Frequently Asked Questions                              Varicose                                                          ...
Frequently Asked Questions                                     is a huge increase in the amount of       	   •	 Heaviness ...
Frequently Asked Questions                                     cause a “pulling” feeling in the calf,       used to see th...
Frequently Asked Questions                                  cause many symptoms. If symptoms are            with healing a...
Frequently Asked Questions                                  painful. Cooling helps reduce the pain.             connected ...
Frequently Asked Questions                                         be used to reduce the chance                 strength. ...
Frequently Asked Questions                                however, more abnormal veins can                  this problem u...
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Varicose & Spider Veins


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"Varicose Veins and Spider Veins". A brochure from U.S. Department of Health and Human Services, Office on Women’s Health

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Varicose & Spider Veins

  1. 1. Frequently Asked Questions Varicose prevent blood from f lowing backwards as it moves up your legs. If the valves become weak, blood can leak back into the veins and collect there. (This Veins and problem is called venous insufficiency.) When backed-up blood makes the veins bigger, they can become varicose. Spider Veins Spider veins can be caused by the back- up of blood. They can also be caused by hormone changes, exposure to the sun, and injuries. 1-800-994-9662 Q: What are varicose veins and spi- der veins? Q: How common are abnormal leg TDD: 1-888-220-5446 A: Varicose (VAR-i-kos) veins are enlarged veins? veins that can be blue, red, or f lesh- A: About 50 to 55 percent of women and colored. They often look like cords and 40 to 45 percent of men in the United appear twisted and bulging. They can States suffer from some type of vein be swollen and raised above the surface problem. Varicose veins affect half of of the skin. Varicose veins are often people 50 years and older. found on the thighs, backs of the calves, or the inside of the leg. During preg- nancy, varicose veins can form around Q: What factors increase my risk of the vagina and buttocks. varicose veins and spider veins? Spider veins are like varicose veins but A: Many factors increase a persons chances smaller. They also are closer to the of developing varicose or spider veins. surface of the skin than varicose veins. These include: Often, they are red or blue. They can • Increasing age. As you get older, look like tree branches or spiderwebs the valves in your veins may weaken with their short, jagged lines. They can and not work as well. be found on the legs and face and can • Medical history. Being born with cover either a very small or very large weak vein valves increases your risk. area of skin. Having family members with vein problems also increases your risk. Q: What causes varicose veins and About half of all people who have spider veins? varicose veins have a family member A: Varicose veins can be caused by weak or who has them too. damaged valves in the veins. The heart • Hormonal changes. These occur pumps blood filled with oxygen and during puberty, pregnancy, and nutrients to the whole body through menopause. Taking birth control the arteries. Veins then carry the blood pills and other medicines containing from the body back to the heart. As estrogen and progesterone also may your leg muscles squeeze, they push contribute to the forming of varicose blood back to the heart from your lower or spider veins. page 1 body against the f low of gravity. Veins • Pregnancy. During pregnancy, there have valves that act as one-way f laps to U.S. Department of Health and Human Services, Office on Women’s Health
  2. 2. Frequently Asked Questions is a huge increase in the amount of • Heaviness blood in the body. This can cause • Swelling veins to enlarge. The growing uterus also puts pressure on the veins. • Rash that’s itchy or irritated Varicose veins usually improve within • Darkening of the skin (in severe three months after delivery. More cases) varicose veins and spider veins usually • Restless legs appear with each additional pregnancy. • Obesity. Being overweight or obese can put extra pressure on your veins. Q: Are varicose veins and spider This can lead to varicose veins. veins dangerous? 