Back on their Feet
Richard Gray minimizes pain and discomfort for patients who have unsightly varicose veins and other conditions associated with venous insufficiency
by Bill Donahue

Although Lisa Peterson’s career as a Newtown-based real estate agent was in full bloom, the rigors of the job started taking a toll on her body. She spent so much time on her feet—showing houses, meeting with prospective clients, etc.—that by day’s end, both of her legs were throbbing. The pain was bad enough to keep her awake at night.

She started seeing a vein specialist, but after “a couple of years” of treatment she was not experiencing the relief she was seeking. At the recommendation of her OB/GYN, she opted to see Richard Gray, M.D., FISR, vein specialist and medical director of The Vein & Vascular Centers of Philadelphia at American Access Care.

“I was in my mid- to late 40s and having a lot of issues with my legs, but I was too young to not be getting results,” Peterson says. “I was having pain and throbbing in both legs. … I was still waking up at night because of the pain, so I needed Dr. Gray to do something.”

Dr. Gray did not disappoint. During the course of a thorough consultation and examination, he diagnosed the problem and prescribed a minimally invasive laser treatment to relieve Peterson of her pain. Her insurance company approved the procedure, which Dr. Gray performed last February, and her quality of life has improved dramatically since that time.

“It hasn’t been quite a year yet, but it’s much, much better,” says Peterson. “I sleep much better now, and at the end of the day my feet and legs do not have that throbbing. It has made a huge difference in my life.”

Peterson is among the millions of American men and women who suffer from leg pain, swelling, itchiness, fatigue and other symptoms related to venous insufficiency. This occurs when the valves in leg veins do not open and close properly, preventing proper blood flow. The condition can result in varicose veins (swollen veins that bulge from the surface of the skin, which are both unsightly and potentially harmful), as well as spider veins (threadlike veins stemming from the same underlying causes as varicose veins, though purely cosmetic in nature). Chronic venous insufficiency eventually affects as many as 75 percent of women and more than 40 percent of men, according to data provided by Dr. Gray.

Particularly at risk are people (especially women) who, like Peterson, spend a lot of time on their feet: health care workers, hair dressers, teachers, restaurant staff, mail carriers, etc. Other risk factors include age, genetic predisposition and hormonal imbalance, as well as other conditions, such as pregnancy, that lead to increased pressure in the abdomen.

A decade ago surgical vein stripping was the most prescribed solution for treating varicose veins. During this invasive surgery, several incisions are made in the groin, thigh and calf to accommodate a vein-stripping tool that is threaded through the diseased vein, which is then removed from the leg. Although generally effective, the procedure requires anesthesia and an extensive recovery time. Also, because there is significant post-operative bruising and what Dr. Gray calls “a surprising recurrence rate;” many patients report being unhappy with the results.

Today, patients have more appealing options, with two minimally invasive treatments—specifically, radio-frequency ablation and laser ablation—offered by Dr. Gray’s practice. Both of these outpatient procedures, which are performed one leg at a time, take about an hour using tiny incisions, through which the damaged vein is effectively destroyed. These procedures require only moderate sedation. Data suggests the laser causes slightly more soreness and bruising than its radio-frequency counterpart; yet within two weeks of the procedure date the results tend to be equally successful. These minimally invasive treatments alleviate pain and typically improve the skin’s overall appearance by at least 75 percent.  

“Compared to surgery, the results are much less invasive and the procedure is much more easily tolerated with fewer complications, and the recurrence rate is lower,” Dr. Gray says. “There is a cosmetic component to the procedure, but if people have physical symptoms—swelling, aching—most insurance companies will cover it. The biggest reason for people wanting treatment is to improve their quality of life.”

Dr. Gray renders treatment based on the underlying cause of each patient’s condition, which is determined with the help of an ultrasound to create a “road map” of veins in the legs. Patients who have undergone these minimally invasive treatments are usually back to work the day after the procedure, with minimum restrictions for one week. An overwhelming percentage of Dr. Gray’s patients—as many as 98 percent he suggests—say they would recommend the treatment to others who suffer from a similar condition. Before approving such procedures, however, insurance companies require that patients first try more conservative treatments such as compression stockings and pain medications.

“With all varicose-vein issues, the approach is to find the underlying cause,” he says. “If not dealt with, a minority of people can develop more serious symptoms and changes in their skin so that it becomes dry and scaly, and some can develop open sores. By the age of 30, 40 or 50, people think it’s normal to feel tired and have to put up their feet. Although that can be true to a degree, if you have venous insufficiency then you will have leg heaviness and fatigue that are abnormal. Fortunately there are now treatments for all these things.”

Dr. Gray, a board-certified vascular and interventional radiologist by training, has authored numerous publications in the field and has repeatedly been voted a “Best Doctor” by other physicians. He previously served as director of interventional radiology at the Washington Hospital Center, as well as program director of Georgetown University. He joined The Vein & Vascular Centers of Philadelphia after discovering the staggering number of people affected by problems associated with venous insufficiency.

“A lot of people don’t realize how much their legs bother them until after their treatment is done, after which point they think: Why did I wait so long?” he says. “Many people look at varicose veins as a purely cosmetic issue. But this is a serious health issue, common in working age people, that by the age of 50 affects almost half of women and 25 percent of men.

“The most rewarding part for me,” he continues, “is when I get to see people get confidently back on their feet and enjoy their life more. This treatment makes a big difference in people’s lives.”

The Vein & Vascular Centers of Philadelphia
7959 Bustleton Ave.
Philadelphia, PA 19152
215-742-5662 |

Photograph by Alison Dunlap