The heart pumps blood to
supply oxygen and nutrients to all parts of the body. Arteries carry
blood from the heart towards the body parts, while veins carry blood
from the body parts back to the heart. As the blood is pumped back to
the heart, veins act as one-way valves to prevent the blood from
flowing backwards. If the one-way valve becomes weak, some of the
blood can leak back into the vein, collect there, and then become
congested or clogged. This congestion will cause the vein to
abnormally enlarge. These enlarged veins can be either varicose veins
or spider veins.
Varicose veins are very
swollen and raised above the surface of the skin. They are dark purple
or blue in color, and can look like cords or very twisted and bulging.
They are found most often on the backs of the calves or on the inside
of the leg, anywhere from the groin to the ankle. During pregnancy,
varicose veins called hemorrhoids can form in the vagina or around the
anus.
Spider veins are similar
to varicose veins, but they are smaller, are often red or blue in
color, and are closer to the surface of the skin than varicose veins.
They can look like a tree branch or spider web with their short jagged
lines. Spider veins can be found on both the legs and the face. They
can cover either a very small or very large area of skin.
Women are more affected -- up to
50% overall. It also is estimated that 41% of all women will suffer
from abnormal leg veins by the time they are in the 50s.
No one knows the exact
cause of spider and varicose veins, but there are several factors that
cause a person to be more likely to develop them. Heredity, or being
born with weak vein valves, is the greatest factor. Hormones also play
a role. The hormonal changes that occur during puberty, pregnancy, and
menopause, as well as taking estrogen, progesterone, and birth control
pills can cause a woman to develop varicose veins or spider veins.
During pregnancy, besides the increases in hormone levels, there also
is a great increase in the volume of blood in the body that can cause
veins to enlarge. The enlarged uterus also puts more pressure on the
veins. (Within 3 months after delivery, varicose veins usually
improve. However, more abnormal veins are likely to develop and remain
after additional pregnancies.)
Other factors that weaken
vein valves and that may cause varicose or spider veins include aging,
obesity, leg injury, and prolonged standing, such as for long hours on
the job. Spider veins on the cheeks or nose of a fair-skinned person
may occur from sun exposure.
Medical treatment usually
is not required for varicose or spider veins. However, varicose veins
can become quite uncomfortable as well as look unattractive. Varicose
veins usually enlarge and worsen over time. They can cause the legs
and feet to swell. Although severe leg pain is not common, leg muscles
may feel fatigued or heavy, or throb and cramp at night. The skin on
the legs and around the ankles also can itch or burn.
In some cases, varicose
veins and spider veins can cause more serious problems, and medical
treatment will provide benefits. If the veins become severe, they can
cause a condition called venous insufficiency, a severe clogging of
the blood in the veins that prevents it from returning to the heart.
This condition can cause problems like a deep-vein thrombosis (blood
clot), or a severe bleeding infection. These usually are caused by
injury to the varicose vein. A blood clot can be very dangerous
because of the possibility of it traveling from the leg veins to the
lungs, where it may block the heart and lungs from functioning.
Lastly, because the skin tissue around the varicose vein may not
receive enough nourishment, sores or skin ulcers may develop.
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Sclerotherapy - Of all available treatments, this one
is most commonly used for both spider veins and varicose veins. It
involves injecting a solution into the vein that causes the lining
of the vein walls to swell, stick together, and eventually seal
shut. The flow of blood is stopped and the vein turns into scar
tissue. In a few weeks, the vein should fade. Although the same vein
may need to be injected with the solution more than once,
sclerotherapy is very effective if done correctly. The American
Academy of Dermatology states that most patients can expect
a 50% to 90% improvement. Also, a new and improved type of
sclerotherapy called microsclerotherapy uses improved solutions and
injection techniques that increase the success rate for removal of
spider veins. Sclerotherapy does not require anesthesia, and can be
done in the doctor's office.
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Electrodesiccation - This treatment is similar to sclerotherapy
except the veins are sealed off with an electrical current instead
of the injection of solution. This treatment may leave scars.
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Laser
surgery – Until recently, laser treatments mostly were used for
treating spider veins on the face. Varicose veins in the legs did
not respond consistently to this treatment, and some doctors doubted
whether laser treatment actually worked, and it was not covered by
most health insurance plans. Now, however, new technology in laser
treatments can effectively treat varicose veins in the legs.
Laser surgery works by
sending very strong bursts of light onto the vein that makes the vein
slowly fade and disappear. Lasers are very direct and accurate, and
only damage the area being treated. All skin types and colors can be
safely treated with lasers. The American Academy of Dermatology
believes that the new laser technology is more effective with fewer
side effects. Laser surgery is more comfortable for patients because
there are no needles or incisions. When the laser hits the skin, the
patient only feels a small pinch, and the skin is soothed by cooling
both before and after the laser is applied. There may be some redness
or swelling of the skin right after the treatment, but this disappears
within a few days. The skin also may be discolored, but this will
disappear within one to two weeks. Treatments last 15 to 20 minutes,
and depending on the severity of the veins, two to five treatments are
generally needed to remove varicose veins in the legs. Patients can
return to normal activity right after treatment.
Surgery is used mostly to
treat very large varicose veins. Available surgical options include:
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Surgical Ligation and Stripping - With this treatment, the veins are
tied shut and completely removed from the leg. Removing the veins
will not affect the circulation of blood in the leg because veins
deeper in the leg take care of the larger volumes of blood. The
varicose veins mostly removed through surgery are superficial or
surface veins, and collect blood only from the skin. This surgery
requires either local or general anesthesia and must be done in an
operating room on an outpatient basis.
Serious side effects or
complications with this surgery are uncommon. However, with general
anesthesia, there always is a risk of cardiac and respiratory
complications. Similar to the risks of sclerotherapy, bleeding and
congestion of blood can be a problem, but the collected blood usually
settles on its own and does not require any further treating. Wound
infection, inflammation, swelling and redness also can occur. This
surgery also can leave permanent scars. A very common complication is
the damage of nerve tissue around the treated vein. Small sensory
nerve branches are difficult to avoid when veins are removed. This
damage can cause numbness in small areas of skin, burning, or a change
in sensation around the surgical scar. The most serious, but rare,
complication of surgery is the creation of a deep vein blood clot that
may travel to the lungs and heart. To be safe, many surgeons give
injections of heparin, a drug that reduces blood coagulation, for one
to two days before the surgery. However, heparin also can increase the
normal amount of bleeding and bruising after the operation.
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Ambulatory Phlebectomy - With this surgery, a special light source
marks the location of the vein. Tiny incisions are made in the vein,
and then with surgical hooks, the vein is pulled out of the leg.
This surgery requires local or regional anesthesia. The vein usually
is removed in one treatment. Side effects and complications are
similar to those of ligation and stripping. The most common side
effect is slight bruising. Compared to traditional surgery,
ambulatory phlebectomy allows the removal of very large varicose
veins while leaving only very small scars. Patients can return to
normal activity the day after treatment.
Current treatments for
varicose veins and spider veins have very high success rates. Although
it is uncommon, these veins can return after treatment. One reason may
be hidden areas in the body where there is a lot of pressure on the
veins. This pressure may cause new spider veins. Doctors can diagnose
this with ultrasound. Another cause may be new re-growth of vein
branches. Doctors have found that tiny vein branches can grow through
scar tissue to connect to both deep and superficial veins even after
surgery.
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