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.
What is phlebology?Phlebology is the branch of medicine that deals with veins and disease of veins.
What is a phlebologist?A Phlebologist is a physician who specializes in the diagnosis and treatment of vein disorders.
What are varicose veins?Varicose Veins are veins that become abnormally swollen and large, usually due to defective valves in the vein. Varicose veins are sometimes bluish in color, protrude from the surface of the skin, and frequently have a winding or worm-like appearance.
What causes varicose veins?Increase in the diameter of a vein results in the malfunction of valves inside of the vein that are designed to prevent blood from flowing backward in the vein. An inherited weakness of the vein wall (genetic) and circulating hormones that relax the smooth muscle of the vein wall are the most common causes. Females have high levels of such a hormone, the hormone progesterone. Pregnancies, obesity, hormone replacement therapy, the use of female oral contraceptives as well as occupations that require a standing position are additional causes of varicose veins. Since females usually have multiple risk factors for the development of varicose veins, about three fourths of the persons who have varicose veins are women and 25% are men.
Can I be cured of my varicose veins?Varicose veins are a problem that can be successfully treated but the disorder cannot be permanently cured. The treatment of the abnormal veins does not remove the original tendency of a patient to develop varicose veins. Therefore, many patients need to return for maintenance treatments after their initial treatment is completed.
How will the blood in my veins get back to my heart after all of the abnormal veins are removed or destroyed?The backward flow of blood in varicose veins and main superficial trunks, the great saphenous vein (GSV) and lesser saphenous (LSV) vein actually interfere with the normal venous return of blood. Removal of these areas of abnormal circulation actually improves circulation of blood in the treated limb. It is this improvement in limb circulation that causes improvement of symptoms of tiredness and heaviness in the limb.
Do I have to treat both legs?The abnormal limb or limbs should be treated thoroughly for best results. They may be treated at the same time or after one another.
What is a skin ulcer?A skin ulcer is caused by a venous reflux disorder that is called a venous stasis ulcer. Early signs that a venous stasis ulcer may develop include a darkening of the skin in the area of the ankle. Gradually, the skin may become leathery or waxy in appearance. Without treatment of the venous disease, the skin may breakdown and bleeding may occur.
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.