Conditions and Treatments
The most common venous conditions are spider and varicose veins, however both can lead to much more serious conditions, including blood clots that form in the superficial and deep veins (aka Superficial and Deep Vein Thrombosis). Spider and Varicose veins can also be a sign of Chronic Venous Insufficiency. If you would like to learn even more about various types of vein disease, check out the book Healthy Veins…Healthy Legs or talk to a vein care specialist.
Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause and severity of the problem. If you’re worried about a possible venous disorder, you should seek professional medical advice from a vein care specialist.
Spider Veins and Varicose veins
If the valves of the veins don’t function well, blood doesn’t flow efficiently, and the veins become enlarged because they are congested with blood. These enlarged veins are commonly called spider veins or varicose veins. Spider veins are small red, blue or purple veins on the surface of the skin. Varicose veins are larger, distended veins that are located somewhat deeper than spider veins.
Deep Vein Thrombosis
When the blood flow in our veins slows down, it can form clots in the veins. When these clots break free, they can travel to the lungs resulting in a pulmonary embolism, which can cause death. Fortunately, DVT is treatable and preventable. The first step is learning if you are at risk by taking the DVT Risk Assessment. The second step is to take preventive measures such as wearing compression socks and keeping your legs moving if you have to sit for a long period of time and discussing DVT with your doctor if you are pregnant or undergoing a medical operations. You can also watch our segment on The Balancing Act to learn more.
Aside from an undesirable cosmetic appearance, frequent symptoms of venous disorders include leg pain, throbbing, burning, fatigue, restlessness. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation, intense itching or even ulceration of the lower leg. In serious cases, most often in elderly patients, vein rupture and bleeding can also occur. Symptoms are often made worse by prolonged standing, sitting, or lying down. The severity of your symptoms will vary based on the severity of the condition.
To understand the causes of venous disorders, you have to start with the circulatory system. Our circulatory system is made up of two separate parts: arteries that take the blood from the heart to all the tissues in our bodies and veins that return the blood back to our heart. The arteries benefit from gravity, which pulls the blood downward from our heart, whereas the veins have to generate their own pumping action to resist gravity and move the blood back up to our heart. To move the blood in this way, our veins are arranged in two layers: deep veins that run vertically within our muscles and superficial veins that are arranged as a network of thousands of vessels. When the veins are unable to pump blood properly, blood begins to pool in our veins instead of moving upward toward our heart. This pooling is what leads to the appearance of spider and varicose veins as well as the more serious symptoms for leg pain, leg swelling, and blood clotting.
There are several risk factors that contribute to vein disease:
Aging is one of the most important risk factors. Small venous problems often progress into large ones over time. A decrease in the body’s production of collagen, a breakdown of the elastic material in vein walls causes them to breakdown and stretch over time, which ultimately results in bulging veins, more visible veins, and swelling in the veins.
Genetics is also a significant risk factor. Vein disorders run in families, and if you have a family member with spider or varicose veins, you are more likely to develop them yourself.
Ethnicity also plays a role in the development of venous disorders. Research has found that Caucasians have a higher incidence of varicose veins than people of Hispanic, African American, and Asian descent.
Mobility can be an important treatment method as well as a risk factor. Sitting, lying, and particularly standing for long periods of time hinders the ability of the leg muscles to pump blood, slowing down the blood flow.
The severity of vein diseases can range from cosmetic to life-threatening, so it’s important to consult a vein care specialist if you think you have a venous disorder or are considering different treatment options. A vein care specialist will be able to evaluate the severity of your condition and recommend different treatment options.
What to Expect from Your Visit with a Vein Care Specialist
Your initial evaluation for vein treatment will vary slightly from physician to physician, but generally, it will include three components: a clinical history, a physical examination, and a discussion about your treatment expectations and concerns. When seeking treatment for venous disorders, it is important to remember that vein disease is a lifelong problem that cannot be cured with a single procedure or treatment. Cosmetic reduction in visibility of spider and varicose veins is very possible, however most patients will continue to develop new spider veins throughout their lives.
