Varicose veins are a very common problem, generally appearing as twisting, bulging rope-like cords on the legs, anywhere from the groin to the ankle. While many people have heard of varicose veins, very few truly understand their underlying cause and the potential they have for developing into a serious medical issue.
Spider veins are similar to varicose veins, but they are smaller. They are often red or blue and are closer to the surface of the skin than varicose veins. They can look like tree branches or spider webs with their short jagged lines. Spider veins can be found on the legs and face. They can cover either a very small or very large area of skin.
What Causes Varicose Veins?
Arteries carry blood from your heart to your extremities, delivering oxygen deep into the tissue. Veins then return the deoxygenated blood back to your heart to be recirculated
To return this blood to the heart, your leg veins must work against gravity. Small one-way valves in the veins open to allow blood to flow upward, towards the heart, and then close to prevent it from flowing backwards.
Varicose veins occur when the valves in superficial leg veins malfunction. When this happens, the valve may be unable to close, allowing blood that should be moving toward the heart to flow backward (called venous reflux). Blood collects in your lower veins, causing them to enlarge and become varicose.
In addition to the visual appearance, many patients may experience one or more of the following leg symptoms:
- Pain (an aching or cramping feeling)
- Burning or tingling sensations
- Tender areas around the veins
If you are experiencing any of the above, consult your physician, as treatment may be required. Delaying treatment may cause symptoms to progress to more serious complications, including:
- Inflammation (phlebitis)
- Blood clots (e.g., deep vein thrombosis)
- Ankle sores or skin ulcers
Factors leading to varicose veins include heredity, gender, pregnancy, age, medication (hormone replacement therapy) and other causes. Some factors may speed up the development of this disease and make the veins worse, including prolonged standing, obesity, hormone levels and physical trauma.
The underlying conditions described above usually make curing varicose veins impossible. However, certain measures – exercise (walking is ideal), weight control, support stockings and avoidance of standing/sitting for long periods – may help relieve discomfort from existing varicose veins and prevent others from arising.
Since these measures do not treat the underlying cause of the disease, varicose veins will usually enlarge and worsen over time. Legs and feet may begin to swell and sensations of pain, heaviness, burning or tenderness may occur. If and when this happens, consult your physician immediately.
Your physician will usually first try preventative methods to relieve your symptoms. Your physician may ask you to:
- Get regular exercise focusing on strengthening the legs and improving circulation. Walking or running are good choices.
- Lose weight to reduce pressure on the legs. Sit with your feet on the floor, rather than crossing your legs.
- Prop up your feet.
- Avoid sitting or standing for too long.
- Support the legs with elastic support stockings.
- Avoid tight-fitting clothing.
- Stick to a diet that's low in salt and high in fiber.
If your varicose veins do not respond to this conservative therapy, more active treatment may be required. Vein stripping is a surgical procedure involving one or more incisions followed by the insertion of a special wire into the vein. This is usually only done in patients who are having a lot of pain or who have skin sores.
New minimally invasive techniques allow effective treatment of varicose veins with no hospitalization, no scarring, minimal postoperative pain, and almost immediate relief from varicose vein pain. An ultrasound may be performed to see if you could benefit from surgery. Procedures include:
- Endovenous Laser Therapy (EVLT)
Closes the underlying vein to decrease the pressure creating the visible varicose vein. Requires only local anesthetic, involving virtually no recovery time. Performed in under an hour.
- Radiofrequency Ablation
Uses intense heat through a catheter to treat the vein. The heat will close off and destroy the vein and the vein will disappear over time.
Injection of a chemical solution into the varicose vein usually guided by an ultrasound. The vein will harden and then disappear.
This is a non-invasive, outpatient test that is a more detailed ultrasound evaluation of the veins in your legs or arms. It can be done in the arms or legs for placement of an arterio-venous fistula for dialysis or in the legs before treatment for varicose veins. Vein mapping of the upper extremity also is done to evaluate superficial veins to determine if they can be used for creation of arterial grafts for use during coronary or peripheral bypass procedures.