October 1st, 2012
I recently posted a comment on my Facebook page asking for topics that would make good blog posts. I got some private messages with requests which I will honor, but will answer the lone public post first (to encourage more of you to post public comments, as much as anything else).
Prominent leg veins are unsightly, and unfortunately become more prominent and prevalent as we age. For one reason or another, men don't seem to be bothered with the cosmetic problems venous disease can cause (I'm not saying they aren't, it just doesn't seem to be discussed much). For women, on the other hand, they can be the cause for great concern and quickly become a constant source of worry. However, it doesn't seem like anyone talks or does much about them, despite them being a problem that over half of all women of childbearing age is affected with.
There are two main types of prominent leg veins - varicose veins and spider veins. These are essentially the same thing, that differ only in the size of the veins in question. Varicose veins are the larger of the two, while spider veins are much smaller and less prominent (although equally unsightly).
Both varicose and spider veins are caused by insufficiency of the veins that are affected. Veins are one-way blood vessels with small one-way valves in them that keep blood from being pumped backwards towards the skin. If and when those valves stop working, blood will pool in the veins instead of being returned to the heart. It is this pooling of blood that results in the discoloration or dilation of the visible veins in the legs.
Varicose veins are much larger veins, and appear as twisted, bulging "cords" in the legs, and are often raised above the surface of the skin. Spider veins, on the other hand, tend to be flat and very fine blue or red lines in a "starburst" type of pattern. They are commonly present on the legs or face, and can be worse in women who are pregnant, on birth control, or even in women going through menopause. Sun exposure can make spider veins worse, as well.
Treatment is aimed at either removing or destroying the offending vein or veins. There are a number of ways - both non-surgical and surgical - to accomplish this.
Sclerotherapy is a common treatment and involves injecting a chemical into the veins which causes the vessel walls to swell closed and scar down, essentially destroying the vein itself. There is almost no down time from this procedure, which is done under local anesthesia in the office.
Another in-office procedure that is available is laser therapy. A laser is used to transmit bursts of laser light through the skin and destroy the veins. These treatments are limited in they can't treat larger veins, and usually 2-5 treatments are needed to eliminate the vein itself.
Endovenous ablation is a technique that can also be done using local anesthesia. This is better for larger veins - a catheter is introduced into the vein and either laser light or radiofrequency pulses are used to destroy the vein from the inside. Some smaller spider veins that persist after endovenous ablation can be taken care of with sclerotherapy.
Lastly, vein stripping can be used to remove large varicose veins. During this procedure, small incisions are made and the veins are removed through the skin (much like winding up a garden hose). This is done in the operating room, and requires a few weeks to return to full activity. Obviously, it also leaves permanent scars, and is usually done for varicose veins that are causing skin problems or wounds of the legs.
With both varicose veins and spider veins, the key is prevention. While nothing is 100% effective in preventing them the following can help: