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Varicose and Spider Veins

Varicose veins and spider veins are enlarged veins close to the skin’s surface. They affect millions of people in the U.S., primarily women. 

For some, spider veins create unsightly blue or red lines under the skin. For others, swollen, bulging veins cause problematic itching, aching, night cramps and feelings of fatigue after standing. Some patients even go on to develop painful ulcerations and wounds.

The vascular surgeons at the Washington University and Barnes-Jewish Heart & Vascular Center can provide relief. We offer many treatments for varicose and spider veins to improve cosmetic appearance, reduce discomfort and prevent further complications.

What Are Varicose Veins?

Varicose veins occur due to a problem with blood flow in veins, the blood vessels that carry blood back to your heart. They usually develop in leg veins. Blood vessels in your legs have to work the hardest to send blood back to your heart because they are working against gravity. 

Problems with valves in the leg veins cause varicose veins to develop. When these valves break down, blood can flow in the wrong direction and pool in veins in your legs and feet. This condition is called venous reflux. As blood collects in the vein, the vein swells and enlarges.

What Are Spider Veins?

Spider veins are tiny superficial veins. They look like a nest of fine red or blue lines just under the skin.

Spider veins are not a serious medical problem, but they can be a cosmetic concern. They can cause aching or burning pain or itching.

Causes of Varicose Veins

Women are more likely than men to develop varicose veins. Varicose veins usually affect people between the ages of 30 and 70. Pregnancy often causes varicose veins, which sometimes improve after childbirth.

Other risk factors for varicose veins include: 

  • carrying extra weight
  • family history
  • long periods of standing
  • sedentary lifestyle

Symptoms of Varicose and Spider Veins

Varicose and spider veins are easy to identify by sight. They most often appear on the legs. 

Spider veins usually look like tiny red lines just under the skin. Varicose veins may appear blue, purple or dark brown or gray. They often look like lumps, bulges or twisted masses under the skin. 

Varicose veins can cause symptoms including:

  • aching, uncomfortable, heavy-feeling legs
  • dry skin or color changes in the lower leg
  • itchy skin above the varicose vein
  • muscle cramps in your legs, especially at night
  • swollen ankles and feet

Complications of Varicose Veins

If left untreated, varicose veins can progress and cause skin damage, including brown pigment deposits under the skin or skin ulcers (sores). 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. 

In some cases, varicose veins appear in other parts of the body. We provide diagnosis and second opinions for people who have varicose veins due to complications of pelvic venous disease, or varicose veins in the pelvis. Our surgeons offer a wide range of care, including deep venous reconstruction. Learn more about venous disease treatment at Barnes-Jewish.

Diagnosing Varicose and Spider Veins

Most of the time, doctors diagnose varicose and spider veins with a physical exam. We discuss your symptoms and lifestyle to understand what you are experiencing.

We may use a test called venous duplex ultrasound to diagnose varicose veins. Duplex ultrasound uses painless, high-frequency sound waves to look for clotted segments of a vein. The test can check for blood that is flowing the wrong way through damaged valves. We perform duplex ultrasound in our offices. The test takes about 20 minutes for each leg.

Treatments for Varicose Veins

Most varicose veins do not need treatment. And many people find relief from mild to moderate varicose veins with nonsurgical treatment. 

Simple lifestyle changes can ease your discomfort and reduce swelling and pain. Your doctor may recommend: 

  • elevating your legs, propping your feet above the level of your heart a few times a day
  • moving your legs regularly, especially when standing for long periods
  • exercising to improve circulation and maintain a healthy weight
  • wearing compression stockings, tall, elastic socks that squeeze the veins and stop excess blood from flowing backward

Surgery for varicose veins and spider veins

Sometimes, nonsurgical treatments for varicose veins do not help, or you want a permanent solution. We may recommend a procedure to repair or remove damaged segments of a vein. 

We use endovascular (inside the vein) procedures for nearly all varicose veins. These minimally invasive procedures often do not even require numbing medications. You receive them in our offices, with no incision — only a needle poke. You can get back to your usual activities right away.

Our team offers:

  • Radiofrequency ablation (RFA): RFA uses a catheter (a thin, flexible tube) to destroy the damaged area of the saphenous vein, the largest superficial vein in the leg. The quick procedure eliminates “wrong-way” blood flow in the saphenous vein due to damaged valves.
  • Micro-incision venectomy: We make tiny incisions to remove varicose vein clusters. You may have micro-incision venectomy with RFA or on its own.
  • Sclerotherapy: Using tiny needles, we inject a chemical into spider veins and small varicose veins. The chemical prevents abnormal veins from filling with blood, which instead returns to the heart through other veins. You may have two to four treatments to get rid of all unsightly veins.
  • Nonthermal vein closure: We may insert a specialized glue through a catheter to close unhealthy veins and eliminate varicose problems.
  • Vein stripping: If RFA is not possible, we can make a small incision in the groin area and another in the calf below the knee. We tie off the major varicose vein branches associated with the saphenous vein and remove the saphenous vein.

These procedures relieve the heaviness and discomfort caused by venous reflux. When blood no longer flows through the treated veins, the veins gradually fade as the body reabsorbs them. Treatment also limits the formation of new varicose veins. Learn more about therapies provided by the Vein Center at Washington University and Barnes-Jewish Hospital

Contact Us

To make an appointment with a Washington University vascular specialist at Barnes-Jewish Hospital, call 314-362-5347.