1-800-994-9662 A: Spider veins rarely are a serious health • Lack of movement. Sitting or problem, but they can cause uncom- TDD: 1-888-220-5446 standing for a long time may force fortable feelings in the legs. If there your veins to work harder to pump are symptoms from spider veins, most blood to your heart. This may be a often they will be itching or burning. bigger problem if you sit with your Less often, spider veins can be a sign legs bent or crossed. of blood backup deeper inside that you • Sun exposure. This can cause spi- can’t see on the skin. If so, you could der veins on the cheeks or nose of a have the same symptoms you would fair-skinned person. have with varicose veins. Varicose veins may not cause any prob- Q: Why do varicose veins and spider lems, or they may cause aching pain, veins usually appear in the legs? throbbing, and discomfort. In some A: Most varicose and spider veins appear cases, varicose veins can lead to more in the legs due to the pressure of body serious health problems. These include: weight, force of gravity, and task of • Sores or skin ulcers due to chronic carrying blood from the bottom of the (long-term) backing up of blood. body up to the heart. These sores or ulcers are painful and Compared with other veins in the hard to heal. Sometimes they cannot body, leg veins have the toughest job of heal until the backward blood f low carrying blood back to the heart. They in the vein is repaired. endure the most pressure. This pressure • Bleeding. The skin over the veins can be stronger than the one-way valves becomes thin and easily injured. in the veins. When an injury occurs, there can be significant blood loss. Q: What are the signs of varicose • Superf icial thrombophlebitis veins? (throm-bo-f li-BYT-uhs), which A: Varicose veins can often be seen on the is a blood clot that forms in a vein skin. Some other common symptoms of just below the skin. Symptoms varicose veins in the legs include: include skin redness; a firm, ten- der, warm vein; and sometimes • Aching pain that may get worse after pain and swelling. page 2 sitting or standing for a long time • Deep vein thrombosis, which is • Throbbing or cramping a blood clot in a deeper vein. It can U.S. Department of Health and Human Services, Office on Women’s Health
  3. 3. Frequently Asked Questions cause a “pulling” feeling in the calf, used to see the veins’ structure, check the pain, warmth, redness, and swelling. blood flow in your veins, and look for However, sometimes it causes no sig- blood clots. This test uses sound waves to nificant symptoms. If the blood clot create pictures of structures in your body. travels to the lungs, it can be fatal. Although less likely, you might have a venogram. This test can be used to Q: Should I see a doctor about vari- get a more detailed look at blood f low cose veins? through your veins. A: You should see a doctor about varicose If you seek help for your varicose veins, veins if: there are several types of doctors you can see, including: • The vein has become swollen, red, 1-800-994-9662 • A phlebologist, which is a vein spe- or very tender or warm to the touch TDD: 1-888-220-5446 cialist • There are sores or a rash on the leg or near the ankle • A vascular medicine doctor, who focuses on the blood system • The skin on the ankle and calf becomes thick and changes color • A vascular surgeon, who can perform surgery and do other procedures • One of the varicose veins begins to bleed • An interventional radiologist, who specializes in using imaging tools • Your leg symptoms are interfering to see inside the body and do treat- with daily activities ments with little or no cutting • The appearance of the veins is caus- • A dermatologist, who specializes in ing you distress skin conditions If you’re having pain, even if it’s just Each of these specialists do some or all a dull ache, don’t hesitate to get help. of the procedures for treating varicose Also, even if you don’t need to see a veins. You might start out by asking your doctor about your varicose veins, you regular doctor which specialist he or she should take steps to keep them from recommends. You also might check with getting worse (see How can I prevent your insurance plan to see if it would pay varicose veins and spider veins?). for a particular provider or procedure. Q: How are varicose veins diag- Q: How are varicose and spider nosed? veins treated? A: Your doctor may diagnose your vari- A: Varicose veins are treated with lifestyle cose veins based on a physical exam. changes and medical treatments. These Your doctor will look at your legs while can: you’re standing or sitting with your legs dangling. He or she may ask you about • Relieve symptoms your symptoms, including any pain • Prevent complications you’re having. Sometimes, you may have • Improve appearance other tests to find out the extent of the problem and to rule out other disorders. Your doctor may recommend lifestyle page 3 changes if your varicose veins don’t You might have an ultrasound, which is U.S. Department of Health and Human Services, Office on Women’s Health
  4. 4. Frequently Asked Questions cause many symptoms. If symptoms are with healing and decrease swelling. more severe, your doctor may recom- This treatment is very effective when mend medical treatments. Some treat- done correctly. ment options include: Possible side effects include: Compression Stockings • Stinging, red and raised patches of Compression stockings put helpful skin, or bruises where the injection pressure on your veins. There are three was made. These usually go away kinds of compression stockings: shortly after treatment. • Support pantyhose, which offer the • Spots, brown lines, or groups of fine least amount of pressure. These also red blood vessels around the treated often are not “gradient” or “gradu- vein. These also usually go away 1-800-994-9662 ated.” That means they provide shortly after treatment. TDD: 1-888-220-5446 pressure all over instead of where it is needed most. • Lumps of blood that get trapped in the vein and cause inf lamma- • Over-the-counter gradient compres- tion. This is not dangerous. You can sion hose, which give a little more relieve swelling by applying heat and pressure. They are sold in medical taking aspirin. Your doctor can drain supply and drugstores. the trapped blood with a small pin- • Prescription-strength gradient prick at a follow-up visit. compression hose, which offer the There is a type of sclerotherapy called greatest amount of pressure. They ultrasound-guided sclerotherapy (or are sold in medical supply and drug- echo-sclerotherapy). This type of stores. You need to be fitted for sclerotherapy uses ultrasound imaging them by someone who has been to guide the needle. It can be useful trained to do this. in treating veins that cannot be seen Sclerotherapy on the skin’s surface. It may be used Sclerotherapy (SKLER-o-ther-a-pee) is after surgery or endovenous techniques the most common treatment for both if the varicose veins return. This spider veins and varicose veins. The procedure can be done in a doctor’s doctor uses a needle to inject a liquid office. Possible side effects include skin chemical into the vein. The chemi- sores, swelling, injection into an artery cal causes the vein walls to swell, stick by mistake, or deep vein thrombosis (a together, and seal shut. This stops the potentially dangerous blood clot). f low of blood, and the vein turns into Surface Laser Treatments scar tissue. In a few weeks, the vein In some cases, laser treatments can should fade. This treatment does not effectively treat spider veins and smaller require anesthesia and can be done in varicose veins. This technique sends your doctors office. You can return to very strong bursts of light through the normal activity right after treatment. skin onto the vein. This makes the vein The same vein may need to be treated slowly fade and disappear. Not all skin more than once. Treatments are usually types and colors can be safely treated done every four to six weeks. You may with lasers. page 4 be asked to wear gradient compression No needles or incisions are used, but stockings after sclerotherapy to help the heat from the laser can be quite U.S. Department of Health and Human Services, Office on Women’s Health
  5. 5. Frequently Asked Questions painful. Cooling helps reduce the pain. connected veins can be treated with Laser treatments last for 15 to 20 min- sclerotherapy or other techniques. utes. Generally, two to five treatments Surgery are needed to remove spider veins in Surgery is used mostly to treat very the legs. Laser therapy usually isn’t large varicose veins. Types of surgery effective for varicose veins larger than for varicose veins include: 3 mm (about a tenth of an inch). You • Surgical ligation and stripping. can return to normal activity right after With this treatment, problem veins treatment. are tied shut and completely removed Possible side effects of lasers include: from the leg through small cuts in • Redness or swelling of the skin right the skin. Removing the veins does 1-800-994-9662 after the treatment that disappears not affect the circulation of blood TDD: 1-888-220-5446 within a few days in the leg. Veins deeper in the leg • Discolored skin that will disappear take care of the larger volumes of within one to two months blood. This surgery requires general anesthesia and must be done in an • Burns and scars from poorly per- operating room. It takes between one formed laser surgery, though this is and four weeks to recover from the rare surgery. This surgery is generally safe. Endovenous Techniques Pain in the leg is the most common (Radiofrequency and Laser) side effect. Other possible problems These methods for treating the deeper include: veins of the legs, called the saphenous • A risk of heart and breathing (SAF-uh-nuhs) veins, have replaced problems from anesthesia surgery for most patients with severe varicose veins. These techniques can be • Bleeding and congestion of done in a doctor’s office. blood. But, the collected blood usually settles on its own and The doctor puts a very small tube, does not require any further called a catheter, into the vein. A small treatment. probe is placed through the tube. A device at the tip of the probe heats up • Wound infection, inf lammation, the inside of the vein and closes it off. swelling, and redness The device can use radiofrequency or • Permanent scars laser energy to seal the vein. The proce- • Damage of nerve tissue around dure can be done using just local anes- the treated vein. It’s hard to avoid thesia. You might have slight bruising harming small nerve branches after treatment. when veins are removed. This Healthy veins around the closed vein damage can cause numbness, take over the normal f low of blood. burning, or a change in feeling The symptoms from the varicose vein around the scar. improve. Usually, veins on the surface of the skin that are connected to the • A deep vein blood clot. These treated varicose vein will also shrink clots can travel to the lungs and page 5 after treatment. If they don’t, these heart. The medicine heparin may U.S. Department of Health and Human Services, Office on Women’s Health
  6. 6. Frequently Asked Questions be used to reduce the chance strength. Focus on exercises that work of these dangerous blood clots. your legs, such as walking or running. But, heparin also can increase the • Control your weight to avoid plac- normal amount of bleeding and ing too much pressure on your legs. bruising after surgery. • Don’t cross your legs for long times • PIN stripping. In this treatment, when sitting. It’s possible to injure an instrument called a PIN stripper your legs that way, and even a minor is inserted into a vein. The tip of the injury can increase the risk of vari- PIN stripper is sewn to the end of cose veins. the vein, and when it is removed, the vein is pulled out. This procedure • Elevate your legs when resting as 1-800-994-9662 can be done in an operating room or much as possible. an outpatient center. General or local • Don’t stand or sit for long periods TDD: 1-888-220-5446 anesthesia can be used. of time. If you must stand for a long • Ambulatory phlebectomy. With time, shift your weight from one ambulatory phlebectomy (AM-byoo- leg to the other every few minutes. luh-TOHR-ee fluh-BEHK-toh- If you must sit for long periods of mee), tiny cuts are made in the skin, time, stand up and move around or and hooks are used to pull the vein take a short walk every 30 minutes. out of the leg. Only the parts of • Wear elastic support stockings and your leg that are being pricked will avoid tight clothing that constricts be numbed with anesthesia. The your waist, groin, or legs. vein is usually removed in one treat- • Avoid wearing high heels for long ment. Very large varicose veins can periods of time. Lower-heeled shoes be removed with this treatment while can help tone your calf muscles to leaving only very small scars. Patients help blood move through your veins. can return to normal activity the day after treatment. Possible side effects • Eat a low-salt diet rich in high- of the treatment include slight bruis- fiber foods. Eating fiber reduces the ing and temporary numbness. chances of constipation, which can contribute to varicose veins. High- fiber foods include fresh fruits and Q: How can I prevent varicose vegetables and whole grains, like veins and spider veins? bran. Eating less salt can help with A: Not all varicose and spider veins can the swelling that comes with vari- be prevented. But, there are some steps cose veins. you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discom- Q: Can varicose and spider veins fort from the ones you already have: return even after treatment? • Wear sunscreen to protect your skin A: Current treatments for varicose veins from the sun and to limit spider and spider veins have very high success veins on the face. rates compared to traditional surgi- cal treatments. Over a period of years, page 6 • Exercise regularly to improve your leg strength, circulation, and vein U.S. Department of Health and Human Services, Office on Women’s Health
  7. 7. Frequently Asked Questions however, more abnormal veins can this problem under control. develop because there is no cure for The single most important thing you weak vein valves. Ultrasound can be can do to slow down the development used to keep track of how badly the of new varicose veins is to wear gradi- valves are leaking (venous insufficien- ent compression support stockings as cy). Ongoing treatment can help keep much as possible during the day. n For more information For more information on varicose and spider veins, call at 1-800-994- 9662 or contact the following organizations: 1-800-994-9662 TDD: 1-888-220-5446 National Heart Lung and Blood American Society for Dermatologic Institute (NHLBI) Surgery Phone Number: 301-592-8573 Phone Number: 847-956-0900 Internet Address: Internet Address: The American College of Phlebology The American Venous Forum Phone Number: 510-346-6800 Phone Number: 978-744-5005 Internet Address: Internet Address: American Academy of Dermatology Society of Interventional Radiology Phone Number: 847-240-1280; Toll-Free: Phone Number: 703-691-1805; Toll-Free: 866-503-SKIN (7546) 800-488-7284 Internet Address: Internet Address: Reviewed by: Robert J. Min, M.D. Chairman of Radiology Weill Cornell Medical College Melvin Rosenblatt, M.D. Chairman, Public Education Committee American College of Phlebology All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Womens Health in the Department of Health and Human Services. Citation of the source is appreciated. Content last updated June 2, 2010. page 7 U.S. Department of Health and Human Services, Office on Women’s Health