Because genetics plays a large role in vein disease, gathering a comprehensive medical history is an important part of your evaluation. Generally, the office staff will gather demographic data and initiate a patient chart for you. This chart may include financial and insurance information as well as a privacy disclosure. Information on your past medical history is typically gathered at this point, and often you will be asked about the vein problems you are currently experiencing.
When meeting in private with the physician or their staff, you may be asked more in depth questions regarding your and your family’s medical history.
The specialist will ask you about the symptoms you’ve been experiencing, and conduct an examination. After carefully examining your legs, the physician may also examine the abdomen or pelvis to search for other abnormal veins. You may wish to bring loose-fitting (baggy) shorts with you to the physician’s office, and ask the staff if it would be appropriate for you to change into them once in the exam room.
After the initial exam is complete, your physician may decide that further testing is in order. These tests often include duplex ultrasound and/or Doppler exams of the legs. These non-invasive procedures use sound waves to evaluate the function of the valves in the veins of the leg. These tests are very important in diagnosis, and can improve the effectiveness of any treatment.
At this point, your physician will discuss your treatment expectations and options with you. You should feel free to ask any questions about costs, complications, and potential benefits as well as side effects of treatment. You should also feel free to question your physician about their qualifications, training, background, and the number of previous procedures performed of the type they are suggesting.
Veins that are cosmetically unappealing or cause pain or other symptoms are prime candidates for treatment. There are two general treatment options: conservative measures, such as compression stockings or herbal remedies, and corrective measures such as sclerotherapy, surgery and light source/laser treatment. In some cases, a combination of treatment methods works best. A number of factors go into determining the right treatment for you, including your desired outcomes and the severity of your condition. It’s important to discuss your treatment options with a vein care specialist. If you don’t already have a specialist, you can use our physician finder tool to find one in your area.
Graduated compression stockings are first line of defense and a mainstay of conservative management of venous disease. Graduated compression stockings create a tight pressure around the foot and ankle that gradually decreases as it moves up the leg. This “graduated compression” promotes the normal flow of blood up the leg. Most vein specialist recommend that patients who suffer from spider veins, varicose veins, or venous insufficiency wear compression stockings. Compression stockings can also be used to supplement other forms of treatment.
Natural plant medicines may strengthen the vein wall or decrease the inflammation that often comes with vein disease. Horse chestnut extract is the most commonly recommended herbal preparation for venous disease. Although there is no documented evidence of its efficacy, there are many anecdotal reports of beneficial effects on the symptoms of vein disease.
Endovenous Laser Treatment
Image courtesy of Diomed, Inc.
Endovenous Radio Frequency Ablation (Procedure)
Endovenous Radio Frequency Ablation is a minimally invasive, in-office treatment alternative to surgical stripping of the great saphenous vein. Instead of removing the saphenous vein, it is sealed closed in place. The skin on the inside of the knee is anesthetized and a radio-frequency catheter is inserted into the damaged vein through a needle stick in the skin. The catheter delivers radiofrequency energy to the vein wall causing it to heat. As the vein warms, it collapses and seals shut.
1. Catheter inserted, 2. Vein warmed and collapses, 3. Catheter slowly withdrawn, closing vein
Image courtesy of VNUS Medical Technologies, Inc.
Ultrasound Guided Sclerotherapy (Echo-Sclerotherapy)
Ultrasound Guided Sclerotherapy (Echo-Sclerotherapy) is another in-office treatment alternative to surgical stripping. With this technique and based on the clinical judgment of the doctor, sclerotherapy is done with either a liquid or “foamed” sclerosant, while the doctor visually monitors the vein on an ultrasound screen. This enables treatment of veins that can’t be seen because they are below the surface of the skin and would otherwise require surgical removal. Ultrasound imaging is used to guide a needle into the abnormal vein and deliver medication to destroy the lining of the blood vessel and seal it shut. Ultrasound guided sclerotherapy is primarily used to treat large veins beneath the surface of the skin.
Traditional Ligation & Stripping
Ambulatory phlebectomy is a method of surgical removal of surface varicose veins. Ambulatory phlebectomy is usually performed in a doctor’s office using local anesthesia. The area surrounding the varicose vein clusters is flooded with anesthetic fluid. A needle is then used to make a puncture next to the varicose vein and a small hook is inserted into the needle hole and the varicose vein is grasped and removed. The punctures typically leave nearly imperceptible scars.
Photos courtesy of S. Zimmet, MD
Laser and intense pulsed light (IPL) can be used to treat small spider veins and facial redness. A light beam is pulsed through the skin and onto the veins in order to seal them off and cause them to dissolve. Light-based treatment is generally used only to treat small veins. Treatments may be combined with sclerotherapy, and multiple treatments are usually required.
With the evaluation and treatment methods available today, spider and varicose veins can be treated in minimally invasive but effective ways that were not possible in the past. When seeking treatment for venous disorders, it is important to remember that vein disease is a lifelong problem that cannot be cured with a single procedure or treatment. Although there is no cure for venous disorders, there are many treatment options that can reduce the appearance and painful symptoms of spider veins, varicose veins, and chronic venous insufficiency.
The results will depend on the treatment options chosen. But regardless of which treatment method is used, its success depends on the careful assessment and treatment by a knowledgeable vein care specialist. If you don’t have a vein care specialist already, you can use our Physician Finder tool to find one in your area.
What Happens If I don't treat my varicose veins?
There are several adverse consequences of untreated varicose veins, and their severity will vary from person to person depending on their circumstances. Many people who don’t treat their varicose veins will experience continued symptoms of pain, fatigue and swelling of the legs or ankles. More advanced medical problems can include hyperpigmentation, lipodermosclerosis, venous leg ulcers, spontaneous bleeding, superficial thrombophlebitis, and a potentially life-threatening condition called deep vein thrombosis. If you’re unsure of the severity of your varicose veins, you should see a vein care specialist, who will be able to determine the severity of your condition and whether treatment is necessary.
Blood that pools in the varicose veins is depleted of oxygen and nutrients. The veins also do not tolerate high pressure well and begin to allow red blood cells and fluid to leak into the tissues of the leg, which causes painful swelling. The red blood cells in the tissues cause chronic inflammation and the skin becomes dark and discolored. The medical term for the dark discoloration is hyperpigmentation.
When the skin and the fat under the skin are inflamed for years, the tissues become woody and firm. The medical term for this woody, hard tissue is lipodermosclerosis.
A condition that may occur over time, when there is chronic venous insufficiency, is a venous leg ulcer. The ulcers due to varicose veins are painful and difficult to heal. Sometimes the ulcers cannot be healed until the backward blood flow in the veins is corrected.
Another possible consequence of untreated varicose veins is spontaneous bleeding from the varicose veins. As the skin over the veins becomes thin, eventually the vein can be exposed to the outside world and be easily injured by clothing, bedding, etc. The blood loss can be significant and is painless.
Superficial thrombophlebitis (ST) is an inflammation of a vein just below the surface of the skin. The cause of inflammation is not an infection. Rather, inflammation is due to decreased blood flow through the vein, damage to the vein and blood clotting. The features of ST include redness to the skin and a firm, tender, warm vein. Localized leg pain and swelling may occur as well.
Deep vein thrombosis (DVT), unlike ST, can be associated with significant and serious medical problems. DVT is often first noticed as a “pulling” sensation in the calf of the lower leg, and it can be quite painful. Symptoms also include associated warmth, redness and swelling. The swelling often extends to above the knee.
Some patients are at higher risk for developing DVT. These include people with one or more of the following characteristics:
Over 60 years of age
History of prior DVT
Blood Clotting Disorders
Pregnancy and Postpartum
When a diagnosis of DVT is made, anticoagulation treatments are often started. Anticoagulation prevents progression of the blood clot, breaks up the clot and prevents the clot from traveling to the lungs. If a clot travels to the lungs it is called a “pulmonary embolus” and the outcome can be fatal.
If you’re not sure whether you need to treat your varicose veins, see a vein care specialist for a consultation. A specialist will be able to evaluate your condition and determine what kind of treatment is needed. If you don’t have a specialist, you can find one in your area.