Frequently Ask Questions
FAQ
Dr. Poonawala, a varicose veins specialist, is a Harvard trained board certified Vascular and Interventional Radiologist with a passion for veins. Extensive knowledge of vascular anatomy, and proficiency in minimally-invasive image guided procedures are the fundamental skill set of an interventional radiologist. This skill set also happens to be key to accurately diagnosing and effortlessly treating vein disease. Additionally, Dr. Poonawala is one of the very few diplomats of the American Board of Venous & Lymphatic Medicine in the DFW metroplex, a certification gained only through rigorous testing of venous disorders.
Having performed thousands of advanced venous procedures throughout the body, Dr. Poonawala has now focused his entire career to helping patients end suffering from varicose vein disease.
To shut down veins in your body might sound severe but these diseased veins are actually no
longer performing their intended function of efficiently returning blood back to the heart. When
these veins become abnormal, our body finds alternative pathways and uses the ample
surrounding healthy veins to circulate blood. Treatment will actually improve circulation and
relieve any symptoms caused by the diseased veins.
Varicose veins are enlarged, swollen, and twisting veins. They can protrude from the skin or
may not be visible at all. Varicose veins are often found on the thighs, backs of the calves, or the
inside of the leg. They form when your vein valves do not function properly and in some cases,
can be dangerous resulting in skin changes, swelling, and ulceration.
Spider veins are tiny red, purple or blue veins that appear in clusters like tree branches or spider
webs. They are closer to the skin surface than varicose veins. They can be found anywhere on
the legs and can cover either a very small or very large area of skin. Spider veins can be the tip
of the iceberg as approximately 20% of people with spider veins have underlying vein problems
that require treatment.
Very common! Overall, they affect approximately 35% of the population in the United States.
While there is no definitive answer, there are a number of different risk factors which can
increase your chances. A strong hereditary component leads the list. If your parents have
varicose veins, there’s a high chance you will develop them too. Others include pregnancy,
obesity, standing or sitting for long periods of time, and previous blood clots or leg injury. The
likelihood of forming varicose veins also increases as veins weaken with age.
There are a number of different treatment options available for varicose veins including
Radiofrequency Ablation, Endovenous Laser Ablation, Venaseal Ablation, Sclerotherapy and
Ambulatory Phlebectomy. At The Vein Clinic of Dallas, we will recommend the most appropriate
treatment option for you after a thorough initial assessment.
To shut down veins in your body might sound severe but these diseased veins are actually no
longer performing their intended function of efficiently returning blood back to the heart. When
these veins become abnormal, our body finds alternative pathways and uses the ample
surrounding healthy veins to circulate blood. Treatment will actually improve circulation and
relieve any symptoms caused by the diseased veins.
Radiofrequency ablation (RFA) is a minimally-invasive procedure used to treat large, non-visible
varicose veins deep to the skin’s surface (saphenous veins). These are typically the source of
vein disease and feed the ropey varicose veins visible on the legs. Over the past decade, RFA has
emerged as the gold standard treatment, due to high success rates, short recovery times and
minimal discomfort for patients. This treatment has effectively replaced surgical vein stripping
and offers much improved results.
RFA uses high-frequency radio waves to create just the right amount of heat to immediately seal
the problematic veins. The radiofrequency energy is administered directly into the vein through
a tiny catheter. This causes the collagen in the vein wall to shrink and prevent blood from
circulating through this abnormal vein. After the vein seals, the body naturally reroutes the
blood through other healthy veins, improving circulation and resolving symptoms. This process
is virtually painless.
Yes. This is crucial in avoiding discomfort and obtaining the best results. The length of time
compression stockings need to be worn will vary based on type of procedure.
It is rare for them to recur, especially since current treatments have extremely high success
rates. However, vein disease is a progressive disease and no treatment can prevent new veins
from becoming faulty. This is why we follow each patient at regular intervals to make sure we
address any new disease early.
Follow-up of patients is highly individualized depending on the severity and type of venous
disease. Since venous problems are progressive, and since early treatment reduces long-term
complications, periodic follow-up to evaluate and treat new problems is important. Most vein
patients should be re-evaluated at least annually.
No, you may drive yourself to and from the procedure.
Most insurance plans including Medicare do cover evaluation and treatment. We believe in full
transparency. We will work with you and your insurance company and disclose any and all costs
prior to treatment. No surprises!
No. There is no relationship between the way to sit and the development of varicose veins
Compression stockings are obviously a non-invasive option to help relieve some of the swelling
and discomfort associated with varicose vein disorders. Compression may slow the progression
of the disease, however, the veins often gradually become worse. Symptoms from abnormal
veins (aching, heaviness, restlessness, burning, itching, and swelling) will typically improve while
compression hose are on. This will not correct the underlying malfunction of the veins, but is an
option for the patient who does not want procedures.
Aching, throbbing pain typically worse at the end of the day after standing or sitting for a
long period of time
● Tired and heavy feeling legs
● Leg cramping (particularly at night)
● Leg Swelling
● Restless legs (particularly towards bedtime)
● Itching around your veins
● Skin changes in the lower leg, including darkening
Can varicose veins appear in one leg only? Yes, this is quite common. Especially with a history of previous blood clots or leg trauma, which damage the vein walls and valves.
Varicose veins are usually not dangerous but should not be brushed off as simply a cosmetic
concern, as they are typically a sign of underlying vein disease. The pooling of blood within
varicose veins can cause heaviness, tiredness and discomfort in the legs initially. If left
untreated, varicose veins may progress to more serious health problems including:
– Sore and skin ulcers
– Bleeding with significant blood loss
– Phlebitis – tender inflammation and thrombosis of the varicose veins below skin surface
– Blood clots (DVTs). If the blood clot travels to the lungs, it can be fatal.
Spider veins are rarely a serious health problem, and predominantly a cosmetic
nuisance. However, they most certainly can cause discomfort including itching or
burning at the site. Frequently, spider veins can be the first sign of underlying hidden
vein disease.
Absolutely. If you have one parent with varicose veins, you have about a 40 percent chance of
inheriting them. If both your parents have them, your risk drastically increases to 90 percent.
Although women are affected more frequently, men can most certainly suffer from varicose
veins and their associated symptoms. In fact, as many as 45% of men may develop varicose
veins at some stage in their life.
Unfortunately, there is very little you can do to prevent varicose veins. Support/compression
stockings can help tired aching legs but are inadequate to prevent new varicose veins from
forming. Although there are no sure-fire ways of preventing vein disease, below are a few steps
which may slow progression and help ease discomfort from the ones you already have.
● Exercise regularly to improve circulation, and vein strength. Ideally, walking or running.
● Try to avoid standing or sitting for long periods of time. If you must, move around or take
a short walk every 30 minutes to help your calf muscles move blood through your veins.
● Wear support stockings and avoid tight clothing that constricts your waist, groin, or legs.
High-heels do not cause varicose veins although they reduce the calf muscle pump
action.
● Keep your weight in a healthy range to avoid excess pressure on your legs.
● Eat a high-fiber and low-salt diet. This reduces strain on your veins from constipation
and can help with leg swelling.
● Elevate your legs when resting as much as possible, especially towards the end of day.
Eating a high fiber diet, staying well hydrated, avoiding excess salt and maintaining a healthy
weight should all positively impact your vascular health. However, if you already have varicose
veins, dietary changes will not reverse vein disease.
– Age: With age, vein walls and valves weaken and may not work as well. This malfunction
occurs slowly with gradual development of symptoms and is typically why the associated
symptoms are brushed off as part of normal aging, leading to unnecessary suffering.
– Family History / Genetics – There is robust evidence that weakness in the valves and
walls of your veins is inherited and accounts for approximately 80% of cases. If you have
one parent with varicose veins, you have about a 40 percent chance of inheriting them.
If both your parents have them, your risk drastically increases to 90 percent.
– Pregnancy – Multiple changes during pregnancy including increased blood volume,
hormonal changes, natural weight gain and the pressure the enlarging uterus exerts on
pelvic veins all contribute to weakening of veins and valves. Each pregnancy typically
deteriorates vein health. Birth control pills may also contribute to forming varicose or
spider veins.
– Body Mass Index: Being overweight puts extra strain on your veins, again contributing to
early failure. Moderately overweight women have a 50% increased risk of developing
varicose veins.
– Occupational: Sitting or standing for long periods of time can lead to vein disease. When
active, calf muscle contractions assist in pumping blood back to the heart. Sitting or
standing for long periods of time puts significant strain on veins forcing them to work
harder against gravity, causing early failure.
– Previous blood clots or injury: Previous vein blood clots (deep vein thrombosis) or
extensive surgery can damage veins and cause varicose vein disease, many a times
severe and debilitating.
Venous insufficiency is a chronic, progressive problem which will get worse over time and
which will result in new, enlarging varicose veins and/or vein symptoms. Even with very
effective treatment of venous insufficiency, the effect of gravity will cause future enlargement
of previously normal veins resulting in valve failure.
A careful clinical history and exam followed by venous color duplex ultrasound will help to
sort out the location of problem veins so appropriate therapy can be chosen.
Varicose Veins and Pregnancy
Developing varicose veins during pregnancy is common. In fact, up to 50% of pregnant women
will develop them, which may worsen with each subsequent pregnancy. Physiological changes
during pregnancy including a) increase in blood volume, b) pressure on the pelvic veins from the
growing uterus, and c) elevated pregnancy hormones which make vein walls less rigid, can
cause pooling of blood in your veins and lead to the formation of varicose veins.
Fortunately, varicose veins may resolve on their own for many after pregnancy. For a small
percentage, however, varicose veins will not resolve and may require medical attention.
Unfortunately, there is no sure fire way of prevention. We do, however, recommend wearing
medical grade compression stockings from the beginning of the pregnancy and for months after
birth. This will provide the extra support your veins require, reducing blood pooling and
significantly decreasing any associated symptoms.
Approved by the FDA in 2015, the most recent innovation in the treatment of vein
disease is the use of a special medical grade adhesive known as cyanoacrylate. This
cutting-edge procedure immediately and permanently closes off damaged veins
rerouting blood flow to healthier veins and providing symptom relief.
Similar to other treatment options, VenaSeal has high success rates, short recovery
times and minimal discomfort for patients.
It works by delivering a small precise amount of medical adhesive to the diseased vein,
permanently sealing it off. After the vein seals, the body naturally reroutes the blood through
other healthy veins, improving circulation and resolving symptoms. This process is virtually
painless and the sealed vein is gradually absorbed by the body, disappearing over time.
Sclerotherapy is a minimally-invasive procedure for treating small damaged varicose veins and
spider veins. It is the gold-standard treatment and involves injecting a sclerosing agent precisely
into the problem vein, functionally removing it from the vascular system. It may or may not be
performed under ultrasound image guidance, depending on the size and location of the faulty
vein.
Are varicose vein treatments safe?
All treatments offered at The Vein Clinic of Dallas are performed by Dr. Poonawala, a highly
trained and experienced interventional radiologist and vein specialist. The latest treatment
advancements in vein disease are minimally invasive with a high safety profile. However, there is
no medical procedure devoid of risk and the rare possibility of complications is present.
Vein treatments should not be painful. Treatments are described more as a discomfort rather
than pain. Most treatments require only minimal local anesthesia, which is expected to cause
brief mild stinging. Cosmetic sclerotherapy for spider veins does not require local anesthetic as
extremely fine needles are used.
Will I need to take time off work? What is the recovery time?
We are a walk-in walk-out clinic offering minimally-invasive treatments typically performed in
under an hour. Most patients will experience some mild discomfort post procedure, but nothing
that should interfere with daily routines. Patients rarely need to take any time off of work and
are able to drive and resume routine activities immediately after the procedure. Strictly
following post procedure instructions, including walking and wearing compression stocking,
significantly alleviates discomfort and shortens recovery
Recent newly developed technologies have dramatically improved treatment options. We only
utilize cutting-edge FDA approved technology which are extremely safe, virtually painless, and
cause no significant disruption to your usual activities. While it is ultimately your decision when
to get treatment, it is important to know that vein disease is progressive. The longer you wait,
the worse the symptoms and appearance become.
By the time a saphenous vein is diseased enough to require treatment, it no longer is
acceptable for use for a heart bypass procedure. Cardiac surgeons use the radial artery from
the forearm or the internal mammary artery (from inside the chest) for the heart bypass.
See us for a detailed clinical exam and venous color duplex ultrasound exam. Most ankle ulcers
are due to venous insufficiency, which is quite treatable.
High pressure in the veins of the ankles due to venous insufficiency, blockage of veins draining
the legs, and/or obesity may cause swelling of the ankle, skin discoloration at the ankles, pain,
or leg ulcers.
ALL patients with leg ulcers associated with swelling or discolored skin should be evaluated for
venous insufficiency with a venous color duplex ultrasound exam to detect venous insufficiency.
An ultrasound exam which tests only for thrombus (DVT) as is commonly done outside vein
centers does not evaluate for venous insufficiency.
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