Varicose veins are a vascular affliction that goes beyond being a mere cosmetic condition. And, if left untreated, they can lead to more serious problems. That's why Dr. Kakish is focused on early treatment, specializing in minimally invasive techniques to treat unpleasant-looking, and often uncomfortable, varicose veins.


What are varicose veins?

Varicose veins are veins that become abnormally swollen and large, usually because of defective valves in the vein. Varicose veins are sometimes bluish in color, protrude from the surface of the skin, and frequently have a winding or worm-like appearance.

What causes varicose veins?

Varicose veins normally result from a faulty valve in the affected vein. The valve malfunctions by not closing completely while blood makes its way to your heart. This allows some blood to follow gravity and flow back toward your feet. The pooling blood and increased venous pressure cause unsightly bulges and other painful symptoms.

In most cases, varicose veins are hereditary. However, the following events also put you at risk:

  • Prolonged sitting or standing
  • Pregnancy
  • Hormonal influences (e.g., hormone replacement therapy, female oral contraceptives)
  • Obesity
  • Local trauma
  • Aging

Since females usually have multiple risk factors for the development of varicose veins, about three-fourths of sufferers are women.

Can I be cured of my varicose veins?

Varicose veins can be successfully treated – but not permanently cured. Treatment of abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, some patients must return for maintenance treatments after completing their initial one.

How will the blood in my veins get back to my heart after all of the abnormal veins are removed or destroyed?

The backward flow of blood in varicose veins and main superficial trunks – the great saphenous vein (GSV) and lesser saphenous vein (LSV) – actually interferes with the normal venous return of blood. Removing these areas of abnormal circulation improves blood circulation in the treated limb. That improved circulation causes immediate relief of your symptoms.

Do I have to treat both legs?

The abnormal limb or limbs should be treated thoroughly for best results. We do not treat both legs at the same time.

What happens if I don’t treat my varicose veins?

Treating varicose veins offers more than just a cosmetic fix. It also provides relief from symptoms like aching, throbbing, burning, tingling, itching, swelling, numbness, night cramps, restlessness, tiredness and a heavy feeling in the leg.

If left untreated, you may experience more significant complications, such as phlebitis, blood clots, dermatitis, edema, eczema, hemorrhage and hyperpigmentation.

At the end stage, you may also develop a non-healing venous leg ulcer. An early warning sign is darkening of the skin around the ankle. Gradually, the skin becomes leathery or waxy in appearance. Then it breaks down and bleeding occurs.

What is a duplex ultrasound examination?

Most patients undergo a duplex ultrasound exam prior to diagnosis and treatment. It allows Dr. Kakish to see the anatomy and check the flow characteristics of veins beneath your skin. He uses this information to diagnose your specific vein problem and to plan and guide treatment.

What is sclerotherapy?

Sclerotherapy is the treatment of varicose veins by injecting them with chemicals that destroy them. The procedure is performed with the aid of ultrasound imaging (for veins below the surface of the skin that cannot be seen with the naked eye) or without (for surface veins visible to the naked eye). Many patients who select this option for cosmetic reasons notice improvement in the way their legs feel after treatment. However, new minimally invasive alternatives (such as the EVLT® procedure) offer less pain, shorter recovery and better cosmetic results.

Is sclerotherapy safe?

Most patients do not experience any complications from sclerotherapy. Some patients develop changes in skin pigment in locations where the veins are injected, while some experience chemical burns of the skin. A rare patient develops an allergy to the medication. Serious complications, such as deep vein blood clots and unintentional arterial injection, rarely occur.

What new minimally invasive treatment options exist for patients with varicose veins?

Varicose veins result from the backward flow of blood in the vein (normally caused by faulty valves). To control this reverse blood flow, the vein that is the source of the visible varicosities must be sealed shut or removed. The vein may be sealed shut using energy sources such as light (laser used in the EVLT® procedure). This procedures is virtually pain-free and requires little or no recovery time.

What are the main benefits of the EVLT® procedure?

Dr. Kakish performs this minimally invasive procedure in our office in an hour or less, which fits into most patients’ lunch breaks. In addition, the EVLT procedure has about a 98% success rate. Patients experience rapid relief of symptoms and can return to normal activity right away. Only local anesthesia is necessary, so you don’t assume the risks of general anesthesia. And, because the procedure requires just a few needle pricks, you won’t be left with unattractive scars.

Why do doctors sometimes recommend gradient compression stockings as an alternative to EVLT® or sclerotherapy?

A properly fitted gradient compression stocking can temporarily reverse the effects of vein disease and lessen discomfort as well as skin damage. Many insurance companies require a trial of stocking use before approving definitive therapy.

Source: American College of Phlebology

EVLT® Procedure

In-office laser treatment with no scarring; performed in less than an hour.