What are Varicose Veins?
Varicose veins are dilated superficial veins in the legs. The word “Varicose” comes from a Latin word that means “twisted.” Veins of the legs contain one way valves that allow the blood to flow upwards toward the heart from the feet and from the superficial veins into the deep veins. When these valves don’t function properly, the blood slips past these leaky valves and flows backwards toward the feet and into the superficial veins. The highly pressurized blood pools in the superficial veins causing the veins to stretch and become larger.
Varicose veins are usually lumpy, twisted, bulging, and sometimes bluish in color. They sometimes look like cords. Sometimes, varicose veins can lie deep in the leg and cannot be seen with the eye. Ultrasound imaging is used to determine if you have this type of varicose veins.
What causes Varicose Veins?
Varicose veins occur when the valve in the vein does not function properly. This can be due to the destruction of the valve, or merely, the fact that the vein is dilated so much that the edges of the valve do not meet allowing the blood to slip past. There are several factors that increase your chances of having varicose veins:
- Genetics –this is the most common cause of varicose veins. Varicose veins tend to run in families.
- History of Blood Clots – blood clots in the veins destroy the valves and cause them to not function properly.
- Age – as we age, the valves in our veins lose their ability to function properly.
- Obesity – being overweight increases abdominal pressure, resulting in an increase in the pressure of the leg veins. This increase in pressure can cause dilation and leakage of the valves in the veins.
- Sex – woman are more likely than men to develop varicose veins. Female hormones during pregnancy, pre-menstruation, menopause, and hormone replacement can relax the walls of the veins causing them to become dilated.
- Standing – standing for long periods of time allows blood to pool in the lower extremities. Some occupations such as teachers, nurses, factory workers, hair dressers, and physicians are more likely to develop varicose veins due to extended periods of standing.
What are symptoms of Varicose Veins?
- An achy or heavy feeling of your legs (often worse at night or after exercise)
- Burning or throbbing of your legs
- Itching in the lower part of your legs or around a vein
- Swelling of your legs
- Easily tired legs
- Color changes of the legs with skin darkening
- Skin ulcers or sores near your ankle
- Restless Leg Syndrome (RLS)
What are spider veins?
Spider veins are thin threadlike veins that lie very close to the skin and are often purple or red in color. Spider veins grow from reticular veins that have can have a blue or green appearance beneath the skin. Both of these types of veins can be treated easily in the office through injection of a liquid to close them, called a sclerosant.
Should I see a doctor about varicose veins?
You should see a doctor about varicose veins if:
- The vein has become swollen, red, or very tender or warm to the touch
- There are sores or a rash on the leg or near the ankle
- The skin on the ankle and calf becomes thick and changes color
- One of the varicose veins begins to bleed
- Your leg symptoms are interfering with daily activities
- The appearance of the veins is causing you distress
If you’re having pain, even if it’s just a dull ache, don’t hesitate to get help. Also, even if you don’t need to see a doctor about your varicose veins, you should take steps to keep them from getting worse.
How are varicose veins diagnosed?
Your doctor may diagnose your varicose veins based on a physical exam. Your doctor will look at your legs while you’re standing or sitting with your legs dangling. He or she may ask you about your symptoms, including any pain you’re having. Sometimes, you may have other tests to find out the extent of the problem and to rule out other disorders.
You will need to have a venous ultrasound, which is used to see the veins’ structure, check the blood flow in your veins, and look for blood clots. This painless test uses sound waves to create pictures of structures in your body.
Although less likely, you might require a MR or CT scan. These tests can be used to get a more detailed look at blood flow through your veins if necessary.
How are varicose, spider and reticular veins treated?
Varicose veins are treated with lifestyle changes and medical treatments. These can:
- Relieve symptoms
- Prevent complications
- Improve appearance
Your doctor may recommend lifestyle changes if your varicose veins don’t cause many symptoms. If symptoms are more severe, your doctor may recommend medical treatments. Some treatment options include:
Compression stockings
Compression stockings put helpful pressure on your veins. There are 3 kinds of compression stockings:
- Support pantyhose, which offer the least amount of pressure. These also often are not “gradient” or “graduated.” That means they provide pressure all over instead of where it is needed most.
- Over-the-counter gradient compression hose, which give a little more pressure. They are sold in medical supply and drugstores.
- Prescription-strength gradient compression hose, which offer the greatest amount of pressure. They are sold in medical supply and drugstores. You need to be fitted for them by someone who has been trained to do this.
