Spider veins (or thread veins), medically known as telangiectases are dilated capillary veins less than 2mm. in diameter. They are small blue to red appearing blood vessels that lie close to the surface of the skin and occur either in lines or web-like patterns. They are usually visible on the legs but sometimes are visible around the nose and lips and are commonly referred to as “broken veins.” While they can ache, burn or itch now and then, but they are usually not symptomatic. Spider veins are not harmful and are simply unsightly.
Varicose veins are ropy appearing blue vessels under the skin, usually 1½ inch or larger in diameter. They are most often branches from the saphenous trunk veins, and have enlarged due to the excess pressure in the saphenous system. Varicose veins are unsightly and often painful. A clotted varicose vein causes the classic phlebitis, hot and red and painful skin at the site of the clot. Beside the visible symptoms, physical symptoms are tiredness, restless legs at night, heaviness in the leg, pain, aching, itching, throbbing & swelling, burning or a cramping sensation.
Occasionally, severe varicose veins can damage the skin of the leg above the ankle causing itchiness and discoloration (eczema). Without treatment an ulcer may eventually occur.
After a comprehensive evaluation that includes an ultra-sound examination of the veins, your vein specialist will determine the optimal treatment for each patient’s needs. Occasionally an x-ray will be needed before advice about treatment can be given.
Do I need treatment?
Treatment for varicose veins is seldom essential since serious complications rarely occur. The choice is yours and many patients have varicose veins for the whole of their adult life and never suffer any problems with them.
How can I help myself?
Avoid being overweight and wear support stockings if you have to stand up a lot of the time. Regular exercise such as walking also helps to pump the blood out of the leg. Dry itchy skin can often be helped by moisturising (emollient) creams or bath additives available at the chemist.
If I need treatment, what treatments are available?
1. Support Stockings
These may be all that is required if aching and swelling are the main problems. Properly fitted medium-strength compression stockings up to the knee usually work best.
2. Ultrasound-guided Foam Sclerotherapy (injections)
This is a new development of a long established treatment for varicose veins. A small amount of a special chemical (Sclerosant) is mixed with air to make a foam (this is the new bit – although the chemical is approved to treat varicose veins it is not licensed in the UK for mixing with air to make a foam). Under ultrasound monitoring the foam is then injected into each vein and the leg is bandaged and placed in a full length stocking for a week. The foam causes inflammation in the vein which then shrivels up and eventually becomes less visible. Sometimes the inflammation can be uncomfortable for a few weeks, and occasionally the skin can blister and become scarred.
Injections are not a form of “invisible mending”, and cause some skin staining in more than a third of patients. This usually resolves within 12 months but can occasionally be permanent. Other complications which occur in about 5-10% of patients include allergic reactions, temporary visual disturbance, deep vein thrombosis (DVT), and headache.
3. Traditional Operation
Until recently more severe varicose veins were often treated with surgery. This is performed under a general anesthetic. The visible varicose veins, marked before the operation, are removed through a series of small cuts which are then closed with adhesive strips or stitches.
More importantly a cut is commonly made in the groin over the top of the main varicose vein and the leaky valves are tied off (sometimes this is also done behind the knee). The cut in the groin is closed with a stitch, usually hidden under the skin. The vein in the thigh may also be removed (stripped) to reduce the risk of varicose veins returning, however blood can still flow up the leg along deeper, unaffected veins. The leg is then bandaged and placed in a full length stocking for a week.
Operation can still be used to treat most varicose veins and a few patients with varicose veins are still best treated by this type of surgery. Most patients are able to go home the same day after their operation, but you are not usually able to resume driving for 2 weeks, and it may take this long to resume your normal activities after surgery.
Complications of conventional surgery include occasional bleeding from the wounds, infection in the groin wound, deep vein thrombosis (DVT) and some numbness and/or pain in various places in the leg. These usually settle within a few months; rarely a small area of permanent numbness remains. Bruising, especially along the inner thigh is common in the first week or two after the operation and this can require painkillers until the inflammation eases. The scars on your legs will continue to fade for many months.
4. The Closure® Procedure
The VNUS Closure Procedure, an alternative treatment option to traditional vein stripping surgery, brings state-of-the-art technology to an age-old disease.
The Closure procedure is performed on an outpatient basis and only requires a simple local anaesthetic. Using ultrasound, your surgeon will position the Closure catheter into the diseased vein, through a small opening in the skin. The tiny catheter delivers radiofrequency (RF) energy to the vein wall. As the RF energy is delivered and the catheter is withdrawn, the vein wall is heated, causing the collagen in the wall to shrink and the vein to close. Once the diseased vein is closed, blood is re-routed to other healthy veins.
Following the procedure, a simple bandage is placed over the insertion site, and additional compression may be provided to aid healing. Your doctor may encourage you to walk, and to refrain from extended standing and strenuous activities for a period of time.
More than 70% of varicose veins are suitable for day case treatment using the Closure procedure. There may be a few visible varicose veins left after treatment, but these do not cause symptoms and become less visible with time. As with any surgical procedure there is a small risk deep vein thrombosis (DVT).
We do not know how VNUS treatment compares with conventional treatment in the long term, although results over the last 5 years appear to be as good as or even better than surgery.
Patients who undergo the Closure procedure typically resume normal activities within a day.
Highlights of the Closure® procedure
- Relief of symptoms
- Resume normal activity within a day
- Outpatient procedure
- Procedure carried out under local anesthesia
- Good cosmetic outcome with minimal to no scarring, bruising or swelling
5. Endovenous laser ablation (EVLA)
This procedure is similar to the Closure procedure, but uses laser energy to seal the vein closed. The main differences are that there is less information about the long term results of the procedure, and a greater number of patients (about one quarter) experience significant discomfort that comes on about 5 days after the treatment, and lasts for a few days.