Varicose Veins, CVI

What are varicose veins?

Varicose veins are enlarged, twisted blood vessels that are caused by the weakening of the vessel wall. These veins have a blue or purple appearance that can been seen just below the surface of the skin.

Varicose veins are a common condition that can appear anywhere on the body, though they usually appear in the legs, feet, or pelvis areas due to added pressure on the veins from standing and walking. For some people, this can cause moderate pain or discomfort, blood clots, sores, and other problems. But for others, varicose veins are more of a cosmetic problem.

Veins play a key role in the circulatory system. The heart pumps blood to the lung to pick up oxygen, then the oxygen-rich blood pumped to the rest of the body through arteries. Along the way, the blood flows through tiny blood vessels called capillaries, which supplies oxygen to the body’s tissues. The blood then returns to the heart through veins to pick up more oxygen. Veins have tiny valves that keep the blood from flowing backward. If these valves are weakened or damaged, blood can pool in the veins and cause them to swell, which can result in varicose veins.

Risk factors for developing varicose veins include:

  • family history – if others in your family have had varicose veins, there is a higher risk that you will, too
  • older age – as you age, the valves in your veins that regulate blood flow can weaken or become damaged, or the veins themselves can lose their elasticity, allowing blood to flow back into the vein and collect instead of flowing to the heart
  • gender – four times more women have varicose veins than men, which may be due to hormonal changes that occur in women during premenstruation, pregnancy, or menopause; female hormones can relax vein walls, which allows more blood to collect
  • obesity – being overweight places additional weight on your legs, putting added pressure on your veins
  • lack of movement – standing or sitting for long periods of time can keep your blood from flowing properly

Varicose views can also lead to other complications, including a condition called superficial thrombophlebitis. This is a blood clot that occurs in a vein that is close to the surface of the skin, and may cause pain and other problems around it. Varicose veins can also cause dermatitis, which is an itchy rash affecting the lower leg and ankles.

Varicose veins are treatable, and can be controlled through lifestyle changes and medical procedures.

What are the symptoms of varicose veins?

Varicose veins typically have few signs and symptoms. The ones that do develop, usually appear before age 40 and don’t cause any pain. They may include:

  • large swollen clusters of purple or blue veins just under the surface of the skin
  • mild swelling of the legs, ankles, and feet
  • painful, achy, or a heavy feeling in the legs
  • muscle cramps, burning, or throbbing in the legs
  • leg muscles that tire easily
  • itching around one or more veins particularly on the lower leg or ankle
  • brown discoloration around the varicose vein
  • soreness on the back of the knee
  • worsened pain after standing or sitting for an extended period of time
  • skin ulcers near the ankle

Smaller veins that are red or blue that form what looks like a web or patterns of a tree branch are called spider veins. They appear close to the skin’s surface, vary in size, and can be found on the legs or the face. Spider veins may be a sign of another, more serious condition.

If you have any of these signs or symptoms, you should make an appointment to see your doctor.

How are varicose veins diagnosed?

Varicose veins are typically diagnosed by your doctor during a physical exam. However, your doctor may order additional testing to assess the extent of the problem or to make sure your symptoms aren’t being caused by another condition.

During your physical exam, the doctor will evaluate your legs while you are standing to check for signs of swelling. He or she will also ask about any signs or symptoms you are having, and to describe any pain or aching in your legs.

If the doctor decides to order tests, the most common types for varicose veins include:

  • ultrasound, which creates a picture of the blood flow in the veins near the skin’s surface; it can also show blood clots that may be blocking the flow of blood. This is a noninvasive test during which warm gel is applied to your skin and a small handheld device is moved over the affected area of your leg; the images are transmitted to a monitor to help your doctor diagnose your condition
  • angiogram, which involves injecting a dye into your veins so that they can be highlighted on x-ray images so that doctors can evaluate the blood flow in the veins; this test is less commonly used than the ultrasound

Once your doctor has diagnosed you as having varicose veins, you may be referred to a vascular medicine specialist or vascular surgeon, who both specialize in blood vessel conditions.

How are varicose veins treated?

The goals for treating varicose veins include relieving symptoms, preventing complications, and improving their appearance. If you have no or few symptoms, your doctor may suggest lifestyle changes, which may include the use of compression hosiery. If your symptoms are more severe—which includes pain, blood clots, or skin disorders caused by varicose veins—your doctor may want you to have one or more medical procedures.

Lifestyle changes

Making some basic changes in your life is often the first step in treating varicose veins. Such changes can play a key role in stopping the affected veins from getting worse, reducing pain, and keeping other varicose veins from forming.

