Varicose veins, a disorder typically occurring in the legs when a vein malfunctions, more often affect women than men and can raise medical concerns, including fatigue and pain, say health care professionals in Spokane.

The vein disease occurs when one-way valves in veins that return blood to the heart from the leg fail or leak, and the blood flows backwards, causing blood to pool in the veins. The increased pressure from the pooling stretches the vein and causes enlarged, twisted blood vessels.

Up to 50 percent of U.S. women may be affected by abnormal leg veins, says the American College of Phlebology on its website.

"There are genetic issues and hormonal issues as well that make it more common to women," says Dr. Renu Sinha, a Rockwood Clinic physician who sees patients at the Rockwood Vein Care Center-Valley, at 1414 N. Houk. "The majority is due to heredity, but also obesity can be a factor, and trauma, such as an injured leg in a car accident."

Sinha says about 80 percent of the patients she sees for varicose vein treatments are women.

"The majority of patients I see are for medical concerns because their daily activities are impacted because of varicose veins," she adds. "They have swelling in the legs and achiness, itching, or just a feeling like they can't be as active or mobile."

Spider veins, which are tiny varicose veins, are small red, blue, or purple veins appearing on the surface of the skin. They are typically treated with outpatient procedures as only a cosmetic concern.

While women might initially seek treatment to remove varicose veins for cosmetic reasons, practitioners here say many patients who undergo minimally invasive medical procedures find relief from symptoms they hadn't necessarily associated with the disorder, including aches in the legs.

Marilee Walker, a nurse practitioner, is often the first health care professional to screen patients at the Varicose Vein Center at Inland Imaging, operated by Inland Imaging LLC at 525 S. Cowley, near downtown Spokane. She also says family history, hormones, pregnancy, long hours of standing or sitting, and obesity all potentially influence whether someone has varicose veins.

"Most people come in because they think their legs look bad, and when you start talking to them about symptoms, they realize they do have those symptoms," Walker says. "They realize that's why they feel some pain and fatigue, because they have increased pressure on the skin and leg muscles from the back-up of the blood."

Using ultrasound technology, specialists sometimes find problems with veins much deeper below the skin's surface when screening initially because of spider veins or minor varicose veins, adds Dr. Jayson Brower, a physician at Inland Imaging's Varicose Vein Center.

"We rely on ultrasound as a diagnostic tool, and we offer free screening," Brower says.

He adds, "Our ultrasound machines are designed specifically for looking at the blood vessels. It's a vascular ultrasound that can see the direction of blood flow."

Brower says possible consequences of leaving varicose veins untreated include developing or experiencing a worsening of symptoms of heaviness, swelling, aching, pain, and fatigue in the legs. He adds, "When you have blood that pools, you can have potentially skin changes or skin break down, also called ulceration, in extreme cases."

Sinha echoes those concerns. "As far as the medical issues, varicose veins over time increase your risk for blood clots, and skin damage, and also mobility," she says. She also says that modern diagnostic approaches aided by ultrasound technology can help determine if a person has more significant vein problems than what are visible.

"We can find out if they have more serious problems than just a cosmetic concern," Sinha says.

Brower says insurance often covers the cost of medical treatment for varicose veins, although that doesn't include procedures solely to remove spider veins that are considered cosmetic. Both Rockwood's and Inland Imaging's centers provide simple cosmetic procedures in addition to more complex outpatient treatments, which include laser or radio-frequency energy treatments.

The latter treatments eliminate varicose veins, involving a small entry point in the skin to insert a tiny fiber or catheter. Physicians use ultrasound technology to guide treatment to the damaged vein.

"It truly is a medical procedure," Brower says. "Insurance covers it in most cases because the industry understands it is a medical procedure, and it's preventative."

The radio-frequency energy procedure delivers heat to the vein wall. As the thermal energy is applied, the vein wall shrinks, and the vein is sealed closed.

Similarly, the laser treatment uses laser energy, which the Inland Imaging's specialists say is simply a highly concentrated beam of light. A thin fiber is inserted to treat the damaged vein, and the laser light is emitted through the jacketed fiber to deliver the light energy to the targeted tissue. As the fiber is pulled through the vein, it delivers the right amount of focused energy, and the tissue reacts, causing the vein to close and seal shut.

Another minimally-invasive procedure, which generally is known as an ambulatory phlebectomy, can be used to remove a large surface varicose vein through very small incisions that don't require stitches. Walker says the phlebectomy procedure at the Varicose Vein Center involves pulling out the varicose vein with a small device resembling a crochet hook.

An additional common treatment option, referred to as sclerotherapy, is an ultrasound-guided procedure for larger veins and involves using a fine needle to inject a solution that causes the lining of the veins to swell and eventually seal off the blood vessel. Spider vein treatments involve a series of cosmetic sclerotherapy applications that don't require use of ultrasound, Walker says.

The veins that are closed because of the treatments are considered superficial veins that handle less than 5 percent of the body's blood flow, Inland Imaging's website says, and Walker adds that the veins that undergo treatment eventually turn into scar tissue and are reabsorbed into the body.

"Your body has many more veins to do the work, and the blood will just move into healthy veins," she says.

Both Walker and Brower say that treatments aren't painful, although patients may feel minor discomfort. At Inland Imaging, they say, all of the medical treatments that aren't cosmetic involve applying a local anesthetic. Patients also have the option of taking a mild sedative before the procedure to help them relax.

Sinha says more effective techniques for removing varicose veins without surgery have emerged only within the past 10 years.

"In the early 2000s, new minimally invasive nonsurgical approaches were developed, and that has been a win-win for patients and specialists," she says. "Twenty years ago, you basically had one operation, and 10 years ago you maybe had two operations."

She adds, "With the new techniques, we're able to treat patients with the most effective treatments without surgery. Some people still need surgery, but the majority of patients don't."

Most of the minimally invasive medical procedures typically are completed within a two-hour outpatient visit to a clinic. Some people are able to return to work the next day and feel relief from symptoms soon after a procedure, Walker says.

"We see a lot of nurses, hairstylists, waitresses, and bank tellers," Walker adds. "We also see some people who sit for long periods of time, or basically, people who aren't exercising their legs."

She adds, "If you have a job where you are standing all day, then you feel like you can't go out at night. You feel like you need to go home and put your feet up, or you're uncomfortable in shorts out in public even when it's really hot. Women want to be proud of what their legs look like."

She and Brower say that the type of procedure selected, and sometimes a combination of treatments, depends on varying needs and conditions of individual patients.

Some examples of medical procedure costs at Inland Imaging's center, although both Brower and Walker say they're often covered by insurance, include $1,500 to $3,000 per leg for laser treatments, and $2,000 to $4,500 per leg for the radio-frequency treatment.

What the center calls a microambulatory phlebectomy costs $700 to $1,500. It can cost $300 to $900 for a medical sclerotherapy, which for medical treatment is usually ultrasound guided for larger veins and involves using a fine needle to inject a solution that causes the lining of the veins to swell and eventually seal off the blood vessel.

Spider vein treatment involving a series of cosmetic sclerotherapy applications has a cost of about $200 per session for both legs and usually requires three or four sessions, Walker says. However, Inland Imaging offers three sessions at $500 for both legs, she says.

For all varicose vein treatments, doctors here say they recommend that patients wear compression stockings for a period of time after procedures because the support helps in the recovery process.