About Varicose & Spider Veins
Healthy arteries and veins act as ´one–way streets´, allowing blood to flow in one direction only. The pulsating heart directs blood through arteries to the entire body.
Blood is then returned to the heart through the veins. The contraction of the leg muscles provides an efficient pump for blood to move up in the veins, against the force of gravity, with one–way valves in the leg veins preventing the backflow of blood.
There are two systems of veins: deep and superficial. Deep veins are located well below the skin, often within the muscles, and are crucial in maintaining a healthy circulation. Superficial veins are located near the skin surface, and drain into the deep veins via junctions. Superficial veins are also connected to deep veins via multiple small ´perforating veins´. Valves inside these perforating veins and junctions prevent the backflow of blood into the superficial veins.
Blood thus naturally flows from superficial veins into deep veins (via junctions and perforators), and from the deep veins back towards the heart.
Saphenous veins are the main superficial veins in the legs. Saphenous veins collect blood from other superficial veins and drain it into the deep veins.
The longest, the Great Saphenous Vein, is located in the inner aspect of the leg and travels from the ankle to the groin. The Small Saphenous Vein is located at the back of the calf muscle and travels from the outer ankle to the back of the knee. The Great Saphenous Vein is the vein that is most commonly ´stripped´ in varicose vein operations.
Many factors, such as heredity, occupations that require long periods of standing, and female hormones (see below), can lead to a weakness in the walls of the veins. This causes distension of the veins and ultimately varicose veins. Because of this distension, the valves no longer function properly, which causes a ´leakage´, ´reflux´ or ´backflow´ in the affected vein. A varicose vein demonstrating reflux is termed ´incompetent´. Severe varicose veins can compromise the nutrition of the skin and lead to eczema, inflammation or even ulceration of the lower legs.
Backflow into smaller capillaries causes their distension and the formation of so–called ´spider veins´. This is why treatment of spider veins in the presence of an underlying varicose vein is not considered appropriate, because it does not address the underlying problem.
Backflow also leads to congestion of blood in the leg veins, which can cause symptoms such as pain, fatigue, heaviness, aching, burning, throbbing, cramping and restless legs. Symptoms are often made worse by prolonged standing. Vein disorders are not always visible; diagnostic techniques are important tools in determining the cause, severity and extent of the problem. Apart from physical examination, non–invasive ultrasound is often used to assist with assessment of the veins.
Ultrasound investigation can accurately measure vein diameter, assess reflux and contribute to a precise map of both normal and abnormal veins of the leg.
Heredity is generally considered to be a contributing factor in the development of varicose veins. Women are more likely to suffer from varicose veins at an earlier age than men. Up to 30% of men and women are affected.
Varicose veins may worsen with fluctuations of hormones, such as during puberty, pregnancy and menopause, and with the use of birth control pills.
It is common for pregnant women to develop varicose veins during the first trimester. Pregnancy results in elevated hormone levels and blood volume, which in turn cause veins to enlarge. In addition, the enlarging uterus causes increased pressure on the leg veins. Varicose veins occurring in pregnancy will often improve significantly within three months after delivery. However, with successive pregnancies, abnormal veins are likely to get worse.
Other predisposing factors include ageing, standing occupations, obesity, lack of mobility, previous venous thrombosis and leg injury.
Varicose and spider veins are unhealthy superficial veins that do not function correctly and fail to return blood back to the heart. Not only are these veins failing to perform their task, they are a direct cause of ill health associated with long standing blood congestion in the legs.
Varicose veins impose an extra burden on the deep veins, which may otherwise be normal. To compensate for the incompetence of the varicose veins, deep veins have to work harder, and in some cases, the deep veins become abnormal secondary varicose veins.
Once the varicose veins are removed, the blood circulation will improve. In general, varicose veins are not suitable for use in heart by–pass operations, because they are damaged. There are other veins that can be used should the need arise. Spider veins are unsightly, abnormal veins and do not serve a biological purpose.
Before treating varicose veins, duplex ultrasound studies are organised to map the abnormal veins.
Deep vein thrombosis (DVT) scans may also be required if there is a history of clotting. Patients with a personal or family history of blood clots will require blood tests to assess their relative risk.
Patients with concurrent arterial disease may need additional ultrasound studies to assess their arterial blood supply. Once tests are completed, the phlebologist will be able to determine the most appropriate course of treatment.
Early treatment of varicose veins may reverse the symptoms of venous congestion and minimise the risk of varicose vein–related complications and further progression of the disease.
Treatment becomes more urgent if there are coexisting complications such as bleeding, inflammation (phlebitis), clots (thrombosis), dermatitis or ulcers.
In general, it is much easier to treat varicose veins when they are smaller. Early treatment tends to be less complicated and less involved. It is recommended that varicose veins be treated before pregnancy, since complications such as clotting and bleeding can develop during pregnancy.
Varicose veins that have worsened during pregnancy may not fully recover after pregnancy, requiring more involved and complicated treatment than would have been required before pregnancy. Spider veins should be treated only after the varicose veins have been successfully removed.
Many people have difficulty finding a local doctor who has the appropriate expertise in treating leg veins. It is critical that you determine if the doctor who you are considering treating your legs is up to date with the latest treatment techniques.
A good place to check on a doctor is to go to the Australasian College of Phlebology website. This will enable you to determine if a doctor has recognised expertise in different treatment techniques. Techniques such as Ultrasound Guided Sclerotherapy (UGS) and Endovenous Laser Ablation (ELA) require considerably more training than standard sclerotherapy and there are limited doctors in Australia with this additional training.