Varicose Veins
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The heart pumps blood to supply oxygen and nutrients to all parts of the
body. Arteries carry blood from the heart towards the body parts, while veins
carry blood from the body parts back to the heart. As the blood is pumped back
to the heart, veins act as one-way valves to prevent the blood from flowing
backwards. If the one-way valve becomes weak, some of the blood can leak back
into the vein, collect there, and then become congested or clogged. This
congestion will cause the vein to abnormally enlarge. These enlarged veins can
be either varicose veins or spider veins.
Varicose veins are very swollen and raised above the surface of the skin.
They are dark purple or blue in color, and can look like cords or very twisted
and bulging. They are found most often on the backs of the calves or on the
inside of the leg, anywhere from the groin to the ankle. During pregnancy,
varicose veins called hemorrhoids can form in the vagina or around the anus.
Spider veins are similar to varicose veins, but they are smaller, are often
red or blue in color, and are closer to the surface of the skin than varicose
veins. They can look like a tree branch or spider web with their short jagged
lines. Spider veins can be found on both the legs and the face. They can cover
either a very small or very large area of skin.
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As many as 60% of all American women and men suffer from some form of vein
disorder, but women are more affected -- up to 50% overall. It also is estimated
that 41% of all women will suffer from abnormal leg veins by the time they are
in the 50s.
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No one knows the exact cause of spider and varicose veins, but there are
several factors that cause a person to be more likely to develop them. Heredity,
or being born with weak vein valves, is the greatest factor. Hormones also play
a role. The hormonal changes that occur during puberty, pregnancy, and
menopause, as well as taking estrogen, progesterone, and birth control pills can
cause a woman to develop varicose veins or spider veins. During pregnancy,
besides the increases in hormone levels, there also is a great increase in the
volume of blood in the body that can cause veins to enlarge. The enlarged uterus
also puts more pressure on the veins. (Within 3 months after delivery, varicose
veins usually improve. However, more abnormal veins are likely to develop and
remain after additional pregnancies.)
Other factors that weaken vein valves and that may cause varicose or spider
veins include aging, obesity, leg injury, and prolonged standing, such as for
long hours on the job. Spider veins on the cheeks or nose of a fair-skinned
person may occur from sun exposure.
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The veins in the legs have the toughest job of carrying blood back to the
heart. They endure the most pressure -- pressure that can overcome the strength
of these one-way valves. The force of gravity, the pressure from body weight,
and the task of carrying the blood from the bottom of the body up to the heart
make the legs the primary location for varicose and spider veins.
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Medical treatment usually is not required for varicose or spider veins.
However, varicose veins can become quite uncomfortable as well as look
unattractive. Varicose veins usually enlarge and worsen over time. They can
cause the legs and feet to swell. Although severe leg pain is not common, leg
muscles may feel fatigued or heavy, or throb and cramp at night. The skin on the
legs and around the ankles also can itch or burn.
In some cases, varicose veins and spider veins can cause more serious
problems, and medical treatment will provide benefits. If the veins become
severe, they can cause a condition called venous insufficiency, a severe
clogging of the blood in the veins that prevents it from returning to the heart.
This condition can cause problems like a deep-vein thrombosis (blood clot), or a
severe bleeding infection. These usually are caused by injury to the varicose
vein. A blood clot can be very dangerous because of the possibility of it
traveling from the leg veins to the lungs, where it may block the heart and
lungs from functioning. Lastly, because the skin tissue around the varicose vein
may not receive enough nourishment, sores or skin ulcers may develop.
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There are several easy things you can do to help prevent varicose and spider
veins and to relieve discomfort from the ones you have:
- Protect your skin from the sun by wearing sunscreen to limit spider veins
on the face.
- Exercise regularly to improve your leg strength, circulation, and vein
strength. Focus on exercises that work your legs, such as walking or running.
- Control your weight to avoid placing too much pressure on your legs.
- Do not cross your legs when sitting. However, try to elevate your legs
when resting.
- Do not stand for long periods of time. If you have to stand for long
periods of time, shift your weight from one leg to the other every few
minutes. If you have to sit for long periods of time, stand up and move around
or take a short walk approximately every 30 minutes.
- Wear elastic support stockings, but avoid clothing that is too tight or
that will constrict your waist, groin, or legs.
- Make sure to include high-fiber foods in your diet since constipation can
contribute to varicose veins. High fiber foods include fresh fruits and
vegetables and whole grains, like bran. Control your salt-intake. Salt, or
sodium, can cause you to retain water or swell.
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Remember these important questions when deciding whether to see your doctor:
- Has the varicose vein become swollen, red, or very tender or warm to the
touch?
- If yes, see your doctor.
- If no, are there sores or a rash on the leg or near the ankle with the
varicose vein, or are there circulation problems in your feet?
- If yes, see your doctor.
- If no, continue to follow the self-care tips above.
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Besides a physical examination, your doctor can take x-rays or ultrasound
pictures of the vein to assess the cause and severity of the problem. You may
want to speak with a doctor who specializes in vein diseases (phlebology). You
should discuss which treatment options are best for your condition and
lifestyle. It is important to remember that not all cases of varicose veins are
the same. Doctors may differ in the ways they treat you. Some available
treatments or surgeries include:
- Sclerotherapy - Of all available treatments, this one is most commonly
used for both spider veins and varicose veins. It involves injecting a
solution into the vein that causes the lining of the vein walls to swell,
stick together, and eventually seal shut. The flow of blood is stopped and the
vein turns into scar tissue. In a few weeks, the vein should fade. Although
the same vein may need to be injected with the solution more than once,
sclerotherapy is very effective if done correctly. The American Academy of
Dermatology states that most patients can expect a 50% to 90% improvement.
