Preventing and Treating Varicose Veins
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Preventing and Treating Varicose Veins

One in ten Americans, predominantly women, will develop varicose veins. Although a very common and usually benign condition, many women seek plastic surgery and newer laser removal techniques for cosmetic reasons.

What Is a Varicose Vein?

Your heart pumps blood throughout your body in long, muscular pipes called blood vessels. The pipes that transport the fresh, oxygen-rich blood (and the nutrients it carries) to your vital organs and tissues are called arteries. The tubes that return the blood back to your heart are called veins. In medium-sized veins, a series of valves keeps the blood flowing in the right direction.

Sometimes the valves fail or the muscle walls weaken, and instead of flowing forward, tiny amounts of blood pool inside the veins. When this happens, the vein bulges and twists, eventually emerging as a varicose vein . If the varicose vein is near the surface of your skin, it will appear enlarged, lumpy, and dark blue.

Another, less extreme type of varicose vein is a "spider vein." These thin red or purplish networks of very fine veins near the surface of the skin take their name from the pattern they form, often resembling a tangle of spiders. No one knows what causes them.

"They run in families and often follow pregnancy, as do all varicose veins," says Dr. Harold Sussman, director of the Marina Laser Center of the Plastic Surgery Associates in Marina del Rey, California.

Although they can appear anywhere, varicose veins appear most often on the legs, especially behind the knees. Spider veins may also develop on the face.

Are They Harmful to My Health?

Spider veins are strictly a cosmetic issue and don't affect your physical health. Varicose veins, on the other hand, sometimes have medical consequences if left untreated, says Sussman. They may ache or burn after long periods of standing, and can eventually lead to thrombosis (clotting) or phlebitis, an inflammation of the wall of the vein.

"In some people, when the pooling of the blood causes severe varicose veins, you can develop ulcers. That's the end stage, with destruction of the skin," says Sussman.

How Can I Prevent Them?

If you inherited a tendency toward varicose veins, there isn't much you can do to prevent them, says Susman. But it's still a good idea to avoid clothing that restricts blood flow. Try to also avoid long periods of sitting or standing in one position. Regular exercise also helps.

Can I Get Rid of Them?

Once you have varicose veins, they're not likely to go away on their own. Custom-fitted elastic stockings, which put pressure on the legs, may alleviate symptoms and keep varicose veins from becoming worse. If your doctor prescribes these stockings, be sure to put them on first thing in the morning, before you even get out of bed. Take the stockings off at night just before you go to bed.

Periodically during the day, and especially at the end of the day, rest with your feet elevated at least 12 inches above your heart to reduce swelling. You might make it an end-of-day habit to lie back on the couch and prop your feet up on a couple of pillows while you catch up on reading.

Laser Treatment

If you and your physician decide to remove the veins, there are several options to choose from. Laser therapy is very effective for spider veins on the face.

"With certain types of lasers there's no bruising and basically no down time for spiders on the face," says Sussman.

Laser treatment of spider veins on the extremities are another matter.

"You can only treat the small veins, and even then you get redness along where the vein was, and then a cat scratch type crusting which lasts two to three weeks," reports Sussman. Laser treatment is also less successful on the extremities.

Because it is considered cosmetic surgery, laser treatment of spider veins usually isn't covered by health insurance.

Sclerotherapy

Although laser therapy can't successfully be used on veins more than one millimeter in diameter, larger varicose veins can be treated by other means. In a procedure called sclerotherapy, a chemical irritant, called a sclerosing solution, is injected into the vein and basically flushes out the blood and causes the vein to swell shut. Hypertonic saline solution, a very heavy salt solution, was at one time the only substance approved for this use. Newer agents such as sodium tetradecyl sulfate and polidocanol are effective, commonly used especially in Europe, and are likely even more effective when used as a foaming solution and injected into veins under ultrasound guidance. A vein may require more than one treatment before it disappears. As of July 2006, foaming solutions have not been approved by the US Food and Drug Administration (FDA), though they are widely used because at least one is FDA-approved in a non-foaming version.

Potential side effects of sclerotherapy include a stinging sensation after the injection, and in one out of three people there is a brownish stain around the treated area that lasts for several weeks or longer. Occasionally a reddish blush of tiny new blood vessels, called a matte, will form adjacent to the treated vein.

"It's as if the injury to one [vein] releases a substance that wants to form new ones," explains Sussman. This matting can be treated with lasers.

Something else to keep in mind: even in the best of hands, this treatment is not 100% effective, especially on the legs.

"If sclerotherapy is 60%-70% effective, you've done very well," says Sussman. Sclerotherapy cannot correct the problem of reverse blood flow patterns, and for this reason its results are often temporary.

Ambulatory Phlebectomy

Larger varicose veins can be physically removed through a procedure called ambulatory phlebectomy. A series of tiny incisions is made along the course of the vein, under local anesthesia. A little hook is inserted through the openings and used to grasp the vein, so it can be removed a portion at a time.

"It gets rid of them completely," says Sussman.

Although the ambulatory phlebectomies have been performed in Europe for many years, the procedure began to gain acceptance in the United States around 1990, specifically as a replacement for a more invasive procedure called vein stripping. Ambulatory phlebectomy is an outpatient procedure with few side effects. One side effect seen if phlebectomy is performed on leg veins, is swelling of the legs after the procedure.

Closure Technique

In 1999, the FDA approved a treatment for varicose veins called the closure technique, which is similar in concept to scelortherapy. This procedure involves the insertion of a catheter that delivers radiofrequency energy into the vein to shrink and seal it shut. The closure technique can be performed in a doctor's office.

Before undergoing any treatment for varicose veins, ask your physician how many of them he or she has performed, and what the results were. Successful treatment largely depends upon the skill of the physician. And remember, in most cases you don't HAVE to do anything about varicose veins; medical treatment is necessary only if the vascular symptoms become life-threatening. Alternative treatments such as acupuncture are also being used.

RESOURCES:

American Society for Dermatologic Surgery (ASDS)
http://www.asds-net.org

Vericose Veins and Spider Veins
The National Women's Health Information Center
http://www.4woman.gov/faq/varicose.htm



Last reviewed July 2006 by Lawrence Frisch, MD, MPH

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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