Varicose and spider veins
Varicose veins are abnormal veins that protrude and bulge out of the skin. These have a different appearance from spider veins, which are tiny veins that do not bulge out of the skin. However, the underlying problem for both is “venous insufficiency” or abnormal backward flow of venous blood. This occurs when the vein valves don’t work properly allowing blood to flow in a reverse direction – this is called reflux. Because the problem worsens with the effects of gravity the varicose veins are most prominent and symptomatic when the patient is upright or standing.
What are symptoms of varicose veins?
The overwhelming majority of patients with bulging varicose veins have symptoms. These symptoms include pain, aching, fatigue, swelling, leg heaviness, burning and itching. Medical attention should be sought whenever these symptoms are present. By resting, elevating, or supporting the legs these symptoms can be relieved for short periods of time.
If the venous insufficiency becomes more severe and is left untreated it can lead to progressively severe problems called “venous stasis changes.” This results in the overlying skin tissue being damaged by the pooling of blood. Early symptoms include swelling and skin discoloration. If the condition worsens, it may cause the skin to break down and lead to open sores and ulcers. In the most severe cases, venous stasis may lead to venous or wet skin gangrene, a disorder in which the skin dies.
Who is most at risk?
Anyone can have varicose veins, but certain people are more at risk than others. The condition is most common in females. However, one quarter to one third of the patients are male. Patients may be young or old, but risk increases as one gets older. For females, pregnancy increases the risk of developing varicose veins. Varicose veins also tend to be hereditary and run in families. A previous history of blood clots also increases the risk for developing varicose veins.
How do our physicians decide what treatment is needed?
Our interventional radiologists always start with a detailed ultrasound examination. Both the deep and superficial veins are carefully evaluated. The greater and lesser saphenous veins are also carefully examined - if the saphenous veins have abnormal reflux than the patient is a candidate for endovenous laser therapy (EVLT) treatment. If the saphenous veins are normal, we will then offer ambulatory (micro) phlebectomy or sclerotherapy as the treatment. We always discuss the ultrasound findings and treatment options during a pre-procedure consultation.