Varicose veins can go far beyond an issue of vanity and become positively painful. If you suffer from the ropey, blue bulges, there is good news. Whether your desire is to diminish discomfort, or you simply have cosmetic concerns and want to go bare-legged, the treatments have come a long way.

FEMME ROUGE wanted to find out more, and asked Dr. Michael R. Lepore, from Sarasota Vascular Specialists to share his expertise.

WHAT CAUSES VARICOSE VEINS? IS IT MOSTLY LIFESTYLE OR MOSTLY HEREDITARY?
It’s a combination of factors. There is certainly a hereditary component to it. Usually someone has a relative who has had problems with varicose veins. It can also be lifestyle however; if you are overweight, or sit or stand for long periods of time, you may be more prone to varicose veins. Also for women, each pregnancy puts her at a higher risk.”

WHAT IS HAPPENING IN THE BODY WHEN WE GET A VARICOSE VEIN?
A varicose vein is a degenerative process of the veins. The veins that are usually prone to this degeneration are those located superficially, or closest to the skin’s surface. The saphenous vein runs on the inner aspect of the leg but is too deep to be seen externally. When functioning normally, the saphenous vein is supposed to drain the blood out of the superficially located veins in the leg towards the heart. However, sometimes the valves inside the veins don’t function properly. When this is the case, the blood does not go up towards the heart as it should and instead moves down, causing backpressure. The backpressure is what makes the vein dilate. Varicosities caused by high pressure are the easiest to treat. Treatment begins by closing the saphenous vein which can eliminate the backpressure thus improving the varicosity.”

WHAT ARE SOME OF THE EARLY SIGNS THAT YOU MIGHT BE GETTING A VARICOSE VEIN? “People usually complain that they have an achy pain feeling, especially if they have been sitting or standing for a long period of time. Some describe a heavy feeling and that their legs feel so much better after they elevate them. Some people also experience swelling.”

AT WHAT AGE DO VARICOSE VEINS USUALLY BECOME AN ISSUE? “It can really happen at any age. For those who experience it early, like in high school, they usually have a strong familial inheritance pattern, and this is not common. More commonly it will happen after a woman has had multiple births, which could be in her late 20’s or 30’s. Also, as we age, prevalence of varicosities becomes more common.”

SO WE KNOW THAT STANDING OR SITTING FOR LONG PERIODS OF TIME CAN CONTRIBUTE TO VARICOSE VEINS, BUT WHAT ABOUT RUNNING OR WALKING? DOES IT MAKE A DIFFERENCE IF OUR LEGS ARE MOVING? “Any type of exercise helps. When you are exercising the calf muscles in your legs help pump the blood from the veins.”

WHEN WE ARE SITTING, WHAT POSTURE SHOULD WE SIT IN? WE HAVE HEARD THAT CROSSING THE LEGS CAN LEAD TO VARICOSE VEINS, IS THIS TRUE? “Crossing your legs in the traditional fashion where one leg is kind of behind the other – that’s not good. The other way to cross the leg which is not necessarily the most ‘lady-like’ way is with the ankle propped on top of the thigh in a number four shape – this is not so bad.”


MICHAEL R. LEPORE J R. , MD, FACS, RPVI was born in Freeport, New York and moved to Sarasota with his parents in 1974. He graduated with honors from New College of Florida, earned his medical degree from the University of South Florida, and did general surgery training at the University of Alabama, followed by a fellowship in vascular surgery at the Ochsner Clinic in New Orleans, Louisiana. Dr. Lepore then returned to Sarasota to join Sarasota Vascular Specialists. A Fellow of the American College of Surgeons, board certified in Vascular Surgery, and a member of multiple prestigious societies of vascular surgeons, Dr. Lepore has repeatedly been named a “Top Doctor” by the Castle Connolly Corporation.


CAN MASSAGES HELP REDUCE THE APPEARANCE OF VARICOSE VEINS? “Massage therapy has not been shown to change the natural history of varicose veins. I would say the only thing from a massage standpoint is that you are improving some of the flow, but you are probably not going to prevent the process from happening.”

WHAT ARE SOME THINGS THAT PREGNANT WOMEN CAN DO TO PREVENT VARICOSE VEINS? “There are several things that come into play with pregnancies. Part of it is the weight gain, which obviously can’t be helped. What also contribute are the hormonal changes, which cause a dilation of the arteries and a higher blood volume. The good news is that in a lot of these cases the veins go back to normal after pregnancy but may become varicosed again with age or another pregnancy.”

CAN VARICOSE VEINS BE A SIGNAL OF A LARGER HEALTH ISSUE, OR DO THEY PUT US AT RISK OF OTHER HEALTH ISSUES IF LEFT UNTREATED? “If you aren’t taking care of yourself and are not healthy, you are at risk of varicose veins, so it could be an indicator that you are unhealthy and need to make lifestyle changes. Additionally, when a vein is varicose it can develop a clot, which places the leg at increased risk of superficial thrombophlebitis.”

EXPLAIN SOME OF THE OPTIONS AVAILABLE TO TREAT VARICOSE VEINS. “It’s important to know that not everyone who treats these veins is trained. They are not all vascular surgeons and they are doing it as an out-patient procedure in an office that really has no regulations. Not every varicose vein should be treated the same way. Sometimes a vein is better off left alone.

“There are three treatments we use to treat varicose veins. All of them start with an ultrasound of the saphenous vein to see how large it is and determine if it is functioning properly. The ultrasound also checks for clots. If there is an issue with saphenous vein, it is closed off with a procedure called ablation using local anesthetic. The procedure is far less invasive now than it once was and done right in the office. All it takes is a tiny little knick on the skin over the varicosity and the varicosity is removed. Another treatment option is sclerotherapy where we inject a material into the varicose vein that causes it to shrink. There is also laser treatment.

“If somebody has a very large vein and you try to inject it or sclerose it, which is what some people who don’t have the ability to remove them do, the cosmetic results are very poor. There can be brown staining and discoloration and the results overall are just not good. Many times we see patients who are coming to us after going to a place they shouldn’t have with discoloration, and unfortunately there is very little we can do to undo the damage. So it is important to go to a vascular surgeon to treat your varicose veins.”

IF WE DON’T WANT TO HAVE A PROCEDURE, IS THERE ANYTHING ELSE WE CAN DO TO TREAT THE VARICOSE VEINS? ARE THERE ANY TOPICAL PRODUCTS? “A properly fitting compression sock can help. They are available over the counter but they do not always fit properly so it’s best to get a prescription for one that is custom fitted. There is no topical agent that has been shown to do anything for varicose veins.”

SARASOTA VASCULAR SPECIALISTS | 600 N Cattlemen Rd #220, Sarasota | (941) 371-6565 | veinsandarteries.com