What is Vein Disease?
To understand vein disease, which is the primary cause of varicose veins, it’s first important to understand the venous system of the human body. The venous system is the part of the circulatory system that returns deoxygenated blood through veins back to the heart to be recirculated. By contrast, the arterial system carries oxygenated blood away from the heart to be distributed throughout the body. The smallest parts of the venous system are the capillaries, which feed into larger superficial veins.
Our focus on vein disease is on two distinct and common complications as a result of venous insufficiency: varicose veins and spider veins. Both of these progressive conditions create cosmetic concerns, but they can develop into medical issues as well.
Varicose veins are enlarged and twisted rope-like veins that appear near the surface of the skin. While they can develop anywhere in the body, they are most commonly found in the legs and ankles because standing and walking increase pressure in the lower extremities. In normally functioning veins, tiny one-way valves open as blood flows toward the heart and close to prevent blood from flowing backward. When these valves malfunction, blood pools in the veins, resulting in a buildup of pressure that weakens their walls and causes them to bulge. Over time, the increased pressure can cause additional valves to fail. This venous reflux, or venous insufficiency, leads to the development of varicose veins and spider veins.
Spider veins (telangiectasias) are similar to varicose veins, but smaller and found closer to the skin's surface. They take their name from their appearance, which resembles a spider’s web. Usually red or blue in color, they vary in size and can be found in other areas of the body besides the legs, including the face.
Unavoidable underlying causes of chronic venous insufficiency that can lead to varicose veins and spider veins include an inherited genetic predisposition and the normal aging process. Any condition that puts more pressure on leg veins – including standing for long periods of time, being overweight, or pregnancy – can also cause varicose veins or spider veins. Women are at greater risk than men due to hormonal changes that relax vein walls during pregnancy, pre-menstruation or menopause. Birth control pills and hormone replacement therapy may also increase the risk, as do a history of blood clots and conditions that increase pressure in the abdomen, such as tumors, constipation and tight garments like girdles. Other factors include previous venous surgery and exposure to ultraviolet rays.
Varicose veins and spider veins appear most commonly between the ages of 30 and 70. The first physical symptom is usually their appearance. As the disease progresses, the legs begin to feel heavy, tired and achy, and these symptoms worsen with prolonged periods of sitting or standing. Muscle cramping may be accompanied by a burning and throbbing feeling in the lower legs. Varicose veins can also cause a change in skin color (known as stasis pigmentation), dry and thinning skin, inflammation of the skin, open sores and bleeding.
As bad as they may look and feel, varicose veins and spider veins are not usually considered a serious medical problem. However, varicose veins may indicate a critical blockage in deeper veins, a condition called deep vein thrombosis, that can be life threatening. Consequently proper medical evaluation and treatment of varicose veins is important. Because chronic venous insufficiency is a progressive disease, symptoms will worsen if left untreated.
The evaluation includes a visual and physical examination of the legs and feet by a physician, who checks for inflammation, areas that are tender to the touch, changes in skin color, ulcerations and other signs of skin breakdown.
In most cases an ultrasound test is ordered to determine if the valves in the veins are functioning properly and to check for evidence of a blood clot.
If symptoms persist and treatment is required, additional tests are performed to determine the best approach for curative treatment. For decades the only option was the in-hospital surgical ligation and stripping of the veins under general anesthesia. Today’s alternatives include less invasive procedures like endovenous laser treatments like the VenaCure EVLT™ system, and radiofrequency treatment. Varicose veins that have been treated with laser therapy are very unlikely to become varicose again. However, it’s important to note that new veins are still susceptible to developing varicosities.