Also, a new and improved type of sclerotherapy called microsclerotherapy uses
improved solutions and injection techniques that increase the success rate for
removal of spider veins. Sclerotherapy does not require anesthesia, and can be
done in the doctor's office.
Some side effects may only occur at the site of the injection, such as
stinging or painful cramps; red raised patches of skin, small skin ulcers, and
bruises. Spots, brown lines, or groups of fine red blood vessels could appear
around the vein being treated. These usually disappear. The treated vein could
become inflamed or develop lumps of coagulated or congested blood. These are not
dangerous. Applying heat and taking aspirin or antibiotics can relieve
inflammation. Lumps of coagulated blood can be drained. Health insurance
coverage varies. If the treatment is done for cosmetic reasons only, it may not
be covered.
- Electrodesiccation - This treatment is similar to sclerotherapy except the
veins are sealed off with an electrical current instead of the injection of
solution. This treatment may leave scars.
- Laser surgery – Until recently, laser treatments mostly were used for
treating spider veins on the face. Varicose veins in the legs did not respond
consistently to this treatment, and some doctors doubted whether laser
treatment actually worked, and it was not covered by most health insurance
plans. Now, however, new technology in laser treatments can effectively treat
varicose veins in the legs.
Laser surgery works by sending very strong bursts of light onto the vein that
makes the vein slowly fade and disappear. Lasers are very direct and accurate,
and only damage the area being treated. All skin types and colors can be safely
treated with lasers. The American Academy of Dermatology believes that the new
laser technology is more effective with fewer side effects. Laser surgery is
more comfortable for patients because there are no needles or incisions. When
the laser hits the skin, the patient only feels a small pinch, and the skin is
soothed by cooling both before and after the laser is applied. There may be some
redness or swelling of the skin right after the treatment, but this disappears
within a few days. The skin also may be discolored, but this will disappear
within one to two weeks. Treatments last 15 to 20 minutes, and depending on the
severity of the veins, two to five treatments are generally needed to remove
varicose veins in the legs. Patients can return to normal activity right after
treatment.
There are several types of lasers that can be used to treat varicose veins
and spider veins on the legs and face. Although your doctor will decide which
type is best to treat your condition, some of the lasers used to treat veins
include yellow light lasers, green light lasers, and other intense pulsed light
systems. Again, health insurance coverage varies. If the treatment is done for
cosmetic reasons only, it may not be covered.
- Closure Technique – The U.S. Food and Drug Administration (FDA) in March
1999 approved this new procedure for use in the United States. Although it is
not as widely used as sclerotherapy, some doctors feel it may become the
standard for treating varicose veins. It is not very invasive and can be done
in a doctor’s office. This method involves placing a special catheter or a
very small tube into the vein. Once inside, the catheter sends radiofrequency
energy to cause the vein wall to shrink and seal shut. Healthier veins
surrounding the closed vein can then restore the normal flow of blood. As this
happens, symptoms from the varicose vein decrease. The only side effect is
slight bruising.
Surgery is used mostly to treat very large varicose veins. Available surgical
options include:
- Surgical Ligation and Stripping - With this treatment, the veins are tied
shut and completely removed from the leg. Removing the veins will not affect
the circulation of blood in the leg because veins deeper in the leg take care
of the larger volumes of blood. The varicose veins mostly removed through
surgery are superficial or surface veins, and collect blood only from the
skin. This surgery requires either local or general anesthesia and must be
done in an operating room on an outpatient basis.
Serious side effects or complications with this surgery are uncommon.
However, with general anesthesia, there always is a risk of cardiac and
respiratory complications. Similar to the risks of sclerotherapy, bleeding and
congestion of blood can be a problem, but the collected blood usually settles on
its own and does not require any further treating. Wound infection,
inflammation, swelling and redness also can occur. This surgery also can leave
permanent scars. A very common complication is the damage of nerve tissue around
the treated vein. Small sensory nerve branches are difficult to avoid when veins
are removed. This damage can cause numbness in small areas of skin, burning, or
a change in sensation around the surgical scar. The most serious, but rare,
complication of surgery is the creation of a deep vein blood clot that may
travel to the lungs and heart. To be safe, many surgeons give injections of
heparin, a drug that reduces blood coagulation, for one to two days before the
surgery. However, heparin also can increase the normal amount of bleeding and
bruising after the operation.
- Ambulatory Phlebectomy - With this surgery, a special light source marks
the location of the vein. Tiny incisions are made in the vein, and then with
surgical hooks, the vein is pulled out of the leg. This surgery requires local
or regional anesthesia. The vein usually is removed in one treatment. Side
effects and complications are similar to those of ligation and stripping. The
most common side effect is slight bruising. Compared to traditional surgery,
ambulatory phlebectomy allows the removal of very large varicose veins while
leaving only very small scars. Patients can return to normal activity the day
after treatment.
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Current treatments for varicose veins and spider veins have very high success
rates. Although it is uncommon, these veins can return after treatment. One
reason may be hidden areas in the body where there is a lot of pressure on the
veins. This pressure may cause new spider veins. Doctors can diagnose this with
ultrasound. Another cause may be new re-growth of vein branches. Doctors have
found that tiny vein branches can grow through scar tissue to connect to both
deep and superficial veins even after surgery.
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National Heart Lung and
Blood Institute (NHLBI)
American Academy of Dermatology
American Society for Dermatologic
Surgery
The American College
of Phlebology
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