By Joseph V. Lombardi, MD, FACS
Chief, Vascular and Endovascular Surgery
Program Director, Vascular and Endovascular Surgery
Director, Cooper Aortic Center
Nearly 40 million Americans have varicose veins, the blue, bulging, gnarled veins in the legs that show through the skin. Telangiectasia (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 variation in the skin and can precede development of the more unsightly nests commonly found with this variety.
Although spring is months away, now is the right time to begin thinking about getting your legs in shape if you have varicose veins or spider veins. Winter is one of the best times to be treated for these conditions because patients are advised to limit exposure to the sun for six to eight weeks following treatment.
Although many people are concerned about their unsightly appearance, varicose and spider veins are not only a cosmetic issue—they can sometimes result in discomfort and bleeding. You may hear radio advertisements about varicose veins that are frightening, but the truth is, severe medical problems are very uncommon. However, if you and your primary care doctor believe you have symptoms, you should consult a board-certified vascular surgeon for evaluation and a discussion of options.
Leg Veins Defy Gravity and Form Varicose Veins
There are three types of veins in the legs: deep, perforating and superficial. Deep veins lie in groups of muscles, literally deep within the body, close to the bones. Superficial veins are on top, right beneath the skin. Perforating veins connect the superficial and deep veins. All three work together to bring blood back to the heart.
Leg veins are especially vulnerable to venous disorders because the blood in them flows upward, defying gravity. To keep blood moving in the right direction, one-way valves within the veins open and close. When the heart relaxes between beats, the valves close. When the heart beats, the valves open, allowing the return of blood back to the heart. Too much pressure on the vein wall stretches the superficial veins, weakens their walls and causes the valves to stop functioning properly or to become leaky. Blood refluxes back and forth within the superficial veins, causing their branches to bulge and twist.
Typically, every evaluation will include a “reflux” study that your family physician or vascular surgeon may prescribe. This study will give you detailed information on the status of the valves in your veins and help your surgeon make the proper decisions.
Varicose and Spider Veins Affect Everyone
Women are most susceptible to varicose and spider veins, especially after multiple pregnancies, due to hormonal changes and weight gain. However, men can get them, too. Risk factors include aging, weight gain or obesity, prior injuries or illnesses affecting the legs, and jobs requiring standing for long periods every day. Those who have a family history of varicose veins may also be more susceptible to developing them as well.
Common symptoms of varicose veins include:
- Pain, throbbing, fatigue and restlessness.
- Skin rashes, redness, itching or sores.
- Phlebitis, or vein inflammation.
- Superficial thrombosis or blood clots.
- Venous stasis ulcers, enlarged veins not draining properly.
Medical science has advanced the treatment of varicose and spider veins, allowing vascular surgeons to successfully treat them in a number of different ways. All procedures can be done conveniently in the office.
Radiofrequency ablation (RFA) is performed on an outpatient basis and requires no incisions. A tiny catheter powered by radio-frequency energy delivers heat to the vein wall, which then shrinks and seals the vein. Patients who undergo RFA closures typically resume activities within one day.
Endovenous laser therapy (EVLT) is used most frequently and is a minimally invasive procedure performed in an outpatient office. The physician uses ultrasound guidance of laser energy to collapse and seal off the damaged vein. No surgical incisions are made and the procedure is performed under local anesthesia. Patients are back on their feet immediately and can resume all normal activities within a day.
Phlebectomy is used when the largest varicose veins become swollen and inflamed. Physicians remove individual varicose vein clusters from the leg through a series of small incisions. This minimally invasive procedure is done under local anesthesia using micro instruments and magnification. The incisions are so small that no stitches are required. Patients are back on their feet immediately and can resume all normal activities within a day.
Sclerotherapy is a non-surgical procedure that involves injecting a solution directly into the vein, usually the smallest veins. The treated vein will fade over time and the pain associated with the problem is reduced significantly after a few weeks. Multiple injections may be required and the number of veins injected in one session varies, depending on the size and location of the veins and the patient’s overall medical condition. Recovery from the procedure is minimal but the disappearance of the vein may take weeks to months.
Doctors often recommend compression stockings as a first line of treatment for those with mild varicose veins. Compression stockings are elastic hosiery that support the veins and stop blood from flowing backward. They can help heal skin sores and prevent varicose veins from returning. Patients may be required to wear compression stockings to relieve pain and swelling and prevent future problems.
The board-certified and fellowship-trained vascular surgeons at Cooper offer a number of non-surgical and surgical treatment options that can banish varicose and spider veins forever. They work with each patient to identify a treatment plan that best meets their individual needs and expectations. All treatments can be done in one of our five community office locations: Voorhees, Marlton, Sewell, Willingboro and Camden.
Read more about varicose vein and spider vein treatment options at Cooper.
Call the Cooper Vein Center at 856.342.2151 for an appointment.