Healthy veins have valves that open and close in order to assist blood heading back to the heart. In most cases, you can't see these healthy veins. As we age and get bumps and bruises, you may start to notice different vein formations — particularly in your legs.
Spider Veins
Spider veins are tiny web-like veins (1 to 2 mm) that are present in the skin. Spider veins are largely a cosmetic problem, though a large collection in one area (telectangectasia) may cause pain or discomfort. Spider veins have been associated with venous valvular reflux, obesity, smoking, family history, and local trauma.
Spider Vein Treatment
Spider vein treatment is generally a cosmetic, elective procedure that is not covered by insurance. We treat spider veins with sclerotherapy — injecting a solution that clots and dissipates the veins' appearance. Large collections of spider veins (telangiectasias) that cause pain are also treated with sclerotherapy and, in some instances, treatment may be covered by insurance.
Reticular Veins
Reticular veins are larger (more than 3 mm), purple veins seen around the lower calves and ankles. They also in the skin and are often, but not always, caused by some minor trauma. Reticular veins are problematic in that they are prone to bleeding, which in some instances is very severe.
Reticular Vein Treatment
Reticular veins are also treated with sclerotherapy — injecting a solution into the vein. If we recommend treatment because of severe bleeding, most insurance carriers cover the procedure. You should still check with your insurance and verify authorization.
Varicose Veins
Varicose veins are large, dilated, irregular veins usually visible in the legs. They may also be present in the groin, perineum (region between the anus and the genitals) and buttocks.
The veins are under the skin and start to bulge because the valves in the vein are not functioning normally. These valves return venous blood to the heart. When the valves "leak" or become "floppy," the venous blood flows backwards, towards the feet causing the veins to dilate. This is called venous reflux.
These larger varicose veins can also appear if a major vein, usually in the pelvis, is blocked. This can make the reflux or backwards blood flow worse. This causes the blood pressure in the veins to be abnormally high (venous hypertension).
What Causes or Increases the Risk of Varicose Veins
There are several factors that can lead to varicose veins.
- Strong family history of varicose veins
- An occupation where you stand long periods of the day
- Pregnancy
- Vein dilation caused by the high concentration of progesterone in the blood
- The enlarged uterus compressing the largest vein in the abdomen (vena cava) and blocking venous blood returning to the heart
- More prevalent in women.
Varicose Veins Signs and Symptoms
Symptoms vary from person to person. You may experience any of the following:
- Pain, which may be a throbbing type of discomfort
- Feeling of "pins and needles" over the veins
- Swelling when the venous blood cannot return to the heart efficiently
- Clotting because the blood in the vein is not flowing efficiently (superficial thrombophlebitis)
- Painful red lumps in areas where the varicose vein has clotted
Clotting is also associated with a more severe medical problem known has a deep vein thrombosis (DVT). Blood clots form in the larger and deeper veins. When they break free, they can release into the heart and lungs (pulmonary embolism), which is a serious medical condition.
In some patients where the blood pressure in the veins is extremely high, an open wound (venous stasis ulcer) may develop and require medical care.
Diagnosing Varicose Veins
We start by taking a history and performing a physical exam. You may be experiencing pain in the legs. Any persistent and unexplained leg pain should be evaluated by your doctor. The goal is to determine whether the varicose veins are causing symptoms which need to be treated.
Varicose veins are not necessarily dangerous. Some varicose veins are not painful and have never clotted. You may have swelling or edema in the legs due to venous insufficiency without any discomfort as well.
Your medical history may reveal that the size and number of varicose veins are increasing over time which may happen in some, but not all patients. On physical exam, we'll note the size and type of varicose veins in the legs. We are looking for any evidence of clotted varicose veins (superficial thrombophlebitis) or significant inflammation around the calves and ankles. Dry and scaly skin (stasis dermatitis), discoloration around the calves and ankles, tenderness and firmness of the tissue around the ankles indicates inflammation.
Varicose Vein Treatment
We start by treating the veins conservatively with:
- Compression stockings
- Over-the-counter medications
- Weight loss
- Leg elevation
We use a special venous duplex ultrasound to evaluate where the incompetent valves and veins are located. You'll return in several months to determine whether conservative therapy has improved your symptoms.
Surgical Intervention
In the event conservative therapy fails to treat the painful large varicose veins and leg swelling, we have other treatment options to remove the varicose veins and reduce swelling in the legs.
We may consider venous ablation, which involves placing a small catheter in the main vein feeding the varicose veins. This catheter applies heat or energy to the vein which seals it. Any varicose vein fed by the vein sealed will also clot and eventually disappear. The venous ablation is done in the office under local anesthesia, and recovery is excellent.
In some cases, we may recommend small incisions in the leg. We remove the varicose veins (ambulatory phlebectomy) under local anesthesia. Recovery is also excellent with this procedure.
And, as with spider veins and reticular veins, sclerotherapy — injection of a solution into the vein — is an option.