Varicose Veins And Spider Veins - Common Skin Conditions: Skin Health

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Varicose veins and spider veins

More than 56 million people in the United States — 40% of women and 15% of men — have varicose veins or spider veins (telangiectasia). One of the most important distinctions between these conditions is that varicose veins sometimes develop into a serious medical problem.

Although these conditions may mar the appearance of the skin, they aren't actually skin conditions, but rather circulatory problems. In your legs, veins have the unenviable job of working against gravity to push the blood upward. Healthy veins do this with pulsing movements and one-way valves that encourage the blood to flow up and prevent it from flowing back down. As you age, the valves can malfunction, and the veins may stretch. Blood can stagnate, causing the veins to dilate. Heredity and hormonal changes also can influence the development of varicose veins.

For most people, varicose veins are more a cosmetic issue than a medical one. Often you can treat them by wearing elastic support stockings, avoiding standing for long periods, and sitting with the feet elevated. Exercise such as walking, jogging, or bicycling can help. However, advanced cases of varicose veins can result in blood clots, inflammation of the veins, or ulcers. Signs that medical attention is needed include muscle cramps, fatigue or swelling in the legs, excessive tenderness, or any indication of an ulcer. Larger varicose veins may require surgery.

Spider veins form when groups of blood vessels close to the surface of the skin dilate. As a result, fine networks of red, blue, or purple veins — each barely more than the width of a hair — appear on the thighs, calves, and ankles. They may form patterns resembling a sunburst, spider web, or tree branches, or they may appear just as short, unconnected lines. Age, heredity, hormonal changes, or external injuries increase the likelihood of spider veins.

One of the best ways to prevent spider and varicose veins is with regular exercise that keeps blood from pooling in the veins. Walking, jogging, bicycling, and swimming are good choices.

Treating varicose veins

The oldest procedures for getting rid of varicose veins involve open surgery, but a newer, less invasive approach, called endovascular ablation, has become more popular. This method employs heat to collapse and close varicose veins.

Endovascular ablation is done with a thin catheter that contains either a laser (called endovascular laser ablation, or EVLA) or a device that generates high-frequency radio waves (called radiofrequency ablation or VNUS closure). Both procedures can be performed in a doctor's office. Local anesthesia is used to numb the area being treated, and then the catheter is inserted into an enlarged vein in the lower leg and directed to the varicose vein, heating the vein wall. The heat makes the vein collapse and seals it shut. Once the varicose vein is closed, other healthy veins take over and circulate blood from the legs, and symptoms significantly improve. Most people can return to their normal activities after a day or two.

Studies show that endovascular ablation is as effective as surgery for up to two years after treatment, but with less pain, scarring, and recovery time. As a result, endovascular techniques have replaced longstanding surgical procedures in most cases.

One traditional surgical technique is stripping, which involves removing the vein through small incisions and diverting the blood flow to another vein. Ligation is similar to stripping, but instead of removing the vein, the surgeon ties it off at a point close to the source of the blood flow, and the blood is rerouted to another vein.

A less invasive surgery called ambulatory phlebectomy may be recommended for removing varicose veins that remain after endovenous ablation. Using an instrument that hooks the vein, the surgeon removes it by pulling it through a series of tiny punctures created along the length of the vein.

Treating spider veins

Spider veins pose no medical risk. They can be treated with a painless, nonsurgical procedure called sclerotherapy. Sclerotherapy involves injecting a solution, usually a highly concentrated saline, into the blood vessel cluster. The vessel collapses, and blood easily diverts itself into nearby healthy veins. In addition, improvements in laser technology now permit the use of these devices in the successful treatment of spider veins and other enlarged veins. Smaller varicose veins, those 3–5 millimeters long, can also be treated with these procedures.

Last updated:	July 20, 2007