What are varicose veins?
These are enlarged veins in your legs beneath the skin surface, which typically are dilated, extending down the leg, twisting and bulging.
What are spider veins?
These are small varicose veins and typically present as tiny dilated veins that fan out from a central point on the skin surface.
How do varicose veins and spider veins form?
Venous insufficiency is the culprit!!!! The one way valves in the leg veins allow blood to slowly make its way back to the heart. When these valves get damaged, the blood begins to leak back down in these veins towards the feet. "Venous insufficiency" or "venous reflux disease" is the medical term describing the downward flow of blood in the dilated veins with damaged valves.
Who gets varicose veins? What are the causes?
- Heredity (other family members) - This is the most common cause!
- Increasing Age
- Women >> Men
- Hormonal changes - Puberty, pregnancy, and menopause. Birth control pills and other medicines containing estrogen and progesterone also increase the risk of varicose or spider veins
- Pregnancy - During pregnancy there is a large increase in the blood volume in the body, which overloads the veins. This causes veins to enlarge and puts more pressure on the one-way valves. The expanding uterus also puts pressure on the veins. Eventually the one-way valves fail and varicose vein disease begins. With each pregnancy more and more of these veins become damaged.
- Obesity
- Prolonged standing.
- Sun exposure, which can cause spider veins on the cheeks or nose of a fair-skinned person
How common is venous insufficiency (venous reflux disease)?
10x more people suffer from venous insufficiency than peripheral arterial disease in the US. It can affect ALL age groups! 24 million Americans have varicose vein disease and 6 million have severe disease where they have skin changes (darkening of the skin) associated with chronic venous insufficiency. Over 500,000 people in the US have venous ulcers.
What are the symptoms?
- Aching pain
- Easily tired legs
- Leg heaviness
- Swelling in the legs
- Darkening of the skin (in severe cases) called "venous stasis discoloration" and possibly ulcers
- Numbness
- Itching or irritated rash in the legs
- Restless legs (especially at night)
- (All of the symptoms typically progress throughout the day, making it difficult to stand or sit for long periods)
How have varicose veins been treated in the past?
Traditionally the treatment has been surgical vein stripping or ligation.
What is the new method of treatment for varicose veins?
EVLA (EndoVenous Laser Ablation). A laser catheter is inserted into the damaged vein, and the vein is "closed" from the inside by the energy delivered from the laser. This is performed as an outpatient procedure and is done under local anesthesia. The procedure takes about 1 hour and the patients walk out of the office afterwards.
What is sclerotherapy and what is it used for?
This is the injection of a solution into an abnormal vein through a small needle. The solution that is injected destroys the vein wall, with the vein then scarring and shutting down. As opposed to laser treatment, which is termed thermal ablation, sclerotherapy is a form of chemical ablation. Sclerotherapy is typically performed on the smaller varicose vein branches, reticular veins, and spider veins.
What happens to the blood in my legs once the varicose veins are closed and treated?
The previously painful and bulging varicose veins disappear and the leg will finally have normal blood circulation. There will no longer be any leaky veins with damaged valves causing the blood in the veins to back up and cause congestion. The numerous other normal veins (with healthy valves) will take over the work of getting the blood from your feet back to the heart. Your symptoms associated with the varicose veins will resolve.
Can varicose and spider veins return after treatment?
Current treatments for varicose veins (EVLA) and spider veins (sclerotherapy) have very high success rates compared to traditional surgical treatments. However, it is possible that varicose veins in other parts of the legs may develop in the future. If you are predisposed to getting varicose veins, the disease might come back as there is no cure for preventing the development of weak vein valves.