Spider and varicose veins

WEB EXCLUSIVE / DECEMBER 2005
POSTGRADUATE MEDICINE
Update of a handout originally published in September 1999

Download this Patient Note in PDF format

A weblike patch of tiny blue spider veins on the thigh or calf may be annoying, but it's seldom a health hazard. However, large, twisted, ropelike blood vessels, called varicose veins, on the leg can cause pain, swelling, and itching. What should you do if you have these types of veins?

Several options are available for managing telangiectasia (the medical name for spider veins) or varicose veins. First and foremost, if you are concerned about the circulation in your legs, ask your doctor for specific information about what is best for you.

What causes the problem?
After arteries deliver blood throughout the body, veins carry the blood back to the heart and lungs to pick up fresh oxygen. This is an uphill job for veins in the legs. To keep gravity from pulling the blood back down, tiny valves in the veins aid the return of blood to the heart and control backflow. If these valves leak, the blood can't move forward as it normally should, and the veins begin to stretch to accommodate the pooled blood. The swollen veins can be seen through the skin because they are close to the surface.

Who gets varicose veins?
Varicose veins are more common in women than in men, and they tend to run in families. In some women, the enlarged veins may first occur during pregnancy, possibly because of hormone changes and physical pressure caused by the growing baby. Obesity, menopause, aging, and abdominal straining may also be involved. Long periods of standing or sitting, particularly with the legs bent or crossed, make the problem worse.

How are enlarged veins treated?
Spider veins are usually just a cosmetic problem and generally do not need to be treated. Minor vein problems may improve if you take regular walks, avoid long periods of standing, and rest with your feet up. If the veins are more prominent, your doctor may suggest wearing elastic stockings. These stockings compress the veins and provide support.

In some cases, sclerotherapy is recommended for treating spider or varicose veins. This consists of injecting a solution into the vein and bandaging the area tightly for about 48 hours. The solution causes inflammation and scarring, which permanently blocks the vein. The body then absorbs the accumulated blood and the treated vein disappears over time. A new form of this treatment, called microsclerotherapy, offers improved solutions and technique to remove spider veins and is becoming more widely used.

Laser therapy also may be used to treat spider veins and small varicose veins. This treatment sends strong bursts of light into the vein, applying heat and sealing it off. The latest lasers are direct and accurate, and this procedure involves no needles or incisions. Sometimes more than one treatment is needed.

A relatively new technique involves placement of a very small tube, or catheter, into the vein, through which radiofrequency energy is sent. This causes the vein to shrink and seal shut. The only side effect is mild bruising. Catheter-assisted treatments can also involve the delivery of heat or a blade to the affected vein.

Another therapy, called a phlebectomy (fluh-BEC-to-me), can remove small varicose veins through several tiny skin punctures.

A "stripping" procedure is still sometimes used for extensive varicose veins. The vein is tied off above the bulging section. One end of a tiny wire is attached at this section and the other end is threaded through the vein to a small incision at the calf or ankle. The wire, along with the varicose section of vein, is pulled out through the lower incision. This surgery requires anesthesia and may be performed in an operating room.

How is circulation affected?
In general, the body does not miss veins that are blocked or removed surgically. The legs have many routes for the blood to take. Problems never return in the successfully treated veins, but new varicose veins can develop elsewhere. Because mild problems are easier to treat than severe ones, be sure to tell your doctor about any symptoms early.

For more information National Heart, Lung, and Blood Institute NHLBI Health Information Center PO Box 30105 Bethesda, MD 20824 800-575-9355 TTY 240-629-3255 http://www.nhlbi.nih.gov American Academy of Dermatology 1350 I St NW, Suite 870 Washington, DC 20005 888-462-3376 http://www.aad.org

This information is not a substitute for medical treatment.

Please send technical questions related to the Web site to Ann Harste