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Why treat spider veins and varicose veins?
Some people desire treatment for cosmetic reasons only
and others for the medical benefits it will provide to the
legs. Without treatment the leg veins will enlarge and
worsen with time. The circulatory system tends to suffer
more disease with age, be it increasing hardening of the
arteries, increased likelihood of heart attack or stroke,
or a worsening of the spider veins and/or varicose veins.
It may occur gradually or rapidly but the condition almost
surely will become more severe. Patients who seek vein
treatment for medical reasons may fear problems in the
future or may be symptomatic already. Typical symptoms
from venous insufficiency and varicose veins are heavy,
achy, drawing pains, swelling, (edema), tenderness to
touch and a tired feeling in the legs. In women these
symptoms are often made worse when a women is about to
menstruate. Most often as the veins themselves worsen so
do the symptoms.
Untreated, the varicose veins and spider veins may lead to
other medical problems. As they enlarge they can cause
worsening venous insufficiency which is a congestion of
the venous blood that is unable to return from the legs to
the heart. Venous insuffiency itself leads to other
ailments, the most common of which are blood clots
(phlebitis), leg ulcers (breaks in the skin), bleeding
infection and stasis (skin) changes in the legs. A more
detailed explanation of these conditions is below under
phlebitis and venous insufficiency.
How to treat varicose and spider veins?
The old saying "there are many ways to skin a cat"
applies to the many types of therapy available to help
patients with both varicose veins and spider veins. A
conservative treatment is support stockings to be
put on before getting out of bed in the morning and worn
all day. This will not make either the spider or varicose
veins go away and probably not even prevent any leg veins
from worsening but it may provide some symptomatic relief
while being worn. Stockings can be custom fit or bought
over the counter and both types are available in different
degrees of compression.
Injections of medications into veins is known as
sclerotherapy. It has been a successful method of treating
both spider veins as well as varicose veins since the
1600s. The medicines used in sclerotherapy act upon the
inner lining of the vein walls to gradually cause them to
seal shut and stop the flow of blood through them. This
method of treatment of treatment may be employed to treat
the large ropey varicose veins and the smaller spider
veins as well. Today, sclerotherapy is, without question,
the most popular method employed by vascular specialists
worldwide, to help elimiate unwanted veins. It is
minimally invasive and very effective if done correctly by
experienced doctors. In some situations 'foam
sclerotherapy' can be done. Foam sclerotherapy is nearly
identical to 'regular' injection therapy except that the
medications are mixed with air to give it a foamy texture
as opposed to its normal liquid state. Both are done in a
doctor's office on an out patient basis and no anesthesia
is necessary.
Ambulatory phlebectomy is a slightly more invasive surgery
in which multiple incisions are made along the varicose
vein and it is literally "fished-out" of the leg using
surgical hooks. A minority of doctors prefer this method
over sclerotherapy or classic stripping and ligation
surgery and it is not a treatment option for the spider
veins. It is done in either an operating room or the
'treatment room' in an office, using either local or
regional anesthesia.
Lasers for Endo Venous therapy have recently been
used with success in treating large varicose veins. In a
minimally invasive procedure, a narrow tube is inserted
into the main superficial vein (the saphenous vein) at the
knee, and threaded to the groin, where the saphenous vein
flows into the major deep veins. Laser energy is used to
destroy a portion of the saphenous vein at the groin, and
thus interrupt the column of blood causing increased
pressure in the lower leg. Drawbacks of this procedure
include the fact that remaining varicose veins must still
be injected and some insurances may not cover this
procedure. Despite these potential shortcomings, Endo
Venous Laser Treatment is an effective method of treating
large veins in carefully selected patients and proving to
be of great value. Endo Venous Laser Therapy is generally
a preferred treatment method to 'closure' where an
electrode is inserted into the saphenous vein, and radio
frequency is turned on to sort of 'burn' the vein shut as
the electrode is withdrawn. Its generally felt the
'closure' procedure takes longer to perform, is more
costly, and has a higher risk of complications including
skin burns.
Stripping and ligation is classic invasive surgery
to tie the varicose veins shut and remove them from the
leg. It will certainly remove those leg veins that are
operated on but will leave scars from the incisions and it
can only be employed to treat very enlarged varicose
veins. It is done in an operating room with either general
or local anesthesia and is most often done on an
outpatient basis.
Why do leg veins occur?
Veins most often dilate and become varicose as a result of
increased downward pressure on the vein from a point above
it. The pressure can be something as temporary as a
pregnancy or the straining associated with moving your
bowels (both of which increase the abdominal pressure), or
as constant as the forces of gravity and your own body
weight. Medical studies have found that the composition of
a varicosities walls is different from that of normal vein
walls thus suggesting something inherently different about
varicose veins themselves. Patients often say there is a
family history of varicose and spider veins and this most
likely will increase ones chances of suffering from them
in the future. It is rare but some people are born without
the one-way valves that help prevent venous blood from
flowing downward instead of upward toward the heart. More
commonly however these valves are not functioning
correctly as is seen after having suffered a prior
phlebitis (blood clot). People who spend lots of time on
their feet may increase their chances of getting varicose
and spider veins.
