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 to pick up more oxygen. 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 and can lead to varicose veins.

What are varicose veins?

Varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall. They might appear as clusters of blue or purple veins and 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 most often appear on the legs and in the pelvic area. Most varicose veins develop near the surface of the skin. Deeper varicose veins can't be seen but might cause the skin above them to swell, or become darker or hard.

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

Who gets varicose veins?

Almost 50 percent of women between ages 40 and 50 have some form of varicose veins. Four times more women than men have varicose veins, and they become more prevalent with age.

What causes varicose veins?

Varicose veins occur when healthy veins swell and cause 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.

The exact cause of varicose veins is unknown, although family history, pregnancy, obesity, lack of movement, and hormonal changes are contributing factors to this condition. Standing for long periods of time and wearing tight underwear or clothing might also cause varicose and spider veins.

How are varicose veins diagnosed?

During a physical exam, the doctor will check your legs while you are standing. Your doctor also might 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.

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 also should 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 are ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, the skin does not receive enough oxygen and an ulcer (skin sore) might form.
• Phlebitis—This is inflammation of the vein.
• Thrombosis—This is the development of blood clots that form in the dilated vein.

How are varicose veins treated?

Regular exercise, standing only when necessary, and elevating your legs while sitting and sleeping might keep your varicose and spider veins from getting worse. Wearing special elastic support stockings during daily activities also can provide extra support and relieve aching, sore legs. When you need to stand for long periods of time, take frequent
eaks to sit down and elevate your feet.

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

What is sclerotherapy?

Sclerotherapy is a non-surgical treatment option that involves injecting a chemical solution into the veins to make them collapse. Because 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, since one to three 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 reinjected for four to six weeks to allow for complete healing, although other areas may be treated during this time.

The only discomfort during sclerotherapy is the sensation of small needle pricks. For two to four weeks after treatment, you will wear medical-grade support stockings. Walking and moderate exercise also can help speed recovery. Temporary reactions to the treatment might include slight swelling of the leg or foot, minor
uising, itching, redness, or mild soreness. Rare complications include the development of telangiectasias -- small clusters of red blood vessels, skin ulcerations, and
own pigmentation around the treated vessels.

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

What are some other treatment options for dilated veins?

• Photoderm: 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 (ab-LA-shun) 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. Endoscopic vein surgery usually 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.

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

Where can I get more information?

National Heart, Lung and Blood Institute Information Center
P.O. Box 30105
Bethesda, MD 20824-0105
1.800.575.WELL (9355): 24-hour recorded information
Fax: 301.251.1223
Ask for information about varicose veins.
www.nhlbi.nih.gov

American Society for Dermatologic Surgery
930 N. Meacham Road
Schaumburg, IL 60173-6016
847.330.9830
1.800.441.2737
www.asds-net.org

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