Varicose veins and spider veins—those red, purple and blue lines and webs visible just below the surface of the skin—can be an unsightly nuisance. Or worse.
While the biggest threat posed by most such veins is cosmetic, varicose veins can potentially turn into an issue that requires medical treatment.
Lewis V. Owens, MD, a vascular surgeon at Sentara Martha Jefferson Hospital, explains why veins can develop problems.
“Arteries take blood away from the heart, while veins return blood to the heart,” he says. “Arteries are usually more efficient because they have a robust pump: the heart. Veins don’t have that powerful pump and have to work against the force of gravity, so they can become dilated, weak and inflamed.”
Veins also have valves, he adds, which can become a source of problems.
Similar in appearance to varicose veins, spider veins carry less potential for harm. Somewhat hereditary in nature, according to Dr. Owens, spider veins develop due to inadequacies in the elastic tissue of the small valves that primarily function in veins to keep blood moving back toward the heart.
“The valves go up the legs like a stepladder,” says Dr. Owens. “But if the valves get leaky or incompetent, veins can get bumpy and inflamed.”
Spider veins are common, affecting about 25 percent of the adult population.
What Causes These Problems?
“There are many theories about causes,” says Christine Ou, MD, a vascular surgeon at Sentara RMH Medical Center. “Previously we thought females more frequently developed varicose veins, but now we know that men get them quite often, too.”
Dr. Owens notes that although men are just as prone to varicose veins as women, more women come in for treatment.
“They’re more of a cosmetic problem than anything else,” Dr. Owens adds, “so we treat them for aesthetic purposes. Women, in particular, often don’t like the way spider veins look.”
People at risk for varicose veins include those who are overweight or pregnant, and people like teachers, hair stylists and nurses whose professions require them to stand for prolonged periods of time, according to Dr. Ou. Age can be another factor contributing to weakening of the veins, as can hormones and sitting for long periods of time.
Varicose veins may start off looking similar to spider veins, but worsen over time. They can start to itch, burn and swell, and may cause sensations of heaviness in the legs.
As varicose veins worsen, bumps and bulges may emerge under the skin and lead to additional problems. In some cases, the skin may break down, allowing damaged or weak veins to erupt into a venous ulcer that looks like a wound. Bulging veins also may result in thrombosis (blood clotting) in surface veins. Another condition that can arise is phlebitis, in which the veins become inflamed and may block blood flow.
To Treat or Not to Treat?
While many problems with varicose veins probably don’t need to be treated, the condition can become a nuisance when veins become uncomfortable, itchy or swollen.
There are three general approaches to addressing varicose veins, according to Dr. Owens.
“First, you can do nothing—but the condition will progress,” he says. “Second, you can take some conservative measures, including exercising, losing weight, wearing compression stockings and elevating the legs.”
Weight loss and exercise may help relieve varicose veins by improving blood circulation, he explains. Compression stockings can help by assisting the pumping action of the veins in the calf muscles. Elevating the legs can facilitate blood flow upward from the ankles.
“The veins work against gravity,” says Dr. Owens, “so elevating the legs and exercising help augment the pumping action in the calf muscles.”
“I’m pretty conservative in treating varicose veins because all that most patients need is compression and elevation,” Dr. Ou says. “However, for a number of reasons, some people can’t tolerate those measures.”
Elderly people, for instance, often have difficulty in getting compression stockings on and off, so Dr. Ou often explores other conservative options with them.
Doing nothing or taking conservative measures is appropriate for most patients. However, for those who experience significant discomfort, bleeding, open sores or superficial thrombosis, Dr. Owens says medical treatment—the third option—may be necessary.
Treating Spider and Varicose Veins
To treat spider veins, cosmetic sclerotherapy is usually the most effective option. During this outpatient procedure, a special sclerosing solution is injected into the spider vein. The needles used are extremely thin—the size of a human hair—so the injection is well tolerated by nearly all patients. The solution causes the vein to collapse, and the body starts absorbing the vein until it eventually disappears. The blood is then redirected to healthy veins, leading to improved circulation.
“It’s not the ‘fountain of youth,’ but sclerotherapy does a good job with spider veins,” says Dr. Owens.
Topical laser treatments are another option for spider veins, but that technique is much more expensive.
As for varicose veins, about 25 percent of patients require treatment, according to Dr. Ou.
Since patients differ in terms of symptoms, expectations and goals, there’s no one “right” way to treat everyone, and there are many treatment options, Dr. Ou adds. Fortunately, since surface veins are not as important to blood flow as deep veins, procedures generally do not affect circulation.
Before undergoing more aggressive treatment, patients with varicose veins will have a physiologic ultrasound to assess valve function for leaking or incompetent valves. Then patients will be asked to wear compression socks for several months. If this conservative approach fails, other options will be considered.
Endovenous (“inside the vein”) laser treatment is a widely used procedure that offers excellent outcomes with a low complication rate, says Dr. Ou. During this procedure, which takes about 60 minutes and is performed in a clinical setting under local anesthesia, the physician heats the inside of the valve-incompetent vein, which causes it to seal shut and gradually disappear.
Another treatment for varicose veins is transilluminated powered phlebectomy, a minimally invasive technique in which the vascular surgeon uses two small tubes called cannulas. The tubes are inserted through a minimal number of tiny puncture sites to localize and directly visualize varicosities (the areas of bulging) and assist in their complete removal. This is a useful technique for patients who are not candidates for endovenous catheter therapies.
Although these and other treatments can be very effective, people with a genetic predisposition to valve insufficiency can expect to have recurring problems, says Dr. Owens.
“If you’re born with valve problems, you can never take care of it 100 percent,” he cautions. “There will likely be ongoing issues.”
For this reason, most patients who undergo surgery for varicose veins return for further treatment within two to five years.
“Thankfully, however, these vein conditions are rarely life threatening,” points out Dr. Ou. “Whether through conservative measures or more advanced techniques, patients with these issues can achieve reduced symptoms, improved cosmetic appearance and enhanced quality of life.”