As a curious child, you might remember staring at an older relative’s thick stockings at the blue, gnarled veins lying under the skin like bumpy snakes. Known as varicose veins, these blood vessels, which return blood from the legs to the heart, are actually a more superficial system.
The real, working venous system for the legs lies deeper, says to Robert A. Weiss, MD, assistant professor of dermatology at the Johns Hopkins School of Medicine in Baltimore. This is good news, because it means that if the surface veins begin to clump up and bulge, they can be removed or destroyed without ruining circulation to the leg.
The National Institutes of Health estimates that 60% of all men and women suffer from some form of vein disorder. A quarter of varicose vein sufferers are men, although Weiss notes that it is almost always women who seek help for spider veins.
Spider veins, the more delicate red or blue tracings that can pop up on the skin’s surface like kinky spider webs, are a minor form of varicose veins and can precede development of the more unsightly variation or cause cosmetic concerns of their own. Sun exposure can make spider veins worse by breaking down collagen under the skin.
Both varicose and spider veins result when valves designed to keep blood from running backward away from the heart and back down into the leg fail or become loose and flabby — allowing backwash, which stretches veins and even slowly leaks into ankle and leg tissue, causing swelling.
Aside from the “purple snake” effect, varicose veins can cramp or throb at night. So much blood pools into the legs, that it can cause the legs to feel heavy and leaden. If clear fluid from the expanded vessels seeps into tissues, it can choke off circulation to the skin, causing an itchy rash or even a painful ulcer, Weiss warns.
As a rule, varicose veins are more unpleasant and ugly than dangerous.
What are spider veins?
Spider veins, commonly found on the face and legs, are caused by the dilation of a small group of veins near the skin’s surface. They often look like red or purple sunbursts or web patterns and are more common in women.
What are varicose veins?
Varicose veins are swollen or enlarged veins. The veins have enlarged due to a weakening or damage in the vein valves. Located deeper in the skin than spider veins, they may appear raised, bulging, or twisted, and often are blue, red, or flesh colored.
Varicose veins can be serious because they may be painful, or associated with the development of one or more of the following conditions:
- Phlebitis. Inflammation of the vein.
- Thromboses. This occurs when blood clots form in the enlarged vein.
- Venous stasis ulcers. An ulcer is formed when there is not proper drainage in the enlarged vein.
Although the exact causes for varicose and spider veins are unknown, pregnancy, heredity, prolonged standing, increased age, heavy lifting, and hormonal changes seem to be contributing factors.
Treatment for spider and varicose veins
Treatment may include:
- Compression therapy. Wearing compression stocking can help the symptoms of varicose veins.
- Sclerotherapy. This procedure involves the injection of a concentrated saline or specially-developed solution into the spider or small varicose vein. The solution irritates the inside of the vein and over time the vein will collapse and fade. Healthier blood vessels located nearby absorb the blood flow of the collapsed vein.
- Ambulatory phlebectomy. Ambulatory phlebectomy involves the removal of the vein by tiny punctures or incisions along the path of the enlarged vein. Through these tiny holes, the surgeon uses a surgical hook to remove the varicose vein.
- Electrodesiccation. This procedure involves the sealing of the veins with the use of an electrical current.
- Laser surgery and intense pulsed light therapy. Abnormal veins are destroyed by high-intensity laser beams or intense pulsating light.
- Surgical ligation and stripping. This procedure involves the surgeon making an incision in the skin and removing or tying off the blood vessel. This procedure is done for severe cases of varicose veins.
Possible complications associated with the treatment of spider or varicose veins
Possible complications associated with the treatment of spider or varicose veins may include:
- Pigmentation changes. Brownish splotches near the treated area may appear, and may take several months (or even up to a year) to fade.
- Allergic reaction and scarring. Allergic reactions from the injected chemical solution, as well as skin injury and permanent scarring, may result.
- Telangiectatic matting. This reaction involves the appearance of fine, reddish blood vessels near the treated area. Treatment for this condition may require further injections.
- Blood clots. Treatment could cause blood clots in the veins.
Who are candidates for sclerotherapy?
Women and men of any age may be candidates for sclerotherapy, but most are 30 to 60 years in age. Spider veins are more common in women. Men do have spider veins, but often do not consider them to be a cosmetic problem because the veins are usually concealed by hair on the leg.
Pregnant or breastfeeding women should postpone sclerotherapy treatment. Further, it is not known how sclerosing solutions may affect breast milk.
About the procedure
Although each procedure varies, generally, vein removal surgeries follow this process:
- Location options may include:
- Surgeon’s office-based surgical facility
- Outpatient surgery center
- Hospital outpatient
- Hospital inpatient
- Anesthetic options may include:
- Local anesthesia with intravenous sedation, or epidural or spinal anesthesia
- General anesthesia
- Recuperation period:
A compression bandage may be applied on the treated area following the procedure. Support hose may be recommended for a while.
