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Chronic venous insufficiency is the medical term used to describe varicose veins. You will know when you have varicose veins as they are swollen veins that sit close to the surface of the skin. Normally they are found in the legs and appear to be ropes that are wrapping their way around them. They look a lot worse than they feel and for many people, there is no need to have them treated. The good news is that if you do need to have them treated, then there are a lot of types of varicose vein treatment out there. Removal and sclerotherapy are just two of the options.

How varicose veins occur

The problems start when the blood no longer flows through the veins in part of the legs. There are two types of veins in the legs:

  • Superficial veins – These are the ones that are close to the surface. When these are affected it will be easy to see them.
  • Deep veins – These veins lie inside the muscles.

Both sets of veins are joined by perforator veins. Veins that are varicose have suffered as a result of high pressure in them and often will need varicose vein treatment. There are valves in these veins and their role is to send blood back to the heart. They are one way valves and once these become defective, they cannot keep the blood in the vein and it falls back down towards the ankles. It is important that the blood is able to flow correctly, so anything that is impeding it has to be sorted out as soon as possible. There are some people who will be susceptible to varicose veins even if they do not have issues with the pressure and again they could need varicose vein treatment such as sclerotherapy.

Symptoms Requiring Varicose Vein Treatment

Just because the veins are very large and can be seen clearly, it does not mean that you will suffer more than someone who has smaller inflammations. Some people are lucky and do not suffer from any of the possible symptoms. If there are problems they are likely to be:

  • Very prominent Veins. That’s because they cannot get smaller and run the risk of getting worse.
  • Heavy and sore legs. This is made worse by standing for periods of time. This can turn to an itching or burning feeling.
  • Night cramps combined with restless legs. When this happens for prolonged periods of time it can start to have an impact on everyday life.
  • Discolored skin. Purple or brown patches appear on the lower leg and due to being so low down are hard to hide even when wearing trousers.
  • This will be the ankles and it can lead up through the legs causing pain and discomfort.
  • Often there will be an accompanying rash -known as venous eczema.
  • These can appear, but they are not common, but have to be dealt with right away.
  • Some will bleed, but again this is rare and if this happens it is vital that you contact your doctor as soon as possible.

When you have veins that are problematic you will want to have them dealt with as soon as possible and undergo varicose vein treatment. Finding a suitable doctor is important and if you live in or around New York you will be lucky. You will have the chance to make an appointment with Dr. Namrata Khimani who is an expert when it comes to chronic venous insufficiency.

If you want to be treated by an experienced vein and pain specialist, then you should make an appointment with Dr. Namrata Khimani. Dr Khimani was trained at Harvard Medical School and went on to finish her residency at Columbia Presbyterian Hospital and while there was chosen Chief Resident by her peers.

During this time, she ensured that standards were high, and that her chosen area was going to be venous disease. To continue training, she went back to Harvard for Advanced Fellowship Training. Having taken an interest in treatment that is minimally invasive, she now treats sufferers with EVLT – endovenous laser, sclerotherapy, radiofrequency and ultrasound.

A speciality is the use of fluoroscopic technology which allows her to place the needle in the exact spot that it needs to go to relieve pain in even the most complex of cases. Dr Khimani’s work has not gone unrecognised as she has been the recipient pf a host of awards, and her work has been praised both in print and on television. More recently she has contributed to a textbook detailing Venous and Pain disease. Many doctors from around the country visit her in her offices to see how she performs and learn the latest venous treatments and pain management techniques.

Diagnosing chronic venous insufficiency

During the first appointment with your own doctor, there will be a question and answer session. First the doctor will ask you about your medical history and then you will have the chance to ask them about the sort of varicose vein treatment they intend to carry out. It is also likely that you will need an examination and so that they can get the full picture, you will have to be examined sitting down and standing up. It is likely that if they think surgery is necessary then sclerotherapy will be mentioned.

If they decide that you cannot just get on while you have them, then they will refer you to someone more experienced. It will be a vascular surgeon who will become involved, but you should be made aware of the severity. This could determine whether or not your insurance company id prepared to cover the cost or not.

