Disabled vessels

Pain in your leg? The source could be deep within.

A presentation tonight by a Spokane vascular surgeon aims to educate people about possible causes of leg pain related to veins and arteries. As interest grows in some treatments, it’s among presentations and free screenings to reach potential patients with vascular problems. Some presentations may be more enticing than others: One series of local promotional events offers Northwest wines and hors d’oeuvres along with information about the latest treatments for varicose veins.

It’s true the varicose vein business has grown, said Dr. Stephen Murray, of the Providence Vascular Institute, who’ll give the presentation. That’s thanks to treatments that are easier for patients – and more profitable for providers, he said. But less obvious vascular problems may have more serious implications.

At tonight’s event, Murray plans to start with the basics: Arteries carry blood away from the heart; veins carry it toward the heart. That’s good to know, because leg pain related to the circulatory system generally falls under the arterial category or the venous category.

But he’ll also stress that leg pain might be a signal of a life-threatening problems that require attention – and not necessarily from a surgeon, but from the patient.

Vein treatments on the rise

When it comes to faulty veins, varicosities – bulging, bumpy protuberances – are the most common symptom.

Back in the day, varicose veins didn’t get much respect, Murray said: “Varicose veins were the ugly stepchild of vascular surgery.”

These days, he faces more competition for patients with vein complaints.

Veins – or treatment on the varicose ones – started to become sexy around 2000, he said, when the use of radiofrequency and lasers to close off varicose veins became popular. In a microphlebectomy, another “minimally invasive” procedure, several tiny incisions are made in the skin through which the vein is removed. In sclerotherapy, a chemical is injected into the vein that causes it to close off.

Those and other recent techniques have nearly replaced surgical vein stripping in the treatment of varicosities, according to the Mayo Clinic. In those procedures, a flexible instrument is threaded through an incision and up the vein, and the vein grabbed and removed. Requiring general anesthesia, vein stripping in past decades also meant extended hospitalization and long recovery times, racking up big bills.

“If you have family and friends who once had a vein stripping and explain how horrible it is, (new techniques are) nothing like that,” said Marilee Walker, a nurse practitioner who screens patients at the Vericose Vein Center at Inland Imaging, which holds the quarterly Vines & Veins events, mixing refreshments, prize drawings and vein screenings.

Along with interest, the market for devices to treat varicose veins has grown in recent years, according to a 2011 report by the Millennium Research Group, which provides data to the medical technology industry.

As surgical stripping procedures have declined, “the introduction of less invasive treatments during the past decade has garnered much attention from physicians and patients, with more physician specialties performing ablations due to the procedures’ profitability as well as high patient demand,” the report reads.

The research group predicted more growth as the U.S. population gets older and heavier. Older age and obesity can increase the risk of varicose veins.

Varicose veins now are treated in doctors’ offices rather than hospitals, and payments to medical providers have risen “astronomically,” Murray said.

“Now all of a sudden we had an outpatient procedure we could be remunerated for,” he said. “Then all of a sudden a lot of people began to show interest in venous disease who’d never shown interest before,” both doctors and patients.

Varicose veins happen when valves that normally prevent blood from flowing backward don’t work properly. Consider a tree trunk’s relationship with smaller branches, Walker said. The main vein under the skin at the front of the leg, called the great saphenous vein, is a trunk.

“When that tree trunk isn’t working well and the valves aren’t closing well that keep the blood flowing back up to your heart, then it backs up into the tree branches,” Walker said. “And often these varicosities that we see on the outside of the legs are those tree branches. So (a varicose vein) suggests an insufficiency of a deeper vein.”

Many medical centers, including the Inland Vascular Institute and the center at Inland Imaging, offer free screenings. Some patients are referred for ultrasounds to pinpoint the problem’s source. Insurers often cover treatment when the varicose vein affects the patient’s life beyond cosmetically, Walker said.

Mostly congenital, varicose veins most often affect women. Pregnancy increases the risk.

“You’re the victim here,” Murray tells patients. “It’s your children’s fault, and it’s your mother’s fault. You did nothing to deserve this.”

Muscle pain could signal bigger problems

But while he might treat several people in a day for varicose veins, Murray said tonight he really wants to get a message to people with faulty arteries.

“Claudication” – muscle pain in the legs when you walk – is a relatively common arterial problem caused by a narrowing of the arteries that’s caused by an accumulaton of fatty materials, including cholesterol.

Murray said genetics may contribute, but the pain is often brought upon by lifestyle factors such as diet, smoking and a lack of exercise. Healthier habits can take care of the problem, without surgery.

In those cases, though, the pain serves as a signal. Even a patient who’s never had chest pain, a heart attack or stroke is at higher risk for all those things if they suffer pain when they walk that goes away when they rest.

“You may not need to have the arteries in your leg treated, but you need to manage the risk factors that led to this in the first place,” such as high blood pressure, smoking and high cholesterol, Murray said.

“The good news is that now we know what the problem is. The bad news is this isn’t the only vascular bed where you have athrosclerosis. In fact, there’s a much higher likelihood that you actually have significant coronary disease.”