased veins are also often unsightly.
Question: What steps should be taken if someone believes they have varicose veins?
Dr. Werneck: The first step in treatment is to talk to your family doctor. She or he will ask about your symptoms and examine your legs. An ultrasound is commonly used when a detailed examination is required. Symptoms may be eased by elevating the legs, exercising the calf muscles to improve circulation and wearing compression stockings. If medical intervention is deemed appropriate, your physician may refer you to a vascular surgeon. Treatment procedures vary but share the same goal: to seal the diseased veins so that blood is rerouted through neighbouring healthy veins.
Question: What are the options available for treatment?
Dr. Werneck: The traditional treatment is surgical: a section of the vein is cut and removed and the remaining ends of the veins are stitched shut. The cost may be covered by provincial health plans in serious cases. The latest treatments include thermal ablation, in which the veins are closed by heat from a laser or electric current; sclerotherapy, in which a type of foam is injected into the vein to close it, and a method from Medtronic known as VenasealTM, the first procedure to use a medical adhesive to seal the vein. When discussing these options with patients, my first recommendation is the VenasealTM procedure, for several reasons. First, no anesthetic is required. The procedure is performed in the surgeon’s office and normally takes 30 to 40 minutes to complete one leg. The risks of blood clots, infections and other complications are extremely low as is the probability of recurrence. Finally, no major recovery time is involved—patients can drive themselves home and are encouraged to walk after the procedure
Question: Are there any safety concerns about VenasealTM?
Dr. Werneck: Because VenasealTM is relatively new, some patients question its safety. I reassure them the adhesive is specially formulated for medical use and has been used for many years in other parts of the body. As with any medical condition, patients should discuss various treatments with their physician.
 Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the Amer-ican Venous Forum. J Vasc Surg 2011;53:2S-48S.