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Varicose & Spider Veins

Know the Facts

Veins in the legs are categorized as superficial or deep. The superficial veins are close to the surface of the skin and drain blood from the skin and underlying tissue while the deep veins are close to the arteries deep in the muscle.

In the superficial system, the great saphenous vein (GSV), is the one most commonly diseased and associated with varicose veins. It begins at the inside of the ankle and extends up to the groin. Other superficial veins that may malfunction include the anterior, posterior accessory and small saphenous veins.

Varicose veins are blue, bulging, rope-like blood vessels that protrude beneath the skin and often look like a cluster of grapes. They are often found on the inside of the thigh, calf or on the back of the leg. However, they can form anywhere from ankle to groin.

Spider veins are similar to varicose veins, but they are smaller and closer to the surface of the skin. They are red or blue vessels that appear in a spidery or sunburst pattern. They can occur anywhere on the legs, and can cover either a very small or very large area. They don’t bulge like varicose veins, but may be more noticeable.

More than 80 million Americans suffer from disease of the veins. About 55 percent of women and 45 percent of men suffer from some kind of vein problem.

Symptoms

Not all patients with varicose and spider veins develop symptoms. However, when symptoms are present the condition is considered medical and treatment will often be covered by your insurance.

Many patients will experience one or more of the following leg symptoms:

  • pain (an aching or cramping feeling)
  • heaviness/tiredness
  • burning or tingling sensation
  • swelling or throbbing
  • tender areas around the veins

Often symptoms are worse at the end of the day after prolonged sitting or standing, and with warm weather. Symptoms may also worsen for women around the time of menses. Relief of symptoms can be achieved with application of cold, ambulation, leg elevation and the use of compression stockings.

Complications

Vein disease does not go away by itself and may worsen over time if ignored or treatment is delayed.

Complications of untreated varicose veins may include:

  • Thrombophlebitis: Blood flow in the superficial varicose veins is often sluggish and may result in blood clots near the surface of the skin. Superficial vein thrombosis (clots) rarely cause serious problems but can be very painful and may require further evaluation and treatment.
  • Bleeding: The skin over varicose veins may thin over time and if injured may lead to significant bleeding. Elevating the leg and applying pressure can temporarily control bleeding but further evaluation and treatment should be pursued.

Long standing venous disease may result in a condition known as chronic venous insufficiency (CVI). This can cause potentially irreversible skin damage, such as: 

  • swelling or tightness of the skin
  • rash in the lower leg
  • darkened/discolored skin
  • ulcers (wound) around or above the ankle

Causes

Blood is carried through arteries from the heart to the rest of the body to supply oxygen and nutrients to the body. The blood is then returned to the heart through veins, also known as the venous system. Contraction of the leg muscles, for example during walking, pumps blood in the venous system of the leg back to the heart.

Blood moves from the superficial veins to the deep veins and ultimately back to the heart. Veins have valves that act as one-way doors (valves), preventing blood from flowing backward.

Bulging tortuous varicose veins are believed to first result from changes in the vein wall of the superficial veins, initially leading to a stretching and thinning of the vein wall. This, in-turn, leads to damage in the vein valves and reversal (or pooling) of blood. The medical term for backward flow of blood is venous reflux or venous insufficiency. This results in further high venous pressure which leads to further varicose veins and possible skin damage.

To view the video on a full screen, click on the arrows in the top right corner.

Venous reflux most frequently occurs in the great saphenous vein (GSV), and less frequently in the other superficial veins. Elevated venous pressure may also be the result of abnormalities or blockage of the deep vein system.

Risk Factors

There are a several risk factors that increase the likelihood of developing varicose and spider veins.

  • Family history
  • Increasing age
  • Pregnancy and hormonal changes
  • Obesity
  • Prolonged standing/ sitting
  • Prior deep vein thrombosis

Evaluation

Patients with varicose and spider veins are evaluated through medical history, physical examination and duplex ultrasound. Ultrasound of the venous system helps to evaluate for the presence of abnormal veins, location and extent of reflux (backflow of blood) and any venous disease in the deep veins.

Ultrasound is the primary imaging modality used in your evaluation and a valuable tool for mapping your veins and planning your personalized treatment. When selecting a vein center, make sure your examination is performed by well-trained ultrasound technologist in a vascular lab that has obtained accreditation by the Intersocietal Commission for the Accreditation of Vascular Laboratories (ICAVL). The vascular lab at Center for Vein Care is not only ICAVL accredited but also is fortunate to have one of the world’s expert in ultrasound imaging. Physicians and technologists from around the world visit our lab for advanced training.

ultrasound

Treatment Options

Several options are available for the treatment of venous reflux and varicose veins. Based on the results of your evaluation, our team will discuss your options and recommend a personalized plan of treatment that meets your medical and/or cosmetic needs.

Available treatment options include: [link to treatment sections]

How to choose the best vein care specialist for you?

There are many “vein centers” out there when it comes to vein care – so you do have a choice. Most insurance carriers do not require a referral from the primary care doctor to see a vein specialist, so the choice is yours. So how do you decide where to go?

You might be surprised to find out that in most states, any medical doctor can legally perform vein procedures. Any physician who is looking to expand their practice can just take a weekend course, purchase necessary equipment, do some advertising and start performing vein procedures in their office under no regulation. Their primary specialty may be doing facelifts, delivering babies or treating heart attacks but now they advertise themselves as experts in vein care.

What to look for when choosing your vein doctor?
- Are they dedicated in the field of venous disease or are the part-time vein practitioners?
- Do they offer complete vein care or do they limit treatments offered to 1 or 2 types of procedures?
- Is their vascular lab ICAVL accredited?
- Is the vein center IAC accredited?
- What is the experience with their staff? Do they have appropriate training and credentials?