Varicose veins: the tangled web they weave

by Anne Martinez

One in ten Americans, predominantly women, will develop varicose veins. Although a very common and usually benign condition, many women seek out plastic surgery and newer laser removal techniques for cosmetic reasons.

Your heart pumps blood throughout your body in long, muscular tubes called blood vessels. The tubes that transport the fresh, oxygen-rich blood (and the nutrients it carries) to your vital organs and tissues are called arteries. The tubes that return the blood back to your heart are called veins. In medium-sized veins, a series of valves keeps the blood flowing in the right direction.

Sometimes the valves fail or the muscle walls weaken, and instead of flowing, tiny amounts of blood pool inside the veins. When this happens, the vein bulges and twists, eventually emerging as a "varicose vein." If the varicose vein is near the surface of your skin, it will appear enlarged, lumpy, and dark blue.

Another, less extreme type of varicose vein is a "spider vein." These thin red or purplish networks of very fine veins near the surface of the skin take their name from the pattern they form, often resembling a tangle of spiders. No one knows what causes them. "They run in families and often follow pregnancy, as do all varicose veins," says Dr. Harold Sussman, director of the Marina Laser Center of the Plastic Surgery Associates in Marina del Rey, California.

Although they can appear anywhere, varicose veins appear most often on the legs, especially behind the knees. Spider veins may also develop on the face.

Spider veins are strictly a cosmetic issue and don't affect your physical health. Varicose veins, on the other hand, sometimes have medical consequences if left untreated, says Sussman. They may ache or burn after long periods of standing, and can eventually lead to thrombosis (clotting) or phlebitis, an inflammation of the wall of the vein. "In some people, when the pooling of the blood causes severe varicose veins, you can develop ulcers. That's the end stage, with destruction of the skin," says Sussman.

If you inherited a tendency toward varicose veins, there isn't much you can do to prevent them, says Susman. But it's still a good idea to avoid clothing that restricts blood flow. Try to also avoid long periods of sitting or standing in one position. Regular exercise also helps.

Once you have varicose veins, they're not likely to go away on their own. Custom-fitted elastic stockings, which put pressure on the legs, may alleviate symptoms and keep varicose veins from becoming worse. If your doctor prescribes these stockings, be sure to put them on first thing in the morning, before you even get out of bed.

Periodically during the day, and especially at the end of the day, rest with your feet elevated at least 12 inches above your heart to reduce swelling. You might make it an end-of-day habit to lie back on the couch and prop your feet up on a couple of pillows while you catch up on reading.

If you and your physician decide that the veins are to be removed, there are several options from which to choose. Laser therapy is very effective for spider veins on the face. "With certain types of lasers there's no bruising and basically no down time for spiders on the face," says Sussman. Laser treatment of spider veins on the extremities are another matter. "You can only treat the small veins, and even then you get redness along where the vein was, and then a cat scratch type crusting which lasts two to three weeks," reports Sussman. Laser treatment is also less successful on the extremities.

Because it is considered cosmetic surgery, laser treatment of spider veins usually isn't covered by health insurance.

Although laser therapy can't successfully be used on veins more than one millimeter in diameter, larger varicose veins can be treated by other means. In a procedure called sclerotherapy, a chemical irritant, called a sclerosing solution, is injected into the vein that basically flushes out the blood and causes the vein to swell shut. Hypertonic saline solution, a very heavy salt solution, is the only substance currently approved for this use. According to Sussman, other safer, less painful solutions are expected to receive FDA approval later this year. A vein may require more than one treatment before it disappears.

Potential side effects of sclerotherapy include a stinging sensation after the injection, and in one out of three people, a brownish staining around the treated area that lasts for several weeks or longer. Occasionally a reddish blush of tiny new blood vessels, called a matte, will form adjacent to the treated vein. "It's as if the injury to one [vein] releases a substance that wants to form new ones," explains Sussman. This matting can be treated with lasers.

Something else to keep in mind: even in the best of hands, this treatment is not 100% effective, especially on the legs. "If sclerotherapy is 60%-70% effective, you've done very well," says Sussman. Sclerotherapy cannot correct the problem of reverse blood flow patterns, and for this reason its results are often temporary.

Larger varicose veins can be physically removed through a procedure called ambulatory phlebectomy. A series of tiny incisions is made along the course of the vein, under local anesthesia. A little hook is inserted through the openings and used to grasp the vein, so it can be removed a portion at a time. "It gets rid of them completely," says Sussman.

Although the ambulatory phlebectomies have been performed in Europe for many years, the procedure began to gain acceptance in the United States around 1990, specifically as a replacement for a more invasive procedure called vein stripping. Ambulatory phlebectomy is an outpatient procedure with few side effects.