Spider veins, unlike varicose veins, most often do not
occur in response to increased pressure except for the
pressure created by nearby varicosities themselves. They
often arise from the presence of the female hormone
estrogen which is most likely why these spider veins are
seen more commonly in females. Women also are known to
have more development of spider veins when their body
estrogen levels are elevated such as when they are
pregnant when taking oral contraceptives, and obviously
when on estrogen replacement therapy.
What are phlebitis and venous insuffiency?
When the blood in the varicose and spider veins
stagnates in the legs it causes a pooling of that blood
known as venous congestion. Venous congestion is most
evident when the legs are below the heart and least
evident when they are at the heart level, for example when
lying in bed. The inability to adequately move the blood
that is below the heart upward towards the heart is known
as venous insufficiency. This stagnant blood in the veins
causes many of the symptoms that patients with veins
complain of, such as swelling (edema), tired and heavy
legs, throbbing in the legs, drawing pains and pain to
touch. This is often relieved when the leg is elevated.
Venous insufficiency can become chronic which is a more
serious problem in that it increases the risk of
ulceration (breaks in the skin) in the legs and phlebitis
(blood clots). With chronically high pressure on the
veins, blood cells are thought to be forced out of the
veins and capillaries and deposited into the surrounding
tissue. The subsequent breakdown of these red blood cells
causes a dark 'rusty' look to the legs most often on the
inner ankles and most importantly creates a barrier
through which oxygen and nutrient transfer is lessened.
This overlying skin is more prone to ulceration (holes in
the skin) from any minor injury, such as a bump, scratch
or bug bite.
Phlebitis (blood clots) is the result of stagnant
blood that has clotted (congealed) within a vein.
Phlebitis generally occurs when the already slowed blood
flow in the varicose veins becomes slower or the bodies
clotting mechanisms are stimulated. A long trip in a plane
or car, where your legs are not moving much is a common
scenario for the start of a phlebitis. So is a minor
trauma to the legs that 'turns on' the bodies clotting
mechanisms. In certain cases phlebitis is extremely
dangerous and in others it is very benign, depending on
which veins are involved. The greatest danger with certain
clots is that they may break free from the leg veins and
travel to the lungs. These emboli (the name for clots that
have traveled to the lungs) then block the proper
functioning of the heart and lungs and can result in
death. Even those blood clots that don't leave the leg
veins are problematic both while in their acute phase and
in years to come. Acutely they can cause pain, tenderness
throbbing and discomfort. More long term,the leg and veins
effected will suffer further venous insuffiency which
generally worsens over future years.
How does therapy help?
The treatment and elimination of the varicose and
spider veins allows the venous side of the circulatory
system to be improved. By eliminating these veins, the
blood is forced into other better functioning blood
vessels to be returned to the heart. The blood that was
pooled in the varicose and spider veins is no longer
stationary and stagnant as the veins have been sealed shut
and removed from the circulatory system. After the veins
have been eliminated patients whose symptoms were related
to the venous congestion and insuffiency often experience
relief. This is because without that stagnant blood
swelling up the varicose and spider veins, your legs
should feel less heavy and tired. Of course if your leg
pain is not due to venous problems vein treatment will
improve the appearance of the leg but may have no bearing
on how the leg feels. Examples of leg pain not caused by
varicose or spider veins and thus not relieved by
treatment are sciatica, arterial problems (hardening of
the arteries), and arthritis to name just a few.
Can varicose veins and spider veins be prevented?
This is a common question patients ask and one for
which there is no absolute answer. If you have a family
history of varicose or spider veins and its something you
have inherited there is obviously nothing you can do to
change your genes. If you have a rare condition such as
the congenital absence of the one way vein valves it also
is something you were born with (or without) and there is
little you can do. Being overweight may very well help
varicose veins and spider veins to form as this serves to
add pressure (weight), onto the legs and make it that much
more difficult for the venous blood of the legs to get
back up to the heart. Smoking, and drinking are not
believed to be related to the presence of varicose and
spider veins aside from any weight they may add to your
body. Diet also, may be only a weight related issue.
The arteries and veins generally suffer from different
medical conditions and the foods we are warned to avoid
that are high in fat and cholesterol do cause "hardening
of the arteries" but have no effect on the leg veins.
Support hose can provide relief from the symptoms of the
venous pooling as they act to help 'squeeze' the veins so
less blood is held in the vessels. It is generally felt
that long term, support hose wearing will not prevent
veins from forming or cause those veins you already have
to disappear.
Your podiatric physician/surgeon has been trained
specifically and extensively in the diagnosis and
treatment of all manners of foot conditions. This training
encompasses all of the intricately related systems and
structures of the foot and lower leg including
neurological, circulatory, skin, and the musculoskeletal
system, which includes bones, joints, ligaments, tendons,
muscles, and nerves. |