Sclerotherapy
Sclerotherapy (SKLER-o-ther-a-pee) is the most common treatment for both spider veins and varicose veins. The doctor uses a needle to inject a liquid chemical into the vein. The chemical causes the vein walls to swell, stick together, and seal shut. This stops the flow of blood, and the vein turns into scar tissue. In a few weeks, the vein should fade. This treatment does not require anesthesia and can be done in your doctor’s office. You can return to normal activity right after treatment.
The same vein may need to be treated more than once. Treatments are usually done several weeks apart. You may be asked to wear gradient compression stockings after sclerotherapy to help with healing and decrease swelling. This treatment is very effective when done correctly.
Possible side effects include:
- Stinging, red and raised patches of skin, or bruises where the injection was made. These usually go away shortly after treatment.
- Spots, brown lines, or groups of fine red blood vessels around the treated vein. These also usually go away shortly after treatment.
- Lumps of blood that get trapped in vein and cause inflammation. This is not dangerous. You can relieve swelling by applying heat and taking aspirin. Your doctor can drain the trapped blood with a small pinprick at a follow-up visit.
There is a type of sclerotherapy called ultrasound-guided sclerotherapy (or echo-sclerotherapy). This type of sclerotherapy uses ultrasound imaging to guide the needle. It can be useful in treating veins that cannot be seen on the skin’s surface. It may be used after surgery or endovenous techniques if the varicose veins return. This procedure can be done in a doctor’s office. Possible side effects include skin sores, swelling, injection into an artery by mistake, or deep vein thrombosis (a potentially dangerous blood clot).
Endovenous LASER THERAPY
This method for treating the deeper veins of the legs, called the saphenous (SAF-uh-nuhs) veins, has replaced surgery for most patients with severe varicose veins. This technique is also done in a doctor’s office.
The doctor puts a very small tube, called a catheter, into the vein. A laser catheter is placed through the tube. The tip of the laser heats up the inside of the vein and closes it off. The procedure is done using local anesthesia. You might have slight bruising after treatment.
Healthy veins around the closed vein take over the normal flow of blood. The symptoms from the varicose vein improve. Usually, veins on the surface of the skin that are connected to the treated varicose vein will also shrink after treatment. If they don’t, these connected veins can be treated with sclerotherapy or other techniques.
Surgery
Surgery is used mostly to treat very large residual varicose veins. The current standard is called ambulatory or stab phlebectomy.
With ambulatory phlebectomy (AM-byoo-luh-TOHR-ee fluh-BEHK-toh-mee), tiny cuts are made in the skin, and hooks are used to pull the vein out of the leg. Only the parts of your leg that are being pricked will be numbed with anesthesia. The vein is usually removed in 1 treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment. Possible side effects of the treatment include slight bruising and temporary numbness.
How can I prevent varicose veins and spider veins?
Not all varicose and spider veins can be prevented. But, there are some steps you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discomfort from the ones you already have:
- Wear sunscreen to protect your skin from the sun and to limit spider veins on the face.
- Exercise regularly to improve your leg strength, circulation, and vein strength. Focus on exercises that work your legs, such as walking or running.
- Control your weight to avoid placing too much pressure on your legs.
- Don’t cross your legs for long times when sitting. It’s possible to injure your legs that way, and even a minor injury can increase the risk of varicose veins.
- Elevate your legs when resting as much as possible.
- Don’t stand or sit for long periods of time. If you must stand for a long time, shift your weight from one leg to the other every few minutes. If you must sit for long periods of time, stand up and move around or take a short walk every 30 minutes.
- Wear elastic support stockings and avoid tight clothing that constricts your waist, groin, or legs.
- Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone your calf muscles to help blood move through your veins.
- Eat a low-salt diet rich in high-fiber foods. Eating fiber reduces the chances of constipation, which can contribute to varicose veins. High-fiber foods include fresh fruits and vegetables and whole grains, like bran. Eating less salt can help with the swelling that comes with varicose veins.
Can varicose and spider veins return even after treatment?
Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.
The single most important thing you can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.
Does Insurance Cover My Treatment?
Most insurance plans and Medicare covers treatment for varicose veins that are causing symptoms. Frequently, a three month trial of conservative management may be a requirement before approval is given by the insurer to proceed with other treatment options. Check with your specific carrier for more information.
The Vein Center at Cardiology Consultants accepts most insurance carriers.
