FAQs
Have a question? Take a moment to review our list of the most frequently asked questions. If you don’t find your answer here, please don’t hesitate to e-mail us.
Types of Veins
- What are varicose veins?
- What is the difference between varicose veins and spider veins?
- What causes varicose veins and spider veins?
- What generally happens to varicose veins?
- What are symptoms of varicose veins?
- How can varicose veins be diagnosed?
- Are varicose veins serious?
- What problems can occur if left untreated?
- How common are abnormal leg veins?
- Who usually has varicose veins and spider veins?
- Why do varicose veins and spider veins usually appear in the legs?
What are varicose veins?
The word “varicose” comes from the Latin word “varicosus” which means abnormally swollen. Varicose veins are diseased blood vessels that have become permanently swollen (enlarged), and can no longer efficiently carry blood back to the heart. Arteries carry blood away from the heart while veins return blood back to the heart. Varicose veins can arise when this system gets backed up — almost like a traffic jam.
What is the difference between varicose veins and spider veins?
Varicose veins are enlarged veins that can be flesh colored, dark purple or blue. They often look like cords and appear twisted and bulging. They are swollen and raised above the surface of the skin. Varicose veins are commonly found on the backs of the calves or on the inside of the leg
Spider veins are similar to varicose veins, but they are smaller. They are often red or blue and are closer to the surface of the skin than varicose veins. They can look like tree branches or spider webs with their short jagged lines. They can cover either a very small or very large area of skin.
What causes varicose veins and spider veins?
The heart pumps blood filled with oxygen and nutrients to the whole body. Arteries carry blood from the heart towards the body parts. Veins carry oxygen-poor blood from the body back to the heart. The squeezing of leg muscles pumps blood back to the heart from the lower body. Veins have valves that act as one-way flaps. These valves prevent the blood from flowing backwards as it moves up the legs. If the one-way valves become weak, blood can leak back into the vein and collect there. This problem is called venous insufficiency or reflux. Pooled blood enlarges the vein and it becomes varicose. Spider veins can also be caused by the backup of blood. Hormone changes, inherited factors, and local trauma can also cause spider veins.
What generally happens to varicose veins?
In the majority of cases, the varicose veins worsen with time. The varicose veins start to become more prominent because they are engorged with blood and can cause localized pain and itching. Once the veins become prominent, it is very unlikely that they will spontaneously resolve without any treatment.
What are symptoms of varicose veins?
Aside from being unattractive, varicose veins may be responsible for pain, heaviness, and aching. The majority of individuals will complain of leg aching at the end of the day. Symptoms are often worse after prolonged standing and may include feelings of fatigue, heaviness, aching, burning, throbbing, itching, cramping, and restlessness of the legs. With time, swelling and darkening or hyperpigmentation around the ankles typically occurs.
How can varicose veins be diagnosed?
Varicose veins can usually be diagnosed by a simple physical examination. However, the source of the varicose vein requires the use of Doppler ultrasound. This painless test provides a roadmap of all of the veins in the legs to determine which deeper veins are normal and which are not.
Are varicose veins serious?
Varicose veins generally tend to get worse without any treatment. Those who do not get them treated could develop:
- More spider veins
- Leg pain and fatigue
- Swelling around the ankles
- Pigmentation around the ankles
- Occasional blood clots in the veins
- Bleeding from the veins
- Ulcerations
What problems can occur if left untreated?
Most people with varicose veins do not develop complications. It is difficult to predict who will develop complications. Complications that may occur include:
- Superficial thrombophlebitis – in this condition, the varicose vein is inflamed and tender. A clot is usually present in the vein.
- Bleeding – even with minor trauma, the varicose vein may be associated with bleeding. Because the vein is under high pressure, the bleeding can be quite profuse.
- Venous Eczema – the skin round the vein may become dry and very itchy.
- Venous Pigmentation – this is brown staining of the skin around the ankle. It is due to the leakage of small amount of blood from the veins into the skin.
- Venous Ulceration – ulcers at the ankle.
How common are abnormal leg veins?
Approximately half of the U.S. population has venous disease — 50 to 55 percent of women and 40 to 45 percent of men. Of these, 20 to 25 percent of the women and 10 to 15 percent of men will have visible varicose veins. Varicose veins affect one out of two people age 50 and older, and 15 to 25 percent of all adults.
Who usually has varicose veins and spider veins?
Many factors increase a person’s chances of developing varicose or spider veins. These include:
- Increasing age
- Family history of vein problems or weak vein valves
- Hormonal changes that may occur during puberty, pregnancy and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also increase the risk of varicose or spider veins.
- Pregnancy. During pregnancy, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The expanding uterus also puts pressure on the veins. Varicose veins usually improve within three months after delivery. A growing number of abnormal veins sometimes appear with each additional pregnancy.
- Obesity, leg injury, prolonged standing and other factors that weaken vein valves
- Sun exposure, which can cause spider veins on the cheeks or nose of a fair-skinned person
Why do varicose veins and spider veins usually appear in the legs?
The force of gravity, the pressure of body weight, and the task of carrying blood from the bottom of the body up to the heart make legs the primary location for varicose and spider veins. Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart. They endure the most pressure. This pressure can be stronger than the veins’ one-way valves.
Vein Treatments
- What is conservative treatment?
- What types of treatment can be used for spider veins?
- What types of treatment can be used for varicose veins?
- What surgery treatment can be used?
- What happens to circulation once veins are treated?
- Does the endovenous ablation treatment hurt, and are there side effects?
- Who is not a good candidate for treatment?
- Do the veins ever come back?
What is conservative treatment?
Elevating your legs, or avoiding prolonged standing, and using compressions stockings (non-prescription and prescription) to treat unhealthy veins.
What types of treatment can be used for spider veins?
Sclerotherapy is the most common treatment for spider veins. The doctor injects a solution into the vein that causes the vein walls to swell, stick together and seal shut. This stops the flow of blood and the vein turns into scar tissue. In a few weeks, the vein should fade. The same vein may need to be treated more than once. This treatment is very effective if done the right way. Most patients can expect a 50 percent to 90 percent improvement. Sclerotherapy does not require anesthesia, and can be done in the doctor’s office.
Possible side effects include:
- Temporary stinging or painful cramps where the injection was made
- Temporary red raised patches of skin where the injection was made
- Temporary small skin sores where the injection was made
- Temporary bruises where the injection was made
- Spots around the treated vein that usually disappear
- Brown lines around the treated vein that usually disappear
- Groups of fine red blood vessels around the treated vein that usually disappear
- The treated vein can also become inflamed or develop lumps of clotted blood. This is not dangerous. Applying heat and taking aspirin or Advil can relieve inflammation. Lumps of coagulated blood can be drained.
What types of treatment can be used for varicose veins?
Endovenous techniques — both endovenous laser treatment and endovenous radiofrequency ablation — can be used for treating the deeper varicose veins of the legs (the saphenous veins). They have replaced surgery for the vast majority of patients with severe varicose veins. This technique is not very invasive and can be done as an outpatient.
The doctor puts a very small tube called a catheter into the vein. Once inside, the catheter sends out radiofrequency or laser energy that shrinks and seals the vein wall. Healthy veins around the closed vein restore the normal flow of blood. As this happens, symptoms from the varicose vein improve. Veins on the surface of the skin that are connected to the treated varicose vein will also usually shrink after treatment. When needed, these connected varicose veins can be treated with sclerotherapy or other techniques.
Possible side effect is slight bruising.
What surgery treatment can be used?
Through ambulatory phlebectomy, tiny cuts are made in the skin and surgical hooks pull the vein out of the leg. This surgery requires local or regional anesthesia. The vein usually is removed in one treatment. Very large varicose veins can be removed with this treatment while leaving only very small scars. Patients can return to normal activity the day after treatment.
Possible side effects:
- Slight bruising
- Temporary numbness
- Temporary bleeding
What happens to circulation once veins are treated?
Varicose veins and spider veins are diseased and defective veins that are no longer working appropriately. Getting rid of them is not harmful. Because there are so many veins in the legs, the blood that would have flowed through a treated vein is now rerouted to stronger and healthier veins. The loss of diseased veins does not create a problem for the circulatory system.
Does the endovenous ablation treatment hurt, and are there side effects?
Most treatments involve very little to no pain. Temporary bruising is the most frequent side effect. Serious side effects are possible with any medical procedure or medication, but compared to traditional hospital surgery for veins, serious side effects are extremely rare with our advanced techniques.
Who is not a good candidate for treatment?
Those suffering from a blood clot in the deep veins (determined during the Venous Duplex Scan), and those who are not able to actively walk should not undergo treatment. Also, patients should wait at least three months after pregnancy or major surgery before having treatment for varicose veins. It is also advisable to defer treatment of varicose veins until patients have completed breast feeding.
Do the veins ever come back?
After completing treatment, patients can enjoy healthier, more attractive, pain-free legs. The treated veins do not come back but new varicose veins can potentially occur in the future. However, because the initial treatment is so thorough, any new veins tend to be less severe and are more easily dealt with. Periodic touch-up treatment can help patients enjoy their life free from problem veins.
Starting Treatment
- Is an evaluation necessary?
- Is treatment of varicose veins covered by insurance?
- How can I get started?
Is an evaluation necessary?
In order for veins to be treated properly, the exact location of the venous reflux first needs to be identified. This is accomplished by an advanced ultrasound-imaging test called a Venous Duplex Scan, which creates a “map” of patients’ veins by pinpointing the exact location of the damaged valves. This important test is painless, non-invasive, takes about 30 minutes to perform, and is covered by Medicare and most health insurance plans. Armed with this information, we can then determine the best treatment plan, estimated cost, and the anticipated outcome.
Is treatment of varicose veins covered by insurance?
Treatment of symptomatic varicose veins is typically covered by most insurers. Please contact your insurance company to determine your coverage. Treatment for spider veins is considered a cosmetic procedure by insurance companies; therefore, it is not covered by insurance. Once our doctors have had the opportunity to examine your veins, they can tell you what they would expect the cost of treatment to be.
How can I get started?
Please contact our office at (804) 628-4680 to set up an appointment with Malcolm Sydnor, M.D., or Dan Leung, M.D., at VCU Vein Care.