It is possible to make a few lifestyle changes that could help, and this will include things such as: –

  • Losing weight. This will mean less pressure on the legs and therefore on the valves. It may not prevent them if they have got to a certain stage but could reduce the risk of others starting.
  • Increasing the amount of activity that you do. Even a small amount can make a difference and leave small veins small.
  • Sitting and standing for short periods and when possible keeping the legs elevated. At work this may be difficult, but even the slightest change in position will help.
  • Using compression stockings. You will need to have proper medically prescribed ones as others will not be effective.

Varicose vein treatment

Once you have been examined, there will be a duplex ultrasound carried out and it is the results of this that will help the doctor decide the type of varicose vein treatment that they want to carry out. If the outcome is that there are no issues, then you may well have to pay to have them removed.

Non-Surgical Processes

Endothermal ablation

Here you have quite a few options and they will be tried before invasive surgery is carried out. The idea is to block the varicose vein in a way that stops it working but does not affect any of the veins around it. An injection will be given to prevent blood clots and the blood that would normally have used that vein will now go into a nearby one. There will be less pain involved here and recovery will be rapid. Only a local anaesthetic will be required, and this will go along the vein. A catheter will be inserted, and the heat will pass through it.

Foam Sclerotherapy

Next on the list will be foam sclerotherapy and as it sounds, it is a process whereby foam is put into the affected vein. This form of varicose vein treatment will totally ruin the veins on the inside and they will seal shut. This is an effective treatment, although it is likely that you will need more than one session of the varicose vein treatment known as sclerotherapy.


This will be the most invasive form of varicose vein treatment as it will mean taking the entire affected part of the vein out. Again, this will not affect the flow of blood as it will find its way to other veins that have not been affected. This will be used when sclerotherapy is not considered to be effective enough. There are pros and cons when it comes to having varicose vein treatment and you will get advice from the doctor as to what you should do. Here is what you are likely to be told

Endovenous Laser Ablation – pros and cons


  • It is easier to get over than surgery and a return to work will be quicker.
  • All you will need is a local anaesthetic so can go home soon after treatment.
  • It is less painful than an invasive surgery as there are no wounds that need to heal.


  • It is not a suitable form of vein treatment for everyone
  • As it is a new procedure, there is no data regarding the long term effects and if you are fairly young that could be a concern.
  • The leg may be red for a while and pins and needles may occur which can be uncomfortable and worrying.

Foam sclerotherapy


  • Recovery time from foam sclerotherapy is quick.
  • The area only has to be numbed as opposed to you have to be put out.
  • It is suitable for most and will be ideal for people who may not be suitable for some of the other forms of varicose vein treatment.


  • Data cannot be provided to show long term effects.
  • It is rare that only one session is needed so you will have to commit to a number of sclerotherapy treatments.
  • Swelling and bruising is common although they often fade in due course.
  • You could end up with a scar even after time.
  • Small ulcers can be formed after sclerorising therapy and this could lead to further treatment having to be carried out.



  • As this has been carried out for a long time, there is proof that it works.


  • A general anaesthetic will be needed, and you will face the risk that this will always bring.
  • It has a fairly long recovery period – for some this could be around three weeks.
  • Bruising usually occurs.
  • Infection is a risk, as is bleeding.
  • The veins can grow back once they have been taken out.

Ineffective varicose vein treatment

Unfortunately, there is no quick fix such as creams or lotions and anyone who tires to get you to use them should not be listened to. In the future it may turn out that there is something produced that does take away the need for medical procedures, but at the moment there is not enough research carried out to say if it is true or not. You need to keep to something proven such as sclerotherapy if you want to be sure that you are getting the best treatment and that there will be good results. Some products that are intended to treat poor circulation also make claims that they can be uses as varicose vein treatment, but again this cannot be proved.

Links between varicose veins and DVT

A lot of people who develop varicose veins do wonder if there is the risk that they will go on and develop a blood clot. Fortunately, the answer is usually no and that there is no direct link between the two conditions. Some circumstances blamed for DVT are also blamed for the development of varicose veins and this is how the confusion arises. They include: –

  • Getting older
  • Being overweight
  • Being a smoker
  • Not moving around a great deal – this is why compression stockings can help to a degree.
  • Swellings in the legs.

Whether you choose surgery, sclerotherapy, or decide that the veins are not that bad, make sure that you get the best medical advice possible. Remember you will get that from Dr. Namrata Khimani.

Chronic Venous Insufficiency and Seeking Varicose Vein Treatment@VTC