Varicose Veins

What are veins?

Veins are blood vessels that carry blood from your body's tissues to your heart. The heart pumps blood to your lungs to pick up oxygen. The oxygen-rich blood flows through tiny blood vessels called capillaries, where it gives up its oxygen to the body's tissues. Your blood then returns to your heart through your veins.

Veins have one-way valves that help keep blood flowing toward your heart. If your valves are weak or damaged, blood can back up and pool in your veins. This causes the veins to swell leading to varicose veins.

What are varicose veins?

Varicose veins are abnormal, swollen blood vessels caused by a weakening of the vessel wall. They might appear as clusters of blue or purple veins. They are sometimes surrounded by thin red capillaries known as spider veins (a group of small blood vessels located close to the surface of the skin).

Varicose and spider veins can appear anywhere, but they often appear on the legs and in the pelvic area. Most varicose veins develop near the surface of the skin. Deeper varicose veins cannot be seen, but may cause the skin above them to swell, become darker, or harden.

What causes varicose veins?

When the blood vessel walls weaken, veins swell causing blood to back up and pool inside the vein. Normally, blood flows through the vein in one direction toward the heart. Varicose veins become a new route for blood to flow.

What are the symptoms of varicose veins?

Symptoms usually appear before the age of 40 and might include:

• Swollen, twisted clusters of purple or blue veins
• Swollen legs, ankles, and feet
• Muscle cramps, throbbing, soreness, or aching in the legs
• Legs that feel "heavy"
• Soreness behind the knee
• Itching around the vein
• Leg muscles that tire easily
• Brown discoloration of the skin
• Skin ulcers

How are varicose veins diagnosed?

During a physical exam, the doctor will check your legs while you are standing. Your doctor might also request that you have a Doppler Scan, an ultrasound exam to check the blood flow in the veins near the skin's surface (superficial veins) and deep veins.

How are varicose veins treated?

Depending on their size and location, varicose and spider veins can be treated with surgery, injections (sclerotherapy), or laser surgery.

Sclerotherapy

Sclerotherapy is a non-surgical treatment option that involves injecting a chemical solution into the veins to make them collapse. As the veins can no longer carry blood, they will eventually disappear. Circulation improves because the work of carrying the blood is shifted to nearby healthy blood vessels.

Sclerotherapy requires multiple sessions. One to 3 injections are usually required to effectively treat any vein. Ten to 40 veins may be treated in one session. The same area should not be re-injected for 4 - 6 weeks to allow for complete healing, although other areas may be treated during this time.

Sclerotherapy does not require anesthesia.

Will I feel pain during treatment?

No, you will feel no pain during the treatment sessions. However, you will feel discomfort due to the sensation of the small needle pricks.

What are the complications of sclerotherapy?

Temporary reactions to the sclerotherapy might include:

• Slight swelling of the leg or foot
• Minor bruising, itching, redness, or mild soreness

Rare complications include the development of telangiectasias (small clusters of red blood vessels, skin ulcerations, and brown pigmentation around the treated vessels).

What happens after sclerotherapy?

Once treated, the veins disappear over a period of 6 months and do not recur. But sclerotherapy treatment cannot stop new varicose or spider veins from developing.

For 2- 4 weeks after treatment, you will wear medical-grade support stockings. Walking and moderate exercise can also help speed recovery.

What are some other treatment options for dilated veins?

• Photoderm therapy: Intense, pulsed light can be used to treat small spider veins, certain sizes of varicose veins, and vascular birthmarks. This treatment might be recommended when sclerotherapy or laser therapy does not effectively treat the dilated vein. One to six treatments might be required to properly treat the area.
• Laser therapy: Most effective for small facial and leg blood vessels, laser therapy heats the blood vessel and makes the vein fade away.
• Surgical ligation/stripping: Severe varicose veins might require a surgical procedure in which the dilated vein is either removed or tied off through a small incision in the skin. The surgery is done in the hospital by a vascular surgeon.
• Endovenous ablation therapy: Endovenous ablation therapy uses lasers or radio waves to create heat to close off a varicose vein. Your doctor makes a tiny cut in your skin near the varicose vein. He or she then inserts a small tube called a catheter into the vein. A device at the tip of the tube heats up the inside of the vein and closes it off. You will be awake during this procedure, but your doctor will numb the area around the vein. You usually can go home the same day as the procedure.
• Endoscopic vein surgery: For endoscopic vein surgery, your doctor will make a small cut in your skin near a varicose vein. He or she then uses a tiny camera at the end of a thin tube to move through the vein. A surgical device at the end of the camera is used to close the vein. Usually, endoscopic vein surgery is used only in severe cases when varicose veins are causing skin ulcers. After the procedure, you usually can return to your normal activities within a few weeks.

What are the risk factors?

• Sex: Almost 50% of women between ages 40 and 50 have some form of varicose veins. Varicose veins are 4 times more common in women than men.
• Age: There is an increased risk of varicose veins with aging as wear and tear on the valves in the veins develops.
• Obesity: More weight on the legs leads to an increase in pressure in the veins.
• Family history: You have a greater chance of developing varicose veins if there is a family history.
• Lack of movement: Blood does not flow as well within the veins if there is a lack of physical movement.

How can I prevent varicose and spider veins?

• Avoid wearing girdles, control-top pantyhose, garters, and any other tight-fitting clothing.
• Avoid crossing your legs while seated.
• Avoid sitting or standing in one position for a long time.
• Exercise regularly to increase circulation.
• Lose weight if you are overweight.
• Sit or lie down and elevate your legs at least twice a day for 30 minutes at a time.

What is the prognosis after treatment?

There are many ways to keep varicose veins from recurring or worsening. Regular exercise, standing only when necessary, and elevating your legs while sitting and sleeping might keep varicose and spider veins from worsening. When you need to stand for long periods of time, take frequent breaks to sit down and elevate your feet.

Wearing special elastic support stockings during daily activities can provide extra support and relieve aching, sore legs.

Should I be concerned?

Varicose and spider veins might not always require medical treatment. If varicose veins make walking or standing painful, you should call your doctor for advice.

You should also call your doctor if a sore develops on or near a varicose vein, or if your feet or ankles swell.

In some cases, varicose veins can be harmful to your health because they might be associated with the development of:

• Venous stasis ulcers: These ulcers result when the enlarged vein does not provide enough drainage of fluid from the skin. The skin does not receive enough oxygen and an ulcer (skin sore) might form.
• Phlebitis: Inflammation of the vein.
• Thrombosis: Development of blood clots that form in the dilated vein.