Varicose veins are enlarged veins that can be blue, red or flesh-coloured. They often look like cords and appear twisted and bulging. The veins are swollen and raised above the surface of the skin. Varicose veins are often found on the thighs, backs of the calves, or the inside of the leg. During pregnancy varicose veins can form around the vagina and anus.

Spider veins are closer to the surface of the skin than varicose veins. They are often red or blue and can look like tree branches or spider webs with their short, jagged lines. Spider veins can be found on the legs and face and can cover either a very small or very large area of skin.

Varicose veins do not usually cause any pain. Some aching in the legs is sometimes experienced. Swelling of the ankles, skin pigmentation and eczema may also occur. Occasionally ulcers develop around the affected veins, which pose a danger in terms of infection.

Causes


The causes of varicose and spider veins are not entirely understood. In some instances the absence or weakness of valves in the veins, which prevent the backward flow of blood away from the heart, may cause the poor circulation. In other cases, weaknesses in the vein walls may cause the pooling of the blood.

Less commonly, varicose veins are caused by such diseases as phlebitis (inflammation of the veins) or congenital abnormalities of the veins. Venous disease is generally progressive and cannot be prevented entirely.

Prevalence


Varicose and spider veins can occur in men and women of any age, but most frequently affect women during their childbearing years and later in life. A family history of the problem, together with the effects of ageing, increases the tendency to develop these vascular abnormalities.

Data from Medicare Australia suggest that the largest group of patients requiring varicose vein treatment are women between the ages of 35 and 64 years.

This condition is not just a cosmetic nuisance; half of all patients who seek treatment do so because of pain and discomfort.

Preventing varicose veins and spider veins


Not all varicose and spider veins can be prevented, but there are some steps you can take to reduce your chances of developing new varicose and spider veins. These same things can help ease discomfort from the ones you already have:

    • Exercise regularly to improve your leg strength, circulation, and vein strength. Focus on exercises that work your legs, such as walking or running.

    • Control your weight to avoid placing too much pressure on your legs.

    • Don’t cross your legs for long periods of time when sitting.

    • Elevate your legs as much as possible when resting.

    • Don’t stand or sit for long periods of time. If you must stand for a long time, shift your weight from one leg to the other every few minutes. If you must sit for long periods of time, stand up and move around or take a short walk every 30 minutes.

    • Wear elastic support stockings and avoid tight clothing that constricts your waist, groin or legs.

    • Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone your calf muscles.

    • Eat a low-salt diet rich in high-fibre foods. Eating fibre reduces the chances of constipation, which can contribute to varicose veins. High-fibre foods include fresh fruit and vegetables and whole grains, such as bran. Eating less salt will reduce swelling, which is associated with varicose veins.



Treatment


Every year, thousands of people consider getting treatment for varicose veins and spider veins. Advertisements for treating them often promote "unique", "permanent", "painless" or "absolutely safe" methods – making it difficult to decide on the best treatment.

If you are considering a procedure, the following information may help:

Varicose and spider veins may be primarily a cosmetic problem. Severe cases of varicose veins, especially those involving ulcers, typically require treatment. Consult your doctor if you are uncertain.

Simple lifestyle changes (described above) may suffice if your varicose veins don’t cause many symptoms. If symptoms are more severe, your doctor may recommend surgical intervention. Some treatment options include:

Compression stockings


These will place constant pressure on your veins.

Sclerotherapy


Varicose veins are frequently treated by eliminating the "bad" veins. This forces the blood to flow through the remaining healthy veins. Several methods can be used to eliminate the affected veins, including, most commonly, surgery or sclerotherapy.

The latter procedure uses a needle to inject a liquid chemical into the vein so the walls 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. Your doctor will tell you about the side effects and success rate.

During sclerotherapy, after the solution is injected, the surrounding tissue is generally wrapped in compression bandages for several days, causing the vein walls to stick together. The vein later turns into scar tissue that fades from view.

Patients whose legs have been treated are put on walking regimens, which forces the blood to flow into other veins and prevents formation of blood clots. Some doctors treat both varicose and spider veins with sclerotherapy. In most cases, more than one treatment session will be required.

Surface laser treatment


This sends very strong bursts of light through the skin onto the vein. This makes the vein slowly fade and disappear. Discuss the success rate and side effects with your doctor.

Endovenous laser therapy


It treats the deeper veins of the legs and has replaced surgery for most patients with severe varicose veins. These techniques can be done in a doctor’s office.

Surgery


This is used mostly to treat very large varicose veins. Types of surgery for varicose veins include:

    • Surgical ligation and stripping, where veins are tied shut and completely removed from the leg through small cuts in the skin. As with all surgery, your doctor will discuss the side effects and risks involved. Surgical removal of varicose veins, commonly referred to as "stripping", is usually done under local or partial anaesthesia, such as an epidural block. Here, the affected veins are stripped out by passing a flexible device through the veins and removing them through an incision near the groin. Smaller tributaries of these veins also are stripped with this device or removed through a series of small incisions. Those veins that connect to the deeper veins are then tied off. This stripping method has been used since the 1950s.

    • PIN stripping, where an instrument called a PIN stripper is inserted into a vein. The tip of the PIN stripper is sewn to the end of the vein, and when it is removed, the vein is pulled out. This can be done in an operating room or an outpatient centre.

    • Ambulatory phlebectomy. With this technique, tiny cuts are made in the skin and hooks are used to pull the vein out of the leg.



Can varicose and spider veins return after treatment?


Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves.

Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.

The single most important thing you can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.

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