Varicose Veins and Spider Veins

Leg veinsVaricose and spider veins are very common, especially in the lower legs and thighs. But what causes them?

The leg and thigh has two venous systems, which returns the blood back toward the heart. One is a superficial system (visible through the skin) and the other one is deeper, buried inside the muscles of the leg. Both of these systems have connections between them. Think of them as two pipes which are parallel to each other but still connected. Both these venous systems have one-way valves, which, when working correctly, allow the blood to flow from the toes back toward the upper thighs and then into the general venous system, which travels towards the heart. It is the “pumping” action of the leg muscles which forces the blood through these valves. If these valves do not function properly, varicose veins and spider veins may occur. As one can imagine, this problem becomes worst when standing, especially in the superficial system, which is subject to high pressure when erect.

Spider VeinsTherefore, varicose veins and spider veins are really representation of the same underlying problem and are part of the same spectrum, the degree depending on how insufficient the valve system is.

Spider veins are tiny and resemble the legs of a spider. They are typically very thin (the thickness of thick hair). Spider veins, also known as telangectasia, typically do not cause any symptoms. Treatment of spider veins is usually due to cosmetic reasons. Sometimes spider veins can spontaneously burst, causing a small bruise, but it is not dangerous.

Varicose veins, on the other hand, can by asymptomatic or symptomatic. Many patients complain of leg pain and fatigue, when standing for long periods of time. Sometimes, the pressure build-up in the vein becomes large enough to cause ulceration and bleeding. The inadequate return of venous blood may also lead to venous stasis, with pooling of blood in the lower legs. This, in return, can cause discoloration, pain, ulcers, increased risk of infection, poor wound healing, and blood clots which may travel to the lungs and become life threatening.

VeinsWho is at risk for developing spider veins and varicose veins? Theoretically, every one is at risk. However, some are more prone than others. The risk factors are genetics (varicose or spider veins run in the family), hormonal changes due to puberty or menopause, pregnancy (due to increase in the volume of blood), obesity, leg injury affecting the muscle pumping mechanism, tumors or masses which may block the venous return, and prolonged standing. Sun exposure can also be a risk factor for developing spider veins on the face, especially for fair skin individuals.

There are several things a person can do to minimize developing spider and varicose veins. Exercising regularly (specifically exercises which use the leg muscles), will develop the muscles and improve the pumping mechanism of the leg. Maintaining an ideal weight will decrease the “load” which the veins must carry through their system. Wearing tight compression stocking (designed specifically for varicose veins) will help reduce the chance of developing or worsening of varicose and spider veins. If possible, do not stand or sit for long periods of time. If you must sit for long periods, stand up and walk every 30 minutes.

If you have any of the warning signs of varicose veins (brownish or red discoloration of the feet and legs, swelling, tenderness, skin break down or bleeding), you must see a physician for proper management.

SclerotherapySeveral treatments are available for treating varicose and spider veins.
The most common treatment is sclerotherapy. Your doctor will inject a sclerosing agent into the vein, which causes scarring of the wall. This eventually will result in fading of the vein. The same area may need to be treated more than once. I do not recommend sclerotherapy for veins larger than 3mm. Sclerotherapy is an outpatient office procedure and requires no anesthesia. The improvement rate is 50-90%. Possible side effects may include small skin sores or red raised patches in the area of injection, pain and tenderness where the vein has clotted, temporary bruising, brown “ghosts” where the vein used to be (usually temporary), and rarely skin sloughing. Sclerotherapy, in the right hands, is a very safe technique.

Laser therapy is a newer treatment for varicose and spider veins. As with sclerotherapy, it is an outpatient office procedure, and is not recommended for veins larger than 3mm.

Although the laser does not require injections, it will cause a heating sensation, which may be
quite painful. Furthermore, 2-5 treatments may be required. The risks are similar to sclerotherapy. However, as with any laser procedure, skin burns may occur if not performed properly.

For treating the deeper veins of the leg (these veins are not visible, but may be a contributing cause to superficial varicose veins) the endovenous techniques, using radiofrequency and laser are newer techniques with high success rates. These techniques can be done in the physician’s office and have replaced surgery in majority of cases.

EVLTThe physician places a very small tube inside the vein. Once inside, either radiofrequency or laser is used to shrink and seal the vein wall. Side effects are rare and include bruising. This technique is not recommended for spider veins or superficial veins of the leg which are less than 3mm.

Surgery is the original treatment for large or problematic varicose veins. The veins are tied shut and removed from the leg. The surgery addresses the superficial venous system only, and requires either local or general anesthesia. It is performed in an outpatient surgery center setting. Ambulatory phlebotomy is a variation on tradition surgery. A light source finds the location of the vein. Tiny cuts are made in the skin and special hooks are used to pull the vein out through the tiny cuts.

With the endoscopic technique, a tiny video camera is used to locate and remove the veins through small cuts. This procedure requires anesthesia.

Fortunately, majority of patients can be treated with Sclerotherapy. It is the patient with problematic varicose veins, which usually also involve the deep system, when other procedures may be necessary.

It is important to realize that, with time and gravity, new spider and varicose veins may develop. Regular maintenance therapy may be required. The most important preventive measure is to avoid standing or sitting for long periods of time, and use of support compression garment.
Michael A. Jazayeri, M.D. is a board certified plastic surgeon and a member of American Society of Plastic Surgeons. To schedule a complimentary consultation, please call 714-834-0101.