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Varicose Veins

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What are varicose veins and spider veins?

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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How common are abnormal leg veins?

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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What causes varicose and spider veins?

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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Why do varicose and spider veins usually appear in the legs?

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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Are varicose and spider veins painful or dangerous?

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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How can I prevent varicose and spider veins?

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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Should I see a doctor about varicose veins?

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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How are varicose and spider veins treated?

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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Can varicose and spider veins return even after treatment?

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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For More Information...

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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Varicose Veins