Veins are the blood vessels that carry blood back to your heart. Some of these veins are deep inside the muscle, some are superficial lying just beneath the skin, and the rest connect the deep veins to the superficial veins. Veins contain one-way valves that prevent blood from flowing in the wrong direction when someone is standing. When sitting or standing for prolonged periods of time, blood can pool in the veins of your legs, increasing the pressure within them. Overtime this stretching can weaken the walls of the veins and damage the valves. When this happens, blood backs up in the legs due to faulty valves and varicose veins result. They are visible through the skin as bulging, bluish twisted veins. Spider veins are mild, small varicose veins and look like a small collection or red, blue, or purple lines under the skin.
Why Do I Have Spider and Varicose Veins?
There are several factors that can increase your risk of developing spider or varicose veins:
- Family history of varicose veins
- Lack of exercise, sedentary lifestyle
- Standing or sitting for long periods of time
- Female gender
- Age 30-70
- History of deep vein thrombosis (DVT)
How are Spider and Varicose Veins diagnosed?
A physical examination is done to determine the texture and color of prominent veins and how they fill with blood. Patients may report symptoms of their legs feeling tired, achy, or restless. Sometimes rashes or sores develope and legs may be itchy or swollen.
The physician will next order a duplex ultrasound to measure the speed of blood flow and to see the structures of the veins. This test can help the physician decide if there are any other underlying issues that require further testing.
What Are My Treatment Options?
- Compression stockings: Elastic stockings that squeeze your veins and prevent excess blood from flowing backward through the valve. Patients wear these daily for several months to see if this alleviates the pain and swelling associated with the varicose veins.
- Sclerotherapy: This procedure involves injecting a chemical irritant into the affected veins, which causes the vein to scar from the inside out. These veins no longer fill with blood and the body will eventually absorb them. This can be quickly performed in the outpatient clinic by either a physician or well-trained nurse.
- Vein stripping: This procedure involves making a small incision in the groin and another below the knee. The diseased varicose vein is tied off and then removed from the leg.
- Microphlebectomy: During this procedure, small varicose veins are removed through very small incisions in the leg, with no stitches necessary. It can be performed under local anesthetic in the outpatient clinic.
- Laser Venous Ablation: During this procedure, a thin, flexible tube called a catheter is inserted into a vein in the leg. A small fiber laser at the tip of the catheter heats the walls of the veins and destroys them, closing off the vein completely. This is performed in an outpatient clinical setting and the patient can resume normal activities the following day.
How Can I Prevent Spider and Varicose Veins?
Telangiectasia (intradermal spider veins), subdermal reticular veins, and varicose veins have a strong familial and age-related basis, but genetics and age are not the only causes. Other causes that are addressable can help prevent spider veins and the more involved manifestation of venous disease, varicose veins.
Venous valves weaken with age. The venous circulation is a low-pressure circuit, and anything that slows the circulation will encourage the development of stasis, elevated venous pressure, and dilation, especially with deterioration in the venous valvular integrity with age. A large portion of the drive to circulate venous blood back to the heart is the muscle pump action of the legs with ambulation, exercise, or other movement. Therefore, venous valvular insufficiency and a sedentary lifestyle that involves prolonged sitting will provoke and augment venous hypertension. Prolonged standing adds another dimension as gravity pools a significant portion of one’s total blood volume in the legs.
Treating the cosmetic concerns of spider, reticular, and small varicose veins will not prevent future development of reflux venous disease, underscoring behavioral lifestyle changes that need to be implemented to eliminate prolonged inactivity. Since the progression of the pathology is affected by genetics and age, prevention relies on the elimination of the other sources of progression:
- Avoidance of prolonged sitting, standing, or inactivity. Changes in position from sitting to standing every 1-2 hours
- Daily walking to engage the pumping action of the leg muscles for venous return
- Compression stockings
- Smoking cessation
- Lower BMI in a rational weight-loss program
- Avoid excess estrogens, which can be caused by obesity and hormonal supplementation
- Avoid excessive alcohol intake