The body has 2 systems of blood vessels that make up the circulation. The heart pumps blood rich with oxygen and nutrients through the arteries to the whole body.  The veins then carry oxygen-poor blood (now bluish in color) from the body back to the heart and lungs to be re-oxygenated. Nearly 75% of the body’s blood is found in your legs.

During ambulation, the leg muscles squeeze the veins to help to pump the blood back up to the heart.  The veins, however, must work against gravity. Thus, veins have small, one way valves inside of them that act as one-way flaps to prevent the blood from flowing backwards as it moves up the legs. If these one way valves weaken and become faulty then blood can leak around them and pool in the legs. This is called venous insufficiency or venous reflux. Pooled blood then causes the veins to lose elasticity then enlarge and become varicose. Leg veins have the toughest job of carrying blood back to the heart and often the force of gravity and pressure of body weight can damage the valves.

Approximately 55% of American women and 35% of American men will suffer from some form of vein problem. Symptoms range from bulging veins to non-healing venous ulcers.  Risk factors include family history, gender, age, pregnancy, prolonged sitting or standing, obesity, increased hormone levels and physical trauma. The most common signs and symptoms of varicose veins include leg achiness/throbbing, leg fatigue/tiredness, leg heaviness, leg swelling, darkening of the skin, itching/irritating leg rash. Most of these symptoms progressively worsen through the day or after long periods of standing and can be relieved with elevation. More serious symptoms involve superficial thrombophlebitis, non-healing venous stasis ulcers, and bleeding from the vein. Thus, varicose veins can be a serious disorder that restricts work and leisure activities for both men and women.

Superficial thrombophlebitis occurs when a blood clot forms in a superficial vein and causes an inflammatory reaction.  It often results in a red, painful, swollen vein that feels hard and tender to the touch.  There is little danger of the clot moving towards the heart and lungs and is thus treated symptomatically with warm compresses, elevation, and non-steroidal anti-inflammatory medications.

A venous leg ulcer is an open wound caused by severe varicose veins. They commonly occur near the inside of the ankle, but can be found anywhere below the knee. These can take months or even years to heal if the faulty veins leading to the ulcers are not treated.

Prevention

Not all varicosities or spider veins can be prevented but there are ways to help reduce the chance of getting new or worsening veins.  Additionally, these measures can also help ease any discomfort associated with the veins:

*Exercising regularly to improve leg circulation and vein strength

*Compression stockings—medical grade will help to continuously push the blood from the ankles back up towards the heart.

*Weight control to avoid placing too much pressure on the legs

*Elevate legs as much as possible to relieve the venous pressure on the legs

*Avoid standing or sitting for prolonged periods of time as the venous pressure on the veins will gradually weaken the valves and eventually cause them to leak.

Testing

Testing for leaky valves is easy but not commonly done. The test involves an ultrasound of the leg veins with some special maneuvers to test the function of the valves. Usually a regular venous ultrasound of the legs is done to check only for blood clots; thus if you are undergoing testing for venous insufficiency you must ask for this special test to check for reflux.

Treatment

Conservative treatment includes medical compression stockings and elevation of the legs. Other treatments include sclerotherapy, surface laser therapy, endovenous treatment, and surgical ligation and stripping or excision/phlebectomy.

Sclerotherapy involves injection of a solution that causes the vein walls to stick together and seal shut. This stops the flow of blood and the vein turns into scar tissue. This is a common therapy for spider veins and in time the spider veins should fade. This treatment is effective and most patients can expect 50 – 90% improvement. Spider veins can also be treated with surface laser treatments. The surface laser sends strong bursts of light onto the vein causing the veins to slowly fade and disappear. Both of these types of treatments depending on the severity of the veins may require 2 -5 treatments.

Endovenous techniques are newer non-invasive methods of treating the veins from inside the vein and are used for treating the deeper bulging varicose veins or veins with leaking valves (“reflux”). These treatments have replaced surgery for the majority of patients with severe varicose veins. The technique is a quick office procedure and requires no more than local anesthesia. There is very little post procedure discomfort and most are back to work within days. A catheter is placed into the vein with broken valves and either laser or radio frequency energy is used to shrink and seal the vein walls shut. Then like the spider veins, these larger veins scar down. Blood is re-routed through the normal healthy veins and the symptoms such as achiness/heaviness/swelling and fatigue greatly improve within several days.

Traditionally, open surgical procedures have been used to take care of large bulging varicose veins, but since the advent of endovenous techniques these procedures have been used less often.  In the past problematic veins were tied shut and or completely removed (“stripped”) from the leg. This surgery required general or spinal anesthesia and a trip to the operating room. The procedure was associated with significant pain and a long recovery time.

Ambulatory phlebectomy can be done in the office and usually involves small incisions around clusters of veins to remove problematic veins. It is important prior to this procedure, however, to check the deeper veins for reflux with an ultrasound or the risk of recurrence will be high since the root of the problem has not been treated.

Prognosis

Varicose and spider veins tend to worsen over time. Discomfort and progression may be lessened with self care and preventative measures. Have your veins evaluated and treated when you first spot them to avoid more extensive treatment later.*Hand veins are normal, healthy veins that are often more prominent in thin people and typically become more visible as people age and/or exercise. While they are not diseased, many people choose to have them treated for cosmetic reasons.