Here are some simple lifestyle changes you can make to help treat your varicose veins:

  • avoid standing or sitting for extended periods of time; try not to cross your legs when sitting
    keep your legs elevated (preferably above the levels of your heart) when sitting, lying down, or sleeping
  • exercise to get your legs moving and to improve muscle tone, which helps blood move through your veins
  • lose weight if you are above your ideal weight to improve blood flow and reduce pressure on the veins in your legs
  • avoid tight clothing, particularly around the waist, groin/upper thighs, and legs, which can make varicose veins worse
  • wear low-heeled shoes, which helps tone calf muscles for improved blood flow

You may also want to consider using compression stockings, which are made of a special elastic that provides gentle, but steady pressure to relieve aching legs. Wearing them all day helps veins and leg muscles move blood more efficiently and keeps blood from pooling and legs from swelling.

Compression stockings come in three types:

  • support pantyhose, which offers the least amount of pressure
  • over-the-counter (OTC) compression hose, which provides more pressure than support pantyhose and can be purchased in pharmacies or medical supply stores
  • prescription-strength compression hose, which offer the highest level of compression and need to be custom-fitted; these are also available in pharmacies or medical supply stores

Medical procedures

If lifestyle changes and/or compression stockings don’t provide enough relief, or if your condition is more severe, medical procedures may have to be performed to remove or close your varicose veins. Though these procedures can help with your current varicose veins, they won’t stop new ones from forming.

Depending on the size and location of your varicose and spider veins, treatment could include injections, surgery, or laser surgery. The good news is that these procedures are less invasive and, for the most part, can be performed on an outpatient basis. There’s also no need for a long, uncomfortable recovery, because side effects are typically minimal and include bruising, swelling, skin discoloration, and slight pain.

Medical procedures for the treatment of varicose and spider veins include:

  • sclerotherapy, which involves injecting a solution into small- or medium-sized varicose and spider veins, causing irritation and scarring; within a few weeks, the vein closes and fades away. This procedure may require more than one session every 4 to 6 weeks, which is performed in the doctor's office under local anesthesia. After treatments, the legs are wrapped in elastic bandaging to promote healing and reduce swelling.
  • laser surgery, which applies strong bursts of light onto small varicose veins or spider veins, making them fade away without the use of needles or chemicals
  • photoderm therapy, which uses an intense pulsed light to treat certain sizes of varicose veins and small spider veins; this procedure may be recommended if sclerotherapy or laser surgery do not effectively treat the affected vein
  • endovenous ablation therapy, which involves making a small cut in the skin, then inserting a small tube called a catheter into the varicose vein; a device on the tip of the tube heats up inside the vein to close it off. The area around the vein is numbed and you are awake during the procedure; you can usually go home the same day.
  • endoscopic vein surgery, which also involves making a small cut in the skin, then inserting a catheter into the varicose vein; here, a camera with a small device at the end of the tube is used to close the vein. This method is only used in severe cases when the varicose veins are causing skin sores or ulcers on the leg.
  • ambulatory phlebectomy, which is used to remove small varicose veins that are close to the skin surface by making a series of small cuts to the skin. The doctor will numb the area around the procedures, and you can go home the same day.
  • vein stripping and ligation, which involves tying shut and removing a long varicose vein through small cuts in the skin. This procedure is performed in the hospital by a vascular surgeon on an outpatient basis; you will be asleep and won’t feel any pain.

Advanced Cardiovascular Care at Jeanes Hospital

If you're experiencing symptoms or believe you may have varicose veins, the academic-level vascular surgeons at the Temple Heart & Vascular Institute at Jeanes Hospital are ready to assist in the diagnosis and treatment of your condition. From patient consultation to a full range of diagnostic tests and surgical procedures, our Temple doctors are prepared to help you understand and manage all aspects of your condition.

The Temple vascular surgeons at Jeanes Hospital evaluate hundreds of patients every year, managing a wide range of serious vascular conditions. After careful evaluation, they can develop and oversee a treatment plan tailored to meet your specific needs.

If surgery is required, there’s no need to travel to another institution to have it done. Since 2006, Temple vascular surgeons have been performing vascular surgery and procedures at Jeanes Hospital. Our surgeons are supported by a full-time team of anesthesiologists, surgical technicians, and critical care nurses. Dedicated nurse practitioners also collaborate with surgeons to manage patient care in Jeanes Hospital and in our outpatient settings.

Procedures performed here for the diagnosis and treatment of varicose veins include:

  • sclerotherapy for varicose and spider veins
  • endovenous laser surgery
  • radiofrequency ablation in peripheral venous disease

This is the level and quality of care you would expect to find downtown or in another city. Yet, it’s available right here, in your own community.

To schedule an appointment with a vascular surgeon at the Temple Heart & Vascular Institute at Jeanes Hospital, click here or call 215-728-CARE (2273).

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