Varicose and Spider Veins

Varicose veins are swollen, twisted, blue or purple veins that can be seen under the skin’s surface. They result from a weakening in the blood vessel wall or from faulty valves. They can show up anywhere on the body but most often appear on the legs or pelvic area.

Spider veins are a smaller version of varicose veins. They affect the capillaries, the body’s smallest blood vessels. Spider veins, which are red or blue, look like a spider’s web or tree branch, and they tend to appear on the legs and face.

Although varicose veins and spider veins are common, many people find them unsightly. Varicose veins can also cause unpleasant symptoms, such as tiredness, itching, burning, throbbing, tingling, heaviness, soreness, or swelling in the legs.

Sometimes, lifestyle changes can improve symptoms. Some things you can try include:

  • Not standing or sitting for long periods without taking a break.
  • Losing extra weight to improve blood flow and ease pressure on your veins.
  • Not wearing tight clothing, especially around your waist, upper thighs, and legs. Tight clothing can worsen varicose veins.
  • Not wearing high heels for long periods. Shoes with lower heels can help tone calf muscles and improve blood flow through the veins.
  • Elevating legs while sitting, resting, or sleeping -- ideally, to a level above your heart.
  • Avoiding crossing your legs at your knees and ankles.
  • Doing physical activities that move your legs, which will improve muscle tone.

If your doctor recommends them, consider wearing compression stockings. These stockings create gentle pressure up the leg. That keeps blood from pooling in veins and also curbs leg swelling. You can buy compression stockings in pharmacies and medical supply stores.

Usually, varicose veins don’t cause medical problems. But in some people, they can lead to pain that interferes with walking or standing. They can also cause blood clots, skin ulcers, infections, and other troubles.

If lifestyle changes don’t help, if varicose veins become more severe, or if you’re bothered by the appearance of your varicose or spider veins, talk to your doctor about what medical treatments are available.

Be aware, though, that although treatments can help, they won’t prevent new varicose veins from forming.

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Medical Treatments

Sclerotherapy

Sclerotherapy is most often used for smaller varicose veins and spider veins. This procedure can eliminate the pain and discomfort of varicose veins and prevent complications, such as ulcers or vein bleeding. It may also be used simply to improve appearance.

With sclerotherapy, doctors inject a liquid chemical directly into a varicose vein to close it off. The chemical irritates and scars the inside of the vein, making it collapse. Over the course of six months, the vein disappears.

You may need several treatments to close off a vein entirely. Typically, treatments are done every 4 to 6 weeks.

Foam sclerotherapy is a variation in which a foaming agent is mixed into the injection. The foaming agent moves blood out of the vein so that the chemical can come into better contact with the vein wall.

During sclerotherapy treatments, you may feel small needle pricks as your doctor injects the veins. You can also experience temporary muscle cramping from normal saline sclerotherapy injections. Afterward, you’ll need to wear medical-grade support stockings for a few weeks.

Some temporary reactions may occur, including slight leg or foot swelling, mild bruising or soreness, itching, or redness. Rarely, sclerotherapy can cause development of small clusters of red blood vessels, brown pigmentation, and skin ulcerations around the treated veins.

Laser and light therapy

Laser and pulse light therapy can heat blood vessels to shrink them.

Laser therapy applies light energy from a laser onto a varicose vein to make it shrink and fade away. For veins to be treated successfully, several sessions may be required, usually at six week intervals.

Laser therapy is most effective for small varicose veins and spider veins, but lasers are also used in a different procedure called “endovenous ablation therapy” to treat larger varicose veins. Doctors may also use laser therapy as an additional treatment after sclerotherapy, endovenous therapy, or surgery for larger varicose veins.

Another treatment option, Photoderm or intense pulsed light therapy (IPL), uses high-intensity pulsed light to shrink certain sizes of varicose veins and small spider veins. IPL differs from laser therapy, which uses a single emitted wavelength, by emitting a spectrum of light. Photoderm or IPL may help when sclerotherapy or laser therapy doesn't work.

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Endovenous ablation therapy

In this procedure, doctors close off varicose veins by using lasers or high-frequency radio waves within the vein to create intense heat. Your doctor will make a tiny cut near the vein and insert a small catheter. A device at the tip of the catheter heats up the inside of the vessel and closes it off.

Compared to an older procedure called vein stripping and ligation, in which veins are tied shut and removed through small cuts in the skin, ablation therapy closes off varicose veins but leaves them in place, resulting in minimal bleeding and bruising.

This therapy offers similar results in terms of improving appearance and symptoms. But people who have it feel less pain and get back to normal activities faster than those who undergo vein stripping and ligation.

Endovenous ablation therapy is minimally invasive and generally safe and complication-free. There are, though, risks, including infection, damage to the blood vessel, inflammation of the vein, and, rarely, heat damage to nerves, although this typically goes away in a short time. In extremely rare cases, blood clots that form in the veins can travel to the lungs.

Endoscopic vein surgery

Typically, endoscopic vein surgery is used only when varicose veins become severe enough to cause skin ulcers or sores. Your doctor will make a small cut in your skin near the vein and use a tiny camera at the end of a thin tube to move through the vein. Then he or she will use a surgical device at the camera’s end to close the vein.

Ambulatory phlebectomy

Ambulatory phlebectomy removes varicose veins closest to the surface of the skin through slit-like incisions. You’ll remain awake during the procedure, but the area around the vein will be numbed. It's an outpatient procedure, meaning there is no overnight stay.

First, the doctor will outline or mark the vein to be removed, then inject local anesthesia into the skin. Then he or she will make a tiny cut and use a surgical instrument or a large needle to hook the vein through the opening. Next, he or she will remove the vein segment by segment. Afterward, you’ll need to wear compression stockings for at least one week.

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An enhanced version called transilluminated power phlebectomy involves fewer cuts and less pain, bleeding, and scarring. Your doctor will insert a fiber optic light under your skin while at the same time injecting a saline and local anesthetic mixture. This makes a silhouette of the veins to guide placement of an instrument that cuts the vein into small pieces and suctions them out.

Vein stripping and ligation

Vein stripping and ligation, which involves tying veins shut and removing them through small cuts in your skin, is usually performed only in severe cases of varicose veins.

Vein stripping and ligation takes about two to three hours and is usually done in an outpatient setting. Full recovery takes about one to two weeks.

Although the procedure is generally safe, risks include infection at the incision site, bruising, or irritation of a nerve that runs by the veins that are stripped.

WebMD Medical Reference Reviewed by Debra Jaliman, MD on November 05, 2019

Sources

SOURCES:

National Heart, Lung and Blood Institute: “What Are Varicose Veins?”
Cleveland Clinic: “Varicose and Spider Veins”

National Heart, Lung and Blood Institute: “Vein Problems Related to Varicose Veins”

National Heart, Lung and Blood Institute: “How Can Varicose Veins Be Prevented?”

National Heart, Lung and Blood Institute: “How Are Varicose Veins Treated?”

FamilyDoctor.org: “Varicose Veins: What You Need to Know”

Cleveland Clinic: “Varicose Veins”

FDA: “FDA Approves Asclera to Treat Small Varicose Veins”

RadiologyInfo.org: “Varicose Vein Treatment (Endovenous Ablation of Varicose Veins)”

American Society for Dermatologic Surgery: “Ambulatory Phlebectomy Information”

Cleveland Clinic: “Vein Ligation and Stripping”

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