Roper St. Francis Physician Partners vascular surgeon Dr. Thomas Appleby has witnessed significant progress in the vascular field, from his early days at the Medical University of South Carolina and his vascular fellowship at Vanderbilt to a successful 34-year career. “Minimally invasive procedures have made the vein side of vascular surgery very rewarding. Now, catheter-based surgery has revolutionized vein treatment,” says the surgeon, who is energized by the specialty’s technical requirements and broad patient population.
Vascular surgeons operate on every artery and vein in the body other than those of the heart and brain. Varicose veins, which affect roughly a quarter of American adults, are one of the most common conditions he treats. “A varicose vein is a vein, usually in the leg, that’s become dilated and visible on the skin because it’s transitioned into a higher pressure system than it was designed for.”
Under pressure
Dr. Appleby begins with a tutorial on the venous system to explain how varicose veins develop. “Arteries are designed as a high-pressure system to carry blood to our extremities, while veins are designed as a low-pressure system to return blood to the lungs and heart.”
Fighting gravity with a low-pressure system may seem backward, but the veins get some anatomical assistance for the job. First, large muscles in the legs act as mechanical pumps whenever they contract and relax. Second, the veins are subdivided with a series of one-way check valves to maintain low pressure.
Pooling can occur when a valve loses function and permits blood to flow back down through the vein (venous reflux). “Longtime Charlestonians know too well the congestion that results from converting a one-way street into a two-way,” says the Charleston-born surgeon.
The problem stems
The condition impacts men and women of any age, though genetics, work history, obesity, pregnancy and a history of clots increase a person’s risk. Dr. Appleby has treated patients from a young mother with uncomfortably thick veins from groin to ankle who just wanted to swim with her kids to a septuagenarian whose grandchildren wondered why his legs looked blue.
Varicose veins can be as varied in appearance as the people they impact, ranging from spidery lines to bluish starbursts to rope-like bulges. In severe cases, damaged veins that leak fluid and proteins can lead to a darkening of the legs, resulting in skin damage known as hyperpigmentation.
But aesthetics is just the surface of symptoms. Engorged veins can cause swelling, heaviness, aching and fatigue in the legs and ankles, particularly later in the day. Untreated varicose veins can also become hard and swollen, and ulcers may form due to poor circulation. Thankfully, “there are so many good options for treatment that it’s unnecessary to delay care,” says Dr. Appleby.
Smooth operator
The vascular surgeon urges anyone with symptoms to see a doctor, noting that “cosmetic complaints are rational and legitimate concerns.” While treating cosmetic concerns is an out-of-pocket expense, “the overwhelming majority of cases are also symptomatic, which insurance will usually cover.”
Depending on the severity of a patient’s condition, the surgeon may opt to begin with non-surgical treatment before progressing to in-office procedures.
Non-interventional
- Elevate the legs. “Sitting with your feet on a stool doesn’t count,” says the doctor. Instead, lie back with your heels higher than your knees and your knees higher than your heart for 30 minutes, several times a day. “The higher the better.” Dr. Appleby recommends investing in a wedge pillow.
- Be cool about compression. “I like below-knee, graduated compression stockings that put more pressure on the ankle than the knee,” says Dr. Appleby. Over-the-counter options typically offer 15-20 mmHG of compression, while entry-level prescriptions are 20-30 mmHg.
- Get active. The doctor recommends that older patients walk daily and younger patients engage in any preferred workouts as long as they’re moving.
Minimally Invasive Surgeries
- Ablate. Vascular surgeons use two types of ablation to treat varicose veins: radiofrequency and endovenous laser therapy. Using either a radiofrequency generator or laser, the procedureheats and seals the faulty vein, diverting blood flow to healthier veins.
- Chemically irritate. Often used to treat spider veins, sclerotherapy injects a chemical irritant that flushes blood out of the vein and inflames the vein wall, causing the inner lining to swell, occlude blood flow and close down. Varithena is a specialized form of sclerotherapy that uses an FDA-approved foam for larger veins.
- Remove the problem. A phlebectomy involves making small incisions to physically remove individual veins. Powered phlebectomy is an option for advanced vein disease.
Reality check
“While these procedures are very effective at controlling symptoms and have long-term impacts, we can’t cure varicose veins because faulty valves can’t be fixed,” explains Dr. Appleby. So, the vascular surgeon welcomes new patients to “The Vein Journey.”
Dr. Appleby closely follows post-surgical patients to ensure the results meet the expectations of both the team and the patient. His physician assistant, Linda Watson, enjoys seeing the boost in a patient’s self esteem following treatment. “It’s about feeling better and improving quality of life.”
Call us at (843) 948-0089 to speak with a representative and schedule your visit.