Deseret Morning News Unless Jeff Hoggan pointed them out, no one was likely to think too much about the lumps on his leg. Anyone looking close, however, could see them, grapelike, rippling just below the surface.

Laura Seitz, Deseret Morning NewsPhysician's assistant Kris Weaver-Miller, left, and Dr. Greg Goodman perform a laser venous ablation procedure on Jeff Hoggan recently at Mountain Medical. At top is medical assistant Stephanie Butterfield. A couple of years ago, a doctor told him they were varicose veins. Did your parents have them? he asked. The answer was yes.

Genetics, obesity, pregnancy, gender, age and a lifetime of standing for long periods are all risk factors for the common condition, which affects 60 million Americans. Hoggan, in his late-40s at the time, was on the young side to have them. It's also more common in women.

While arteries carry blood from the heart to the rest of the body's tissue, veins are responsible for the important return trip. Varicose veins are most common in the legs because those veins must fight gravity to do their job, relying on one-way valves in the vein that prevent the blood from flowing backward.

It is a malfunction in those valves that causes varicose veins, the blood flowing back downhill and pooling, the veins then enlarging and bulging.

At the time, after some discussion, Hoggan decided to just live with the lumps, which were most likely caused - or at least helped along - by a lifetime spent working and playing on his feet. The lumps weren't painful or too noticeable back then. He hoped they'd go away, but they didn't.

Early this month, Hoggan had had enough. It was starting to impact the things he likes to do. "I'm active," he said. "I do a lot of boating, golfing, going to the gym."

The lumps had become large enough that he no longer wore shorts when he worked out at the gym. They were also becoming uncomfortable at times as the blood pooled in his leg.

Varicose veins left untreated might just look ugly, as occurs with the mild form called spider veins. Or something worse can result. Varicose veins sometimes cause the leg to ache, something Hoggan experienced periodically. The condition can also create venous hypertension and/or thickened, inflamed skin. Clots can form. On rare occasions, it can lead to deep-vein thrombosis. And the afflicted veins that are close to the surface can bleed substantially because of the high blood pressure.

Laura Seitz, Deseret Morning NewsDr. Greg Goodman threads a laser into Jeff Hoggan's vein during the venous ablation procedure, which required about an hour. Some people complain of achy, heavy-feeling legs or burning and muscle cramping. Sitting or standing tends to worsen symptoms. It may itch around one or more of the veins. Serious cases can create skin ulcers around the ankle. If that happens, it's important to get immediate medical care, according to the Mayo Clinic's reference guide to varicose veins.

There are a couple of ways to deal with varicose veins, starting with self-care. An individual can limit time sitting or standing, avoid sitting with legs crossed and may wear compression hose. If that's not enough, there are several treatment options: sclerotherapy, where injections are used to scar the vein and shut it down; or a phlebecomy, where the doctor takes out smaller varicose veins with little skin punctures. In severe cases with ulcerations, the surgeon may perform endoscopic vein surgery. One of the most common procedures is "vein stripping," a surgery to cut out the vein entirely. In all cases, the body's smart. It routes the blood a different way.

Increasingly, vascular specialists use lasers, a process called laser venous ablation. And that's the route that Hoggan chose because it's less invasive and takes only about an hour.

A number of Utah physicians use a laser to kill a varicose vein, including vascular surgeon Dr. Greg Goodman, who treated Hoggan while a reporter and photographer watched in the operating room at Mountain Medical in Murray.

The target was the long vein in Hoggan's left leg called the great saphenous vein. The goal, Goodman said, is to treat that vein through the thigh. Once it is obliterated, the blood pressure in Hoggan's leg will decrease, and other symptoms, both medical and cosmetic, will disappear.

Goodman said that's often all that needs to be done, although chronic venous insufficiency is a long-term problem, and many patients will experience it again in other veins. In cases where the problem is extensive, it's treated as a "step-wise process," Goodman said.

Using ultrasound to follow the vein, Goodman injected local anesthetic along Hoggan's leg. The local anesthetic serves another purpose, as well. It absorbs any extra heat from the laser, which will create a steam bubble inside the vein, heating the water component of the blood. It typically causes mild discomfort and a pulling sensation. The vein shuts down permanently, the blood rerouted.

After numbing the area around the vein, the laser is threaded into the vein. Just before using the laser, an assistant handed out dark glasses and they joked about being on the beach. The glasses are mandatory to protect the eyes of anyone in the room. The assistant warned Hoggan that he can get a funny taste or smell when the laser is deployed in his vein.

And just like that, it was over. The blood will reroute, the vein will die and resorb into the body and the lumps in Hoggan's leg will dissipate, Goodman said.

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