Spokane Journal of Business

Overall vascular health should be factored into varicose vein options, physician says

Spokane surgeon suggests women query providers

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-—Treva Lind
Dr. Stephen Murray, surgeon at the Providence Vascular Institute, says that before undergoing treatment for varicose veins, women should ask whether bypass surgery is needed.

Women should talk to health providers about overall vascular health when looking for relief from symptoms caused by varicose veins, says Dr. Stephen Murray, a surgeon at the Providence Vascular Institute, in Spokane. 

Females seeking medical procedures to remove or seal off problem veins also should ask about the experience of doctors in managing vascular disease, such as the potential future need to use a certain vein for bypass surgery, Murray says.

“For many people, as they age, some hardening of the arteries occurs, so there is a need to consider if you need veins for upper heart or lower extremities’ bypass surgeries,” he says.

A vein disorder in the leg occurs when a valve in the vein that returns blood to the heart fails or leaks, causing blood to pool and veins to enlarge. The enlarged veins near the surface of the skin are called varicose veins, and symptoms can include pain, fatigue, heaviness, and itchiness in the leg.

By the age of 50, nearly 40 percent of women and 20 percent of men in the U.S. have significant leg vein problems, says the Vascular Disease Foundation, a Severna Park, Md.-based nonprofit organization providing education and awareness about vascular diseases. Contributing factors include age, heredity, and prolonged sitting or standing in one position, the foundation says.

While vein problems and varicose veins occur more frequently in women than men, doctors aren’t sure exactly why, though some health professionals suggest that female hormonal factors and pregnancies play roles.

Murray says he tells patients that problem veins are most often a factor of heredity. For some women, other factors may be additional weight gained during pregnancies or general obesity that can contribute to problems with vein health, he adds. 

As a vascular surgeon, Murray performs procedures ranging from surgery for thoracic aortic aneurysm, which is a weakened area in the upper part of the aorta, to cosmetic treatments for the removal of spider veins, which are tiny red, blue, or purple varicose veins.

Murray’s primary office is located at 122 W. Seventh, but he also sees patients at Providence Vascular Institute North, at 212 E. Central. The institute provides an initial free screening by appointment at both locations that includes a visual examination of legs, he says.

The institute plans this week to open a third office, Providence Vein Center Manito, at 1923 S. Grand, where two of its vein specialists, Dr. Megan Hoefer and advanced registered nurse practitioner Sandra Tidwell, primarily will work.

Murray says, “It’s our intent to help people relieve their symptoms, and we understand there is a cosmetic concern, but other medical concerns also need to be considered.”

He adds, “You have to judge each patient’s situation. A lot of people are setting up shop to treat varicose veins who are not experts in the management of vascular disease. You have to have an overarching focus on the overall vascular health of a patient.”

Murray says he recalls a procedure he did in recent years for a female patient to treat a damaged vein extending from the ankle region to the groin, but he held off doing the procedure for the same vein in the other leg.

“The same vein in her other leg was bad, but not that bad,” Murray says. “I told her, ‘Let’s save it. You might need it.’ Sure enough, two years later, I used the vein we saved for an artery bypass.”

The surgery involved what he calls a limb-saving artery bypass in the leg, which is a procedure that creates a new pathway for blood flow around a blocked artery by using a graft that typically is from a portion of a major vein in the leg. 

The body’s network of veins include the superficial veins close to the surface of the skin, large veins located deep in the leg, and what are called perforator veins that connect the superficial veins to the deep veins. A surface vein carries a small percentage of blood as part of the body’s system of veins, so when one is sealed off or removed, the blood simply flows through the other veins, Murray says.

He uses an analogy of a ladder in explaining how blood moves through the vein system, with the valves acting much like rungs. When a valve malfunctions, it’s like a broken rung on a ladder, he says, and fluid leaks out into soft tissue and pools up.

Murray adds, “You have valves in the veins, and blood flows along a length or column.”

A common procedure to treat problem veins near the skin’s surface involves essentially sealing veins shut with heat energy, either using laser or radio-frequency energy. The procedure typically is done in a doctor’s office and takes about an hour to perform.

Another treatment is microambulatory phlebotomy, which involves a doctor making tiny incisions in the skin and removing sections of vein through the punctures. An additional option is called sclerotherapy for small varicose veins or spider veins, which involves inserting a tiny needle to inject medication affecting the surface of veins so they aren’t visible.

Two surgical procedures to treat varicose veins include ligation, which is tying off a vein, and stripping, which is removal of a long segment of a vein.

Murray says a disorder also can occur in deep leg veins that aren’t visible on the skin’s surface, and while people still feel symptoms such as pain and heaviness, the only treatment for a deep vein disorder is compression. 

He adds that doctors typically will prescribe specialized compression stockings that are designed to put mild pressure on legs to decrease swelling and improve blood flow. 

Patients can undergo more extensive screening that uses ultrasound technology to locate problem veins, including any deep vein disorder, he adds.

The vascular surgeon practice now called Providence Vascular Institute has operated in Spokane since 1957. Murray moved here as a surgeon for the group in 1997, after 13 years in the U.S. Army.

 He did his general surgery training at Letterman Army Medical Center, in San Francisco, and his vascular surgery fellowship at the University of California, San Francisco. Murray has performed surgeries since completing his residency at the Letterman center in 1989.

He credits a longtime mentor, Dr. J. Leonel Villavicencio, who for many years taught vascular surgery instructors in the Army.

“I still occasionally refer difficult cases to Dr. Villavicencio for discussion,” Murray says. 

Murray says he has served as a trainer at the national level for a company that markets and manufactures the equipment for laser procedures. 

Murray also is sometimes a speaker at the Spokane Women’s Show held annually here, and at that event, he explains the difference between arteries and veins, and their roles in a system that carries blood to and from the heart. 

“Arteries carry blood away from the heart and veins carry blood back to the heart,” Murray says. “They’re joined by the capillaries, which is where the exchange of nutrients and oxygen take place.”

The Spokane Women’s Show is scheduled this year April 25-26 at the Spokane Convention Center, and Providence will offer free varicose vein screenings at the event, he says. 

For people who suffer from varicose veins, Murray adds, “Your problem is gravity, the weight of the blood from the heart to the toes. Fluid is pooling and the legs are feeling that, and there’s swelling. You can counteract it with compression.”

Another consideration he often tells women about is that some insurance providers require a length of time for patients to wear compression stockings, typically for three months, to validate vein disorders before proceeding with a covered vein treatment. 

Murray says some women delay seeking treatment because they find out about this requirement during or near the summer months, when many women want to wear sandals, shorts, and dresses.

“I tell people to be smart about when they come in to be checked, and perhaps come in early in the year, because they may be required to wear stockings,” he adds.

In addition to Murray, three other primary Providence Vascular Institute health providers also perform vein procedures. 

Treva Lind
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