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Medical Edge Newspaper Column from Mayo Clinic

VARICOSE VEINS MAY BE UNATTRACTIVE, BUT RARELY REQUIRE TREATMENT

DEAR MAYO CLINIC: I’m on my feet all day long as a pastry chef. I love to work, but my legs don’t. I’m developing varicose veins! My wife had them during her pregnancy — but me? A man? What should I do about them? I’ve heard this could lead to loss of a limb. — New York City

ANSWER: I often hear outdated information from patients — men and women alike: “You have to fix my varicose veins … my grandfather lost a leg because of vascular problems.” I tell them, “No, the pooling of blood from varicose veins isn’t going to cause you to lose a leg. Varicose veins may be ugly, but you can live with them.”

Anyone can develop varicose veins, but women tend to get them more often than men. However, no one has proven that standing for long periods causes varicose veins; it’s more likely that your genetic background is at work here.

Here’s what’s happening to you: Veins have one-way valves that normally allow blood to flow against gravity — opening to let blood flow toward your heart and closing to keep it from going backward. When the valves break down, blood stops flowing toward your heart and pools in your legs. The result is enlarged, twisted varicose veins.

While varicose veins are neither normal nor beautiful, most don’t need treatment. However, if you experience pain, throbbing, cramping or bleeding, you may in fact need to see a doctor. Many treatments are available, ranging from outpatient surgeries to laser therapy.
— Thom Rooke, M.D., Vascular Medicine; Mayo Clinic, Rochester, Minn.

Additional Resources:
Varicose Veins
Appointment Information

DEAR MAYO CLINIC: I’ve had my blocked coronary arteries opened and reopened by stents three times now, and they keep collapsing. Is there anything new that can be done? — Providence, R.I.

ANSWER: Yes. Coronary artery blockages may now be treated more successfully because of a new technological twist on an old standard therapy for opening narrowed arteries: Think of it as a double-duty stent.

This new kind of stent does two things to improve the blockage: 1) It opens narrowed arteries; and 2) it administers drugs to prevent repeat blockages. The double-duty stent has produced very promising results in a multicenter trial.

The current standard therapy is an ordinary “stent” — a metal scaffolding that is placed inside the walls of a narrowed artery. There, it serves as a durable support to prop open the artery so the artery can carry blood to nourish the heart.

While this mechanical approach is good, it has drawbacks. The procedure may need to be repeated because scar tissue has developed within the stent. In addition, other blockages may form in other areas, diminishing the stent’s effectiveness.

How long the stent “lasts” varies from patient to patient, and is influenced by the underlying disease. This variability makes it hard to predict who will need a repeat treatment. Some repeat blockages may even require open-heart surgery.

Enter the new twist: A drug-coated stent that can prevent repeated blockages. In this scenario, the old mechanical stent is transformed into a precise drug-delivery system. It still functions in its old, reliable and useful capacity as a mechanical scaffold for the artery — while doing double-duty releasing drugs into the blood-vessel wall.

Studies have been performed using several different coatings and drugs that are released over a variable length of time. Taken as a whole, the studies document a dramatic reduction in repeat narrowing after stent placement and a dramatic reduction in problems during follow-up.

After the double-duty stent procedure, the patient recovers faster because the chest has not been surgically opened. Instead, doctors place the stent through a tube, inserting it though a small incision in the patient’s femoral artery (in the groin area) and threading it to the area of the blockage.

All of this is excellent news for heart patients, because coronary artery disease is our nation’s leading disease killer, claiming an estimated 600,000 lives a year.
— David Holmes, M.D., Cardiovascular Diseases; Mayo Clinic, Rochester, Minn.

Additional Resources:
Coronary Artery Blockage
Appointment Information

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.