Varicose and spider veins often become noticeable as we age. Although unsightly, they rarely become medical problems. But just because they are harmless does not mean you have to tolerate them. This article looks at what causes varicose and spider veins and the surgical and non-surgical ways to remove them.

Varicose veins look like jagged purple lines or swollen bluish cords, usually spreading across the thighs and calves. Spider web patterns in red, blue or purple may appear on the legs or on the face. Spider veins are tiny twisted blood vessels that become visible through the skin. Around 60 percent of adults have these faulty or warped blood vessels, which makes them a relatively common problem.

Who gets varicose and spider veins?

Varicose and spider veins occur in both men and women, but usually women are more susceptible to them. Hormonal changes during puberty, pregnancy and menopause, use of birth control pills and postmenopausal hormonal replacement therapy also make women more likely to get varicose and spider veins.

Varicose and