Varicose veins are those unsightly blue, twisting, protruding vessels often seen on the legs, particularly on the calves and ankles and also down the inside of the leg. Thread or spider veins are smaller red/purple veins that do not protrude but can be prominent. They may also form on the thighs- all over, but most commonly medial, anterior and lateral; on the back of the knee, the lateral side of the calf and over the ankle- corona phlebectasia. Spider veins may also appear on the face and other pasts of the body. On the face spiders appear most commonly on the nose and cheeks of people who work in hot environments like kitchens and metal works. There is a lot of information out there about both varicose veins and spider veins but not all of it is accurate, leading to confusion and poor decision-making when it comes to working out how best to deal with them. This article looks at how varicose veins (and spider veins) form, their prevalence in American society, the factors that may increase their prevalence and what preventative measures or treatments are available to manage them.
The Physiopathology of Varicose Veins
Arteries carry blood away from the heart to the tissues and veins return deoxygenated blood back to the heart and lungs for re-oxygenation. Assisting this latter process is the musculature of the lower limbs, which, when normally active, squeeze the deep veins, driving blood back to the heart. Within the deep veins are pairs of bicuspid valves, which are shaped and aligned so as to force the blood to flow in one direction- upwards, and prevent the back-flow of blood by closing shut.
Problems with this system occur when either the walls of the deep veins become weakened and dilate excessively owing to back pressure, or when the valves are absent or faulty; or when the become damaged by injury or clot. Varicose veins often begin when blood begins to pool, exerts back pressure and dilates the veins even more. More collected blood perpetuates more dilation in veins with more pressure, which then stops the valves from performing their function all together. Thus a vicious circle is born, with veins in the superficial venous system becoming visibly and progressively more dilated and misshapen.
Spider veins (telangiectasia) are also excessively dilated but their smaller size (usually 0.5 to 1mm in diameter) makes them less conspicuous and less symptomatic than varicose veins. They can occur concomitantly with varicose veins or on their own, but are often due to hidden varicose, feeding veins but sometimes the feeding, culprit vein cannot be found. Other causes for spider veins include trauma, weather exposure (sun or wind), heat from stoves (cooks) and furnaces (metal workers) and chemotherapy. Reticular veins, which are bigger than spiders, can also become dilated and often form dense, unsightly networks. They tend to be darker than spider veins and are a deeper blue or greenish in color.
Varicose veins may be asymptomatic but often come with a range of associated symptoms involving pain, discomfort, cramps, swelling and skin changes. Pain and discomfort can range from cramps and aches to burning and itching although some patients are only aware of a heaviness in the limb, usually caused by excess fluid in the tissue. Skin changes may include venous eczema (stasis dermatitis) or lipodermatosclerosis, whereby the inflammation of subcutaneous fat can lead to skin induration, discoloration and swelling.
Further complications of varicose veins include leg ulcers, which are slow-healing, shallow wounds caused by tissue breakdown from ischemia (accumulation of deoxygenated blood), accumulation of waste products and edema- all secondary to the high venous back-pressure from the damaged, regurgitant veins. Varicose veins may also be symptomatic of a more serious and sinister vascular problem within the deep venous system, including DVT, which is a deep vein thrombosis whose blood clot can break free and travel to the lungs to form a PE (pulmonary embolism), which can be fatal. This is not very common but the implications are serious enough to warrant investigation by a specialist. Other pathologies may include webs and compression of veins by nearby structures. Spider veins are usually asymptomatic but may occasionally be painful, uncomfortable or lead to local irritation and swelling.
Prevalence and Risk Factors
What are the Risks associated with Varicose Veins Treatment?
There are no accurate figures for the prevalence of varicose veins but it is estimated that around three per cent of the young adult population are affected by them, rising to around 50 per cent for those 50 years old and over, making age a significant risk factor in the development of varicose veins. Other sources (e.g. The Cleveland Clinic) have put the total number of adult Americans with spider veins or varicose veins at over 80 million. Yet, vein society estimates give an incidence of around 20% of people walking in the street.
Clearly, when the muscles of the lower limbs are inactive through long periods of standing or sitting, the pumping of blood upwards, back to the heart is less effective than when walking around. Therefore, lifestyles which involve sedentary behavior put people at a higher risk of developing varicose veins through mechanism of pooling of blood discussed earlier. Obesity is another risk factor, partly due to the increased downwards pressure on the of the groin, returning blood from the lower limbs. Pregnancy may also increase the risk of varicose veins for the same reason and additionally because of the relaxant effect of pregnancy hormones on the blood vessel walls and the increased blood volume. Varicose veins may only be temporary in this case but there is often a correlation of the appearance of varicose veins with a pregnancy, but obviously the more pregnancies a mother has, the greater the likelihood of long-term venous disease.
Genetics plays a big role in the tendency to develop varicose veins with the other factors mentioned, with around half of the sufferers having a close family member with the condition. Other possible causes of varicose veins are trauma to the deep veins, hormonal birth control and previous surgery. Smoking contributes by increasing the venous pressure, increasing relative ischemia and causing chronic cough, which increases the intermittent cough that all smokers have, increasing venous pressure.
Preventative Measures and Treatments
Varicose veins rarely improve of their own accord but complications can often be avoided and symptoms alleviated by taking a number of preventative measures. These include taking part in more exercise that would not elevate core pressure (e.g. Walking, swimming, gentle jogging, climbing stairs and plane-level cycling, etc.), losing weight, elevating the affected limb whenever possible and wearing compression stockings daily for work and exercise. However, removal of varicose veins and spider veins for cosmetic purposes, without performing an ultrasound in the standing position to assess the deeper, feeding veins, may result in an early, unsightly recurrence. No such shortcut like that should be taken.
Prior to recent advances, the favored method for treating unsightly veins was stripping the main greater saphenous vein and phlebectomizing the tributaries, whereby the offending, feeding vein would be removed by making incisions in the leg and then pulling it out, and the branches by removal through inch-long cuts. Newer techniques include endovascular laser ablation (discussed in detail elsewhere), radio frequency ablation and the “reborn” sclerotherapy. Sclerotherapy has been used since the 1960s and involves injecting the vein with an irritating agent (usually a mild, special detergent), causing it to close up and gradually atrophy and dissipate. Sclerotherapy has undergone a rebirth with the discovery of newer, safe agents and the more recent discovery that those agents become more effective when churned with air to form foam. Interestingly, one requires less material to make foam for treatment, which becomes more effective.
Solving the spider veins with Laser treatment: Laser treatment for varicose veins is applied topically, but the previous caution applies that unless the feeding veins are addressed, the spiders are destined to return; while main trunks of varicose veins require endovenous laser therapy, whereby the laser is inserted into the vein under local anesthesia. Although individual treatments depend upon specific factors, these vein treatments, as opposed to stripping and open phlebectomies, are often favored by patients and vein specialists alike, as they require no hospital stays, reduce recovery time and lead to fewer complications.
If varicose veins and/or spider veins are causing you problems, consider contacting us at the Spring of Youth Medical Group Vein and Laser Therapy. Book a consultation by calling (228) 875-0885 and we discuss the various management options. More information can be found on our website: www.springofyouthmedical.com