Varicose and Spider Veins
They could be more than just an unsightly nuisance

Philadelphia, PA– Shorts season is in full swing – and with it, the usual concerns of unveiling pale legs. But for many people, the season also highlights unsightly varicose and spider veins. Depending on the severity of the condition, these veins can cause effects ranging from discoloration and splotchy patches on the legs or other area of the body, to itching, swelling and pain – as well as the risk of certain circulatory problems.

About 50 to 55 percent of American women and 40 to 45 percent of American men suffer from some type of vein problem – and one out of every two people age 50 and older have varicose veins. Both varicose veins and spider veins share similar causes: age, heredity, pressure from excess weight and pregnancy, hormonal changes, a leg injury, and even excess sun exposure or certain medications. Both types of vein problems are the result of venous insufficiency – or weak vein valves. The back-up and pooling of blood in a certain area of the body due to the weakened valves causes these veins to enlarge.

The milder form – spider veins – is so named because their appearance is similar to a spider’s web. They are usually found in the legs, but can also appear on the face and other areas of the body. Spider veins are found closer to the skin’s surface and are usually red or blue in color.

Varicose veins cause greater concern because they are more noticeable, and more frequently cause symptoms. These dark colored, bulging and twisted veins are most common in the legs, particularly the backs of the calves or on the inside of the leg, as well as the feet. They are typically found lower on the body because of the pressure of the body’s weight and the long distance the leg veins must push blood back to the heart. These combined forces can weaken the veins’ valves, which normally prevent the blood from flowing backward and pooling. When these valves weaken, varicose veins form, with blood that has leaked backward and collected.

Symptoms of varicose veins include aching, fatigue, swelling, numbness, itching or throbbing, or a sensation of heaviness in the legs, and a rash or darkening of the skin surrounding the area.

Traditionally thought of as a cosmetic problem, varicose veins can be painful, and become worse over time, contributing to other serious health risks ranging from sores or skin ulcers to severe venous insufficiency and swelling.

Certain self-care techniques can help prevent varicose veins or relieve symptoms (see sidebar), but if veins are swollen, red, extremely tender or warm to the touch – or if they become so prominent that you are concerned for cosmetic reasons – it’s a good idea to see a doctor. Depending on your veins, you may be referred to a dermatologist (for cosmetic treatment) or a vein specialist such as a vascular surgeon. Your doctor may perform an ultrasound to confirm the condition and to check for venous insufficiency or blood clots. Spider and varicose veins can be treated, but the degree of success varies according to their severity. Repeat treatments may be necessary.

Treatments include sclerotherapy, laser surgery, Veinwave thermal ablation, endovenous techniques such as radiofrequency and laser treatment, surgical ligation and stripping, minimally invasive vein surgery.  Sclerotherapy, one of the longest-standing methods, involves an injection of a solution that causes blood to clot and the vein to swell and seal shut, eventually becoming scar tissue. Side effects are minimal and short lived.

Ligation or stripping of varicose veins is an outpatient procedure using general anesthesia, in which veins are tied off and completely removed. Scarring and damage to surrounding nerve tissue is possible, as well as blood clots. Minimally invasive surgery removes a varicose vein using mini-incisions (2-3 mm), and minimally invasive techniques.

Laser therapy for spider veins employs direct, intense light that makes the vein fade and disappear.

Endovenous radiofrequency ablation is similar to endovenous laser therapy, and used to treat larger varicose veins in the legs from the inside. In a minimally invasive procedure, an inserted catheter delivers radiofrequency or laser energy to the vein,  causing it to collapse, shrink and eventually disappear. Best of all, the procedure is quick (less than 30 minutes), and has a rapid recovery and few side effects – only occasional slight bruising, and no scarring.

At Chestnut Hill Hospital, vascular surgeon Mark Kahn, M.D., conducts a comprehensive vein evaluation for patients and recommends the most effective treatments. Learn more about how varicose veins are diagnosed and treated by visiting the Health Resources link at www.chestnuthillhealth.com, and see Venous Studies or Venograms under the Tests and Procedures.

About the Author: Mark Kahn, M.D., is Director of Vascular and Endovascular Surgery at Chestnut Hill Hospital and Clinical Associate Professor of Surgery, University of Pennsylvania School of Medicine. Dr. Kahn is in practice at Chestnut Hill Surgical Associates in Wyndmoor.