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It is estimated that between 20% and 25% of women, and 10% to 15% of men suffer from varicose and spider veins worldwide. This translates to tens of millions of people in the United States alone. Whether you desire cosmetic improvement or relief of symptoms associated with leg vein problems, the following article should give you a better sense of the nature of the condition and the current treatments available.
 

What Are Spider and Varicose Veins?
Veins throughout your body return blood back to your heart. In order to do this efficiently, veins have one-way valves to prevent blood from flowing backwards (reflux). These valves are particularly important in your legs due to the effects of gravity. If they fail to close properly, blood will leak through the valves and result in pooling. Over time, this pooling of blood will create pressure inside the vein walls and result in enlargement and sometimes bulging of the vein. These enlarged veins are the cause of spider veins (telangiectasia) and varicose veins.

Spider veins are small red, purple, or bluish veins located just below the surface of the skin. They can have a linear or spider web-like appearance. Varicose veins are abnormally enlarged veins located deeper under the skin. Varicose veins can also protrude slightly above the skin surface resulting in a rope-like appearance.
 

Who Gets Varicose and Spider Veins?
Hereditary factors play the most important role in determining whether you will develop leg vein problems. If you have varicose or spider veins, your mother or father probably had them too. Women are more likely to have varicose or spider veins due to hormonal factors including pregnancy, birth control pills, or hormone replacement therapy. Pregnancy, especially multiple pregnancies, plays a particularly big role in the development or worsening of vein problems. In addition to changes in hormonal levels, pregnancy increases the amount of blood in your veins and, as the uterus enlarges, the pressure in your pelvic and leg veins increases. Other factors that may accelerate the appearance of varicose or spider veins include:

- The aging process
- Obesity
- Prolonged standing or sitting
- Constipation
- Leg trauma
- Congenital conditions
 

Do Spider or Varicose Veins Cause Any Symptoms?
Most spider veins are nothing more than a cosmetic nuisance. Sometimes, however, they can be associated with symptoms such as itching, burning, or throbbing in the legs. Varicose veins, on the other hand, are often associated with symptoms. The most common symptoms of varicose veins include leg pain, cramps, fatigue, heaviness, swelling, or restlessness. In more severe cases, varicose veins can lead to skin changes resulting in eczema, abnormal pigmentation, ulceration, or bleeding.
 

What Treatments Are Available?
Conservative treatment of varicose and spider veins is geared toward restoring or improving normal direction of blood flow in the damaged veins.

Conservative treatment
The most common type of conservative treatment is wearing graduated compression stockings (tighter at the ankle than the thigh). The added external support of compression stockings increases the function of your calf muscles in pumping blood back to your heart. Although this may not get rid of any existing varicose and spider veins in your legs, your symptoms associated with vein problems can be greatly improved by wearing support stockings. Support stockings can also help slow the progression of leg vein problems. Conservative treatment is well suited for women who are pregnant or for those who are unable to undergo medical therapy due to advanced age or illness.

For many people, merely slowing the progression of varicose or spider veins will not be enough. If you fall into this category, many corrective forms of treatment are available to improve both the cosmetic appearance of your legs as well as alleviate associated symptoms.

Medical therapies
The first step, and likely the most important, is finding a physician with experience and expertise in phlebology, which is the field of medicine that deals with diseases and disorders of veins (the venous system). In addition to a physical examination, additional evaluations using a variety of diagnostic instruments may be necessary when determining the cause, severity, and best treatment options available for your particular problem. These diagnostic tests include duplex doppler ultrasound (an exam that uses ultrasound waves to view structures inside the body as well as measure blood flow), and plethysmography (a test to measure the volume of blood in the veins).

Compression Sclerotherapy
Sclerotherapy involves a series of injections using a tiny needle to administer small amounts of a solution (sclerosant) into the vein. The solution irritates the inner lining of the vein causing it to collapse and ultimately disappear. Depending on the severity of your vein problem as well as the types of veins being treated, you may need one or several treatment sessions. Sclerotherapy is performed as an in-office procedure and should cause only minimal discomfort. Following treatment, you can return to your normal daily activities.

After treatment, external compression is applied to the treated areas and you may need to wear elastic bandages or support stockings for a few days, which will aid in the closure of your treated veins. Bruising at the injection sites is normal following treatment and will resolve in 1 to 2 weeks. Occasionally, abnormal pigmentation of the skin overlying a treated vein will occur. This pigmentation is usually temporary and can be minimized with proper technique and good follow-up. Other adverse reactions including scarring, telangiectatic matting (the formation of new tiny blood vessels in the feet or ankles), allergies can occur but are uncommon.

Duplex ultrasound-guided sclerotherapy
Occasionally, patients with more severe varicose veins will need further therapeutic intervention, in particular those who have reflux (back-flow of blood) at certain areas in the leg. Traditionally in these cases, removal of these veins was considered to be the best treatment. Today, minimally invasive in-office techniques are available and offer good alternatives to invasive surgery for many patients. One such technique is duplex ultrasound-guided sclerotherapy.

This procedure uses duplex ultrasound to first visualize a vein located beneath the surface of the skin, and then guide a needle and/or a small tube (catheter) into the vein. Duplex guidance is used to position the catheter in precisely the desired location prior to administering a strong irritating solution. This procedure allows physicians to treat a large varicose vein that would otherwise require surgical removal. In experienced hands, duplex-guided sclerotherapy is highly effective, very safe, and painless. Following treatment, patients are required to wear a compression stocking for 1 week but may immediately return to their normal daily activities.

Surgical ligation and stripping
Surgical removal (also called ligation and stripping) of the main vein in the leg near the surface of the skin (the greater saphenous vein) may be necessary in some patients with large varicose veins with reflux. This procedure is usually performed under general anesthesia, although local or spinal anesthesia may be used. When properly performed, the greater saphenous vein is removed from the groin to the knee through small (usually two) incisions using a special instrument. Most patients return home the same day and are encouraged to walk immediately following the procedure. Normal daily activities can be resumed within a couple of days.

Ambulatory phlebectomy
Ambulatory phlebectomy is a minor surgical procedure that can be used to remove certain large varicose veins. This procedure can be performed in the office using local anesthesia. The veins are removed in segments through tiny incisions. No stitches are necessary and scars are barely visible in most cases.

Laser therapy
A variety of laser and light source therapies are currently available. Delivery of laser energy is designed to cause selective heating and subsequent closure of the blood vessel without causing damage to the overlying skin. Although many lasers have been highly effective in the treatment of facial spider veins, laser treatment of leg veins has proven to be more challenging. Even though recent advances in this technology have shown promise, compression sclerotherapy remains the best treatment for most unwanted leg veins. As a result, lasers are still best used only as a complementary treatment in a select group of people.

Treatment of choice
The treatment of choice for the majority of varicose veins and nearly all spider veins on your legs is compression sclerotherapy. In some cases, additional treatment, such as surgery or duplex ultrasound-guided sclerotherapy will be necessary. Laser treatment may also provide a useful complementary option for certain patients. Often, a combination of the above treatments will be most beneficial.
 

What Can I Do to Prevent Vein Problems?

Once you have varicose and spider veins, they will not go away without corrective treatment. However, there are preventive measures that can help relieve some symptoms associated with leg veins, and may slow the progression of varicose and spider veins. These include wearing support stockings, getting regular exercise, maintaining your ideal body weight, and avoiding prolonged standing or sitting.
 

Conclusion

If you suffer from varicose and spider veins, you are not alone. It is estimated that nearly one in four people in this country will experience some form of leg vein disorder during their lifetime. Unfortunately, if vein problems run in your family, you will likely also develop varicose or spider veins. The good news is that by understanding and paying attention to the roles of diet, exercise, hormones, and pregnancy, you can minimize your risk and control the progression. If varicose and spider veins are already a problem, modern techniques for both evaluation and therapy have made treatment of this common condition more effective and safer than ever before.