Varicose Vein Treatment

What Are Varicose Veins?

Varicose veins are enlarged veins that are visible through the skin and may appear as blue or purple twisted, knot-like cords. Varicose veins can occur anywhere in the body, but are more commonly found on the legs. Hemorrhoids, a type of varicose vein, can appear during pregnancy around the anus or in the vagina.

What Are Spider Veins?

Spider veins, a milder type of varicose veins, are smaller than varicose veins and often look like a sunburst or "spider web." They are red or blue in color and are commonly found on the face and legs, just under the surface of the skin.

What Causes Varicose Veins?

Varicose veins are caused by increased blood pressure inside the superficial leg veins. Two main types of veins are present in the legs. Superficial veins are near the surface of the skin, whereas deep veins are located in the muscle tissue. Varicose veins occur in the superficial veins in the legs. In contrast, deep veins lead to the vena cava, a large vein that transports blood to the heart.

The blood in the veins of the legs works against gravity in order to return upwards to the heart. The blood is moved up towards the heart by one-way valves in the veins. When the leg muscles contract and squeeze the deep veins, the valves inside the veins open. When the leg muscles relax, the valves close, preventing blood from flowing backward.

When the one-way valves become weakened or damaged, blood can collect in the veins, causing the veins to become enlarged. Sitting or standing for long periods can cause blood to pool in the leg veins, increasing the pressure within the veins. In persons who are prone to varicose veins, the veins can stretch as a result of increased pressure. This stretching of the veins may weaken the walls of the veins and damage the valves. Thick varicose veins or spider veins may result.

Other factors that may lead to weakened vein valves and the development of varicose veins include obesity, aging, leg injury, pregnancy, smoking, hormones, and heredity (being born with weak vein valves). While varicose veins are not considered a severe medical condition, they can be uncomfortable and can lead to more serious problems such as phlebitis (inflammation in the leg) or blood clot. Varicose veins can also be a cosmetic concern to some people.

Varicose veins, because they occur in superficial veins, are not generally linked to a serious condition called deep vein thrombosis (DVT). However, with severe varicose veins, there is a small increased chance of developing DVT. DVT requires immediate medical attention. Symptoms of DVT include sudden, severe leg swelling and can result in blood clots that travel to the brain or the heart.

What Are the Symptoms of Varicose Veins?

The following are the most common symptoms of varicose veins. However, each individual may experience symptoms differently. Symptoms may include:

  • Color changes in the skin
  • Sores on the legs
  • Rash
  • Sensations in the legs, such as a heavy feeling, burning, and/or aching

Severe varicose veins may eventually produce long-term mild swelling that can result in more serious skin and tissue problems, such as ulcers and nonhealing sores. The symptoms of varicose veins may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

What Are the Risk Factors for Varicose Veins?

In the US, as many as 40 million people have varicose veins. The risk of varicose veins is strongly related to age and gender. The following are suggested risk factors for varicose veins:

  • Obesity
    Obesity is a major risk factor for varicose veins. Excessive weight increases the pressure on the veins of the legs and aggravates the condition.
  • Family History
    Heredity is important in determining susceptibility to varicose veins, but the specific factors responsible for this have not been identified.
  • Inactivity
    Prolonged standing or sitting increases pressure in the veins.
  • Gender
    Women are particularly susceptible to varicose veins because of the influence of progesterone on the veins and the effects of pregnancy.
  • Pregnancy
    Pregnant women have an increased risk of developing varicose veins due to the hormonal influences of pregnancy on the veins, but the veins often return to normal within one year of childbirth. Women who have multiple pregnancies may develop permanent varicose veins.
  • Age
    Varicose veins usually affect people between the ages of 30 and 70. With advancing age, the elastic shell of the vein begins to weaken increasing the chance that the vein will dilate.

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases have different risk factors.

Although these risk factors increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors. But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

How Are Varicose Veins Diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for varicose veins may include any, or a combination, of the following:

  • Duplex Ultrasound - A type of vascular ultrasound procedure done to assess blood flow and the structure of the leg veins. The term "duplex" refers to the fact that two modes of ultrasound are used - Doppler and B-mode. The B-mode transducer (like a microphone) obtains an image of the vessel being studied. The Doppler probe within the transducer evaluates the velocity and direction of blood flow in the vessel.
  • Color-Flow Imaging (Also Called Triplex Ultrasound) - A procedure similar to duplex ultrasound that uses color to highlight the direction of blood flow. Vessels in which blood is flowing are colored red for flow in one direction and blue for flow in the other, with a color scale that reflects the speed of the flow.
  • Magnetic Resonance Venography (MRV) - A diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body. An MRV uses magnetic resonance technology and intravenous (IV) contrast dye to visualize the veins. Contrast dye causes the blood vessels to appear opaque on the x-ray image, allowing the physician to visualize the blood vessels being evaluated. MRV is useful in some cases because it can help detect causes of leg pain other than vein problems.

What Are the Treatment Options for Varicose Veins?

Non-invasive options include supportive stockings, exercise and leg elevation.

If the pain of varicose veins is not relieved, other options include:

  • Sclerotherapy
    • The most common treatment for both spider veins and varicose veins, sclerotherapy involves injecting a solution into the vein causing the lining to swell and eventually seal.
    • In a few weeks, the vein fades. Although the same vein may need to be injected more than once, sclerotherapy can be very effective. Most patients can expect up to a 90 percent improvement.
    • Sclerotherapy does not require anesthesia, and can be done in a doctor's office. Side effects include stinging or painful cramps, red raised patches of skin, small skin ulcers, and bruises. The treated vein could become inflamed or develop lumps of coagulated blood. Applying heat and taking aspirin or antibiotics can relieve the inflammation, which is not dangerous.
  • Closure Technique
    • This method involves placing a special catheter, or small tube, into the vein. Once inside, the catheter sends radiofrequency waves to shrink and seal the veins. Healthier veins surrounding the closed vein restore the blood flow.

What About Treatment for Very Large Veins?

Large varicose veins can be treated with outpatient procedures. These procedures are performed with local or regional anesthesia. Available surgical options include:

  • Vein stripping or power excision
    • With this treatment, the varicose veins are completely removed. Removing the veins does not affect the circulation of blood in the leg because deeper veins take up the increased blood volume.
  • Micro phlebectomy
    • The vein is pulled from the leg using a series of tiny incisions and special surgical hooks. The vein can be removed in one treatment. Normal activity can be resumed immediately, and complete recovery is expected after one to two weeks.

Complications of vein surgery are rare but include: bruising, minor skin infections, and mild nerve damage. 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. A rare complication is a blood clot in a deep vein. Treatment of the clot requires blood thinners.

Can Varicose and Spider Veins Return Even After Treatment?

Current treatments for varicose veins and spider veins have very high success rates. However, depending on the severity of the problem, new veins can become varicose over time.

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