Varicose & Spider veins

Overview

Varicose veins are bloated, twisted veins that can be seen just under the skin. Any vein may become varicose but it most commonly occurs in the legs. Hemorrhoids are also a type of varicose vein.

Veins are like a one-way street carrying blood towards the heart. When the valves within the veins become damaged or weak, blood can back up and pool in the veins. This causes the veins to swell, which can lead to varicose veins.

Signs & symptoms

Varicose veins are very common. You are more at risk if you are older, a female, obese, don't exercise or have a family history. They can also be more common in pregnancy.

The signs and symptoms of varicose veins include:

  • Discolored skin in the area around the varicose vein
  • Itchy legs, especially on the lower leg and ankle. Sometimes this symptom is incorrectly diagnosed as dry skin
  • Large veins that you can see just under the surface of your skin
  • Mild swelling of your ankles and feet
  • Painful, achy, or "heavy" legs
  • Throbbing or cramping in your legs

Varicose veins can cause dermatitis, an itchy rash. Dermatitis can cause bleeding or skin ulcers (sores) if the skin is scratched or irritated.

Superficial thrombophlebitis (THROM-bo-fleh-BI-tis), a blood clot in a vein close to the surface of the skin, can also be caused by varicose veins. This type of blood clot may cause pain and other problems in the affected area.

Testing & diagnosis

Varicose veins are diagnosed by a physical examination by a physician. To check for varicose veins in your legs, your doctor will look at your legs while you're standing or sitting with your legs dangling.

Your doctor may recommend duplex ultrasound to check blood flow in your veins and to look for blood clots. During this test, a handheld device will be placed on your body and passed back and forth over the affected area. The device sends and receives sound waves. A computer will convert the sound waves into a picture of the blood flow in your arteries and veins.

Although it is not very common, your doctor may recommend an angiogram to get a more detailed look at the blood flow through your veins. For this procedure, dye is injected into your veins. The dye outlines your veins on x-ray images.

Treatment

Exercising, losing weight, elevating your legs when resting, and not crossing them when sitting can help keep varicose veins from getting worse.

Wearing loose clothing and avoiding long periods of standing can also help. If varicose veins are painful or you don't like the way they look, your doctor may recommend procedures to remove them.

Our approach

Our vascular specialists are leaders in treating unsightly and sometimes painful varicose and spider veins. As experts in cosmetic vein surgery, we use minimally invasive therapies when possible to reduce scarring and pain and improve your recovery time.

Our treatments are provided on an outpatient basis, meaning that they can be done in our office with local anesthesia. For most treatments, you will only need a day or two of downtime before resuming normal activities. With newer treatment methods, you generally only require an over-the-counter pain medication to manage any pain.

Treatment may include:

  • Radiofrequency ablation (RFA), a minimally invasive procedure in which radiofrequency energy is directed through a thin tube (catheter), inserted through a small incision to the vein. The heat energy causes scar tissue to form, which eventually causes the abnormal vein to disappear. Ablation usually takes less than one hour, and allows for an almost immediate return to daily activities.
  • Ultrasound-guided injections, in which ultrasound imaging is used to show the veins under your skin and guide the doctor to the problem location. Ultrasound may be used for both traditional sclerotherapy and foam sclerotherapy
  • Endovenous laser therapy (EVLT), which is similar to RFA but uses lasers to destroy damaged veins
  • Sclerotherapy, where a liquid medication is injected into the damaged vein, causing it to harden and dissolve naturally. This is mostly used with small varicose and spider veins.
  • Foam sclerotherapy, which is one of newer developments in sclerotherapy. The liquid medication used in sclerotherapy is mixed with air to produce a foam. The foam is then injected into the vein, often using ultrasound to guide the injections. The foam causes the affected vein to collapse.
  • Vein stripping, in which your doctor disconnects and removes larger veins through a small incision in your calf. Sometimes avulsion or transilluminated powered phlebectomy is performed at the same time, where veins are teased or sucked from beneath the skin.