What are Varicose Veins?
Varicose veins are large, rope-like, twisted veins that may be tender to touch. Varicose veins occur more commonly in the lower legs such as the calfs and ankles that bear the most weight, but also can occur in the thighs. While varicose veins may be merely a cosmetic concern, varicose veins may also cause leg pain and swelling, and if left untreated, varicose veins may lead to discoloration and ulcers. Varicose veins affect 10%-15% of all men and 20%-25% of all women, and are more common in older age groups. Spider veins, medically known as telangiectasias, are smaller varicose veins, up to 1 mm in diameter. Spider veins are caused by the same underlying condition, which is known as venous reflux disease.
Venous Reflux Disease
Varicose veins and spider veins are caused by the absence or weakening of valves in the veins, especially the great saphenous vein (GSV), which leads to Venous Reflux Disease. Since the GSV carries blood back to the heart from the skin and superficial tissues of the leg, this vein must work hard to pump blood upwards against gravity. Venous reflux disease occurs when the valves in the GSV are not strong enough to prevent the backward flow of blood, and thus the blood may pool within the branch veins of the lower leg, and cause these veins to bulge. Larger veins that are below the skin surface become varicose veins. Smaller veins at the skin surface become spider veins. To prevent venous reflux causing varicose veins and spider veins, someone with venous reflux should wear compression stockings at all times when not lying flat in bed.
Risk Factors for Venous Reflux Disease
- Family history
- Women who have had multiple pregnancies
- Long periods of standing (such as in certain professions including nurses, teachers, and delivery personnel).
- Prior history of phlebitis or blood clots
- Blah new item
Most people know what varicose veins and spider veins look like, but many people do not realize that venous reflux disease can cause other symptoms as well. Typically, the symptoms of venous reflux are worse at the end of the day or after long periods of standing. Also, if left untreated, venous reflux disease can eventually progress to skin discoloration and open skin ulcerations, which can become infected.
Common EARLY symptoms of varicose veins and venous reflux disease include:
- Swelling of the calf or ankle
- Leg pain and discomfort
- Heaviness and fatigue
- Night-time leg cramps
LATER symptoms may include:
- Itching or burning, especially around existing varicose veins
- Dry, itchy, scaly skin on legs and ankles
- Reddish / brownish discoloration of the skin, especially of the lower calf and ankles
- Bleeding or bruising under the skin from a ruptured vein
- Ulcer formation due to rupture of the surface of the skin. These are called 'venous stasis ulcers', and can happen after many years of suffering from venous reflux disease. A venous ulcer can be dangerous because it can lead to an infection of the leg.
Diagnosis and Treatment
Varicose veins are diagnosed through a physical exam and vascular diagnostic testing. Based on the physical exam and consultation, a color Doppler ultrasound study may be performed to evaluate the presence of venous reflux disease. At CFIM, we perform all ultrasounds in our office in order to maintain a very high level of diagnostic quality and consistency.
Once a confirmation of the disease is obtained, CFIM offers the following procedures for the treatment of these varicose veins.
ENDOVENOUS ABLATION is the modern treatment for venous reflux disease. In this procedure, a thin fiber (catheter) is inserted into the defective vein, most commonly the great saphenous vein (GSV). As the catheter is pulled out of the vein, the tip of the catheter heats up, which causes the vein to collapse and seal closed. The procedure is done as an outpatient procedure, and there is little to no down time after the procedure. Endovenous ablation has replaced vein stripping surgery, which was a very painful procedure during which the GSV was surgically removed, requiring up to a 4 week recovery period and potentially resulting in significant complications.
SCLEROTHERAPY requires no anesthesia and is used to treat spider veins and small varicose veins. A solution is injected directly into the vein that closes it. While this may have to be done more than once, when done correctly, the treated veins should disappear within a few weeks. At CFIM, we use only FDA approved medications for sclerotherapy, to maximize safety and results. Patients sometimes ask how sclerotherapy differs from topical (surface) laser treatment. There was a clincal research study that was published several years ago. In this study, they compared sclerotherapy to topical laser treatment for spider veins of the legs, and found that sclerotherapy is generally better for the legs because the laser does not penetrate the thicker skin of the legs very well. Laser seems to work better for facial spider veins, where the skin is thinner. At CFIM, we offer sclerotherapy to treat spider veins of the legs.
PHLEBECTOMY is done to remove a visible larger varicose vein, by making a very tiny incision, and pulling the vein out. The procedure is done with local anesthetic, is usually relatively painless, and is very effective - once the vein is gone, it's gone for good!
It is important to seek treatment from an experienced vein specialist, in order to plan the ideal treatment strategy that resolves the symptoms and ultimately prevents formation of dangerous venous ulcers. Call us today to schedule a free screening for this and other conditions at a CFIM office in northern Virginia (convenient to Springfield, Fairfax, Alexandria, Arlington, Woodbridge) or Maryland (convenient to Waldorf, La Plata, Clinton).