What are varicose and spider veins?

Varicose veins are abnormal, dilated blood vessels caused by a weakening in the vessel wall. They may appear as swollen, twisted clusters of blue or purple veins. Varicose veins are sometimes surrounded by thin, red capillaries known as spider veins (group of tiny blood vessels located close to the surface of the skin, also called telangiectasias).

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.

What are the symptoms of varicose veins?

• Tiredness, burning, throbbing, tingling or heaviness in the legs
• Itching around the vein
• Swollen legs
• Muscle cramps, soreness or aching in the legs
• Brown discoloration of the skin, especially around the ankles

Who gets varicose and spider veins?

What causes varicose and spider veins?

• Heredity/family history of varicose veins
• Advancing age
• Prolonged standing (especially for people who work in occupations such as nurses, beauticians, teachers, factory workers and others)
• Being overweight
• Hormonal influences during pregnancy
• The use of birth control pills
• Post-menopausal hormonal replacement therapy
• Prolonged sitting with legs crossed
• Wearing tight undergarments or clothes
• A history of blood clots
• Injury to the veins
• Conditions that cause increased pressure in the abdomen including liver disease, fluid in the abdomen, previous groin surgery, or heart failure

How are varicose veins diagnosed?

When is treatment necessary?

Varicose and spider veins may require medical treatment. If varicose veins make walking or standing painful, you should ask 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 when they are associated with these conditions:

• Venous stasis ulcers that result when the enlarged vein does not provide enough drainage of fluid from the skin. As a result, an ulcer (open sore) may form.
• Fungal and bacterial infections may occur as the result of skin problems caused by fluid buildup (edema) in the leg. These infections also increase the risk of tissue infection (cellulitis).
• Thrombophlebitis: Inflammation of the vein due to blood clot formation.
• Venous hemorrhage: Bleeding in the vein.

Complications are more likely when varicose veins are the result of a problem or disease in the deep veins or in the perforating veins which connect the deep and superficial veins, such as deep vein thrombosis or chronic venous insufficiency. Ask your doctor if you have an increased risk of developing any of these conditions.

What are the treatment options?

Wearing properly fitting support hose (also called compression stockings) is the most conservative approach for treating varicose veins, especially when the veins are symptomatic. Compression stockings can be purchased at some pharmacies and medical supply stores and come in various styles including below-the-knee, above-the-knee and pantyhose styles. They also come in different compressions varying from 8 to 10 mmHg, up to 40 to 50 mmHg. Your doctor can recommend the compression that is right for you.

Other conservative treatment methods include:

• Practicing good skin hygiene
• Losing weight if you are overweight
• Exercising regularly (especially walking)
• Avoiding prolonged periods of sitting or standing
• Elevating your legs while sitting and sleeping

Sclerotherapy

Sclerotherapy involves the injection of a solution directly into the varicose veins that cause them to collapse and disappear. Several sclerotherapy treatments usually are required to achieve the desired results.

Foam sclerotherapy is a variation of the procedure performed under ultrasound guidance that involves the injection of a foaming agent mixed with a sclerosing agent. The foaming agent moves blood out of the vein so the sclerosing agent will have better contact with the vein wall.

Sclerotherapy is a simple procedure that can be performed in the doctor’s office. Sclerotherapy can eliminate the pain and discomfort of varicose veins and helps prevent complications such as venous hemorrhage and ulceration. It is also frequently performed for cosmetic reasons.

Laser and Light Therapy

Laser and pulse-light therapy are used to heat the blood vessel to shrink it. Laser therapy is most effective for the treatment of small varicose veins. Laser therapy may be used as an additional treatment after sclerotherapy, endovenous procedures, or surgery of larger veins. Lasers are also being used for endovenous ablation of larger varicose veins. Laser treatments may require several sessions, spaced at six-week intervals, to properly treat the vein.

High-intensity, pulsed light (photoderm or light therapy) is another treatment option. It is different than laser and pulse-light therapy because a spectrum of light is emitted during treatment, rather than a single wave-length. It can be used to selectively shrink abnormal veins including small spider veins, certain varicose veins and vascular birthmarks.

This treatment may be recommended when sclerotherapy or laser therapy does not effectively treat the vein.

Minimally Invasive Procedures

Endovenous thermal ablation is a newer version of ligation and stripping (see Surgery section, below). During this procedure, a laser or high-frequency radio waves are used to create intense local heat in the varicose vein. The technology is different with each type of energy source, but both forms of local heat close up the targeted vessel. This treatment closes off the problem veins but leaves them in place so there is minimal bleeding and bruising. Compared with ligation and stripping, endovenous thermal ablation results in less pain and a faster return to normal activities, with similar cosmetic results.

Micropuncture or micro-incision phlebectomy is performed in an outpatient surgery center. The physician makes a tiny incision and uses a surgical instrument or a large needle to hook the problem vein through the opening. The vein is then removed a tiny piece at a time.

Transilluminated power phlebectomy is an enhanced version of stab phlebectomy and was developed to reduce the number of incisions, pain, bleeding and scarring. The procedure involves inserting a fiberoptic light under the skin while simultaneously injecting a mixture of saline and local anesthetic. This creates a silhouette of the veins to guide the surgeon in placing a powered tissue resector. This instrument cuts the vein into smaller pieces and suctions the pieces from the space.

Surgery

Surgery may be the best treatment when varicose veins are severe and associated with problems such as bleeding, or symptoms including pain or swelling. Several surgical treatments are available. Before choosing any treatment option, it is important to discuss the potential benefits, risks, and side effects with your health care provider. Surgical treatments are performed in the hospital or outpatient setting by a vascular specialist.

Will my insurance cover the cost of treatment?

Many insurance companies cover the cost of treating varicose veins, but generally not spider veins. Please check with your insurance company before considering a particular treatment option.

How can I prevent varicose and spider veins?

• Avoid wearing tight-fitting undergarments and clothing that constricts the waist, groin or legs.
• Avoid crossing your legs while seated.
• Avoid sitting or standing in one position for prolonged periods of time.
• Exercise regularly to increase circulation.
• Lose weight if you are overweight.
• Sit or lay down and elevate your legs at least twice a day for 30 minutes at a time.

When should call the doctor?

Call your doctor if:

• Varicose veins make walking or standing painful
• A sore or tender lump develops on or near a varicose vein
• You have swelling in the feet or ankles
• Your leg suddenly becomes swollen and painful
• Skin over a varicose vein bleeds on its own or when injured
• You have any other symptoms that cause concern

References and Resources

Bartholomew J, Sahgal A, King T, Vidimos A. Varicose veins: Newer, better treatments available. Cleveland Clinic Journal of Medicine 2005;72(3):313-328.

Sadick NS, Wasser S. Combined endovascular laser plus ambulatory phlebectomy for the treatment of superficial venous incompetence: a 4-year perspective. Journal of Cosmetic and Laser Therapy 2007; Mar 9(1):9-13.

Subramonia S, Lees TA. The treatment of varicose veins. Annals of the Royal College of Surgeons of England 2007; Mar 89(2):96-100.

“ Varicose Veins,” Medline Plus; National Library of Medicine; www.nlm.nih.gov/medlineplus/varicoseveins.html