Treating bothersome leg veins
Tending to enlarged leg veins can improve their appearance and reduce the risk of swelling, aching, and other problems
45-year-old male with sclerotherapy
But the problem may not be merely cosmetic. Varicose veins can cause pain and discomfort and even, in rare cases, bleeding leg sores. Treating enlarged leg veins can relieve discomfort and prevent complications. The approach that's best for you depends on the size, type and location of your varicose veins.
What causes them?
Leg veins propel oxygen-depleted blood all the way back to your heart, working against gravity and the pressure of your body weight. These veins have one-way valves that prevent blood from flowing backward, but the valves can weaken and stop working properly, especially as we age. As a result of these changes, blood can pool in the veins immediately under the skin, causing them to enlarge and become less elastic. In a varicose vein, the valves are deformed and don't close properly, so the blood flows backward, pools and enlarges the vein.
Size determines type
There are several types of enlarged veins: varicose, reticular and spider veins. Varicose veins are at least one-tenth of an inch in diameter and may be as large as three-quarters of an inch. They often resemble twisted ropes and can form anywhere from the thigh to the ankle. You're most likely to feel the chief symptoms — aching, burning, pressure, heaviness or weakness in the legs — after standing or sitting for a long period of time. At night you may develop a painful muscle spasm in your calf (a charley horse). Your feet and ankles may swell, and the skin around the affected veins may become dry and itchy, or develop a rash or a brownish or bluish discoloration.
Reticular veins, also known as blue veins or feeder veins, are smaller than varicose veins but may also have a ropy appearance. They occur mainly on the back of the leg, usually around the knee. Reticular veins may branch into (or feed) spider veins, which are smaller than reticular veins and don't bulge or cause discomfort. They look like red or blue spider webs on the skin's surface and may occur on the face as well as the legs.
Who gets varicose veins?
More than 40 percent of women over age 50 and 75 percent of women over age 70 have varicose veins. Not only do blood vessels weaken with age, so do calf muscles, which normally help squeeze veins and send blood back toward the heart as you walk.
Other risk factors that can predispose you to varicose veins include gender (women are slightly more susceptible), heredity, jobs that involve standing, and excess weight.
Unless you have symptoms, there's no reason to treat varicose veins. If you have symptoms, try putting your feet up, being active to encourage circulation, avoiding prolonged sitting or standing, wearing compression stockings and taking a pain reliever for occasional mild aches.
Minimally invasive approaches
If self-help approaches don't work, you may want to consider a minimally invasive procedure. Options include:
Sclerotherapy: Also known as injection therapy, this treatment is usually the first choice for spider veins, reticular veins and small varicose veins. The physician injects a chemical irritant into the vein, making it swell, stick together and seal shut. Your circulation isn't impaired because healthy blood vessels nearby compensate for the one that's been closed. What's injected is slightly painful and may cause temporary swelling and bruising.
Sclerotherapy generally requires more than one session, since each vein typically must be injected one to three times. Sessions last from 15 minutes to an hour; no anesthesia is required. After each session, you'll need to wear bandages and compression stockings for a week or two. Once blood is no longer flowing through the vein, scar tissue develops and the vein gradually fades. Brown lines may develop in the treated area, but these, too, usually fade.
Surface therapy (laser): Spider veins, reticular veins, and small varicose veins can be treated with a laser applied to the surface of the skin. Lasers emit a specific wavelength of light that heats up and damages the vein without injuring nearby tissues. You'll feel a strong pinching sensation when the laser is activated. Numbing gels or creams can lessen the sting.
The treatment usually lasts 15 to 20 minutes and doesn't require any bandages. You may experience temporary bruising, itching or swelling, and some patients notice changes in skin color in the treated area. You'll need to wear compression stockings for several days, and while symptoms may improve within a week or two, changes in appearance take longer.
Endovenous therapy: These methods are used to treat deeper varicose veins. The troublesome vein is located with ultrasound, and a small catheter is inserted into the vein. The catheter emits either laser or radiofrequency energy, which shrinks and seals the vein. Swelling and pain can occur, and you should wear compression stockings for at least two weeks. Surface veins connected to the treated vein usually shrink after the treatment.
Distributed by Tribune Media Services
American Society for Dermatologic Surgery: asds.net
Society of Interventional Radiology: sirweb.org
The American Venous Forum: veinforum.org