Varicose veins and spider veins are enlarged superficial veins that afflict millions of Americans, primarily women. The effects can range from unsightly blue or red lines under the skin to more serious itching, aching, night cramps and feelings of fatigue after standing.
The vascular surgeons at Barnes-Jewish & Washington University Heart & Vascular Center offer many treatments for varicose and spider veins that can improve cosmetic appearances, reduce discomfort and prevent further complications.
Understanding Varicose and Spider Veins
Example of varicose veins
Pregnancy, weight gain, long periods of standing, and a family history are all risk factors for varicose veins. Varicose veins can cause bulging under the skin, aching, ankle swelling, night cramps or feelings of leg fatigue or heaviness after prolonged periods of standing.
If left untreated, varicose veins can progress and cause skin damage, including brown pigment deposits under the skin or skin ulcers. Occasionally, the stagnant blood in varicose veins can clot, called superficial phlebitis. Patients with varicose veins also have a slightly increased chance of developing deep vein thrombosis (DVT). DVT may cause sudden, severe leg swelling. DVT is a serious condition that requires immediate medical attention.
Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70. Pregnancy often results in the first noticeable appearance of varicose veins, which sometimes improve after childbirth.
Example of spider veins
Spider veins are not a serious medical problem, but they can be a cosmetic concern, and they can cause symptoms of aching or burning pain, or itching. Spider veins are tiny varicose veins. They look like a nest of fine red or blue lines just under the skin.
Diagnosis and Treatment
In addition to a physical exam and patient history, clinicians might use a venous duplex ultrasound to diagnose varicose veins. Duplex ultrasound uses painless, high-frequency sound waves to look for clotted segments of vein or for blood that is flowing the wrong way through damaged valves. This test can take approximately 20 minutes for each leg.
If you have mild to moderate varicose veins, elevating the legs can help reduce leg swelling and relieve other symptoms. Feet may need to be propped up above the level of the heart three or four times a day. When standing for a long time, the legs should be flexed occasionally to keep the blood flowing from the legs up toward the heart.
For more severe varicose veins, compression stockings may be prescribed. Compression stockings are tall, elastic socks that squeeze the veins and stop excess blood from flowing backward. They also can help relieve symptoms of leg discomfort or even heal skin sores and prevent them from returning. For many patients, compression stockings effectively treat varicose veins and may be all that are needed to relieve pain and swelling and prevent future problems. However, they may be needed every day for the rest of a patient’s life, and they do not actually cure the underlying problem.
Several surgical and minimally invasive therapies are available to repair or remove the damaged segments of vein, including:
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Information adapted from and illustrations used with permission of the Society for Vascular Surgery.
- Radiofrequency ablation: If testing shows that the saphenous vein, the largest superficial vein in the leg, has damaged valves allowing blood to flow the wrong way, this outpatient procedure may be recommended. Radiofrequency ablation (RFA) uses a thin, flexible tube to destroy the area of the vein that is damaged. The tube is inserted into the vein and then withdrawn. A heated tip on the end of the tube heats the walls of the varicose vein and destroys the vein tissue. The vein is then no longer able to carry blood, and it is eventually absorbed by the body. Eliminating the “wrong-way” blood flow in the saphenous vein will relieve the heaviness and discomfort caused by reflux and limits the formation of new varicose veins. The procedure takes less than an hour to complete, and anesthesia is provided for comfort. No incision is required, other than a small nick in the skin for the catheter to enter.
- Micro-incision venectomy: A different procedure, called micro-incision venectomy, or ambulatory phlebectomy, can be done along with radiofrequency ablation or as a separate procedure. Tiny incisions are made in the leg to remove areas of varicose vein clusters. This is typically done as an outpatient procedure while the veins are surrounded by local anesthetic, and recovery time is minimal.
- Vein stripping: Vein stripping is a less common procedure that has been almost completely replaced by the less invasive ablation procedures. To perform vein stripping, a small incision is made in the groin area and usually another incision is made in the calf below the knee. The major varicose vein branches associated with the saphenous vein are tied off, and then the saphenous vein is removed from the leg.
- Sclerotherapy: During sclerotherapy, tiny needles are used to inject a chemical into spider veins and small varicose veins. The chemical irritates the veins from the inside out so the abnormal veins can no longer fill with blood. Blood that would normally return to the heart through these veins returns to the heart through other veins. The body eventually absorbs the veins that received the injection. Typically sclerotherapy will be performed 2-4 times before a final cosmetic appearance is obtained. This procedure doesn’t require any anesthesia or sedation, though compression stockings may be required while the sclerotherapy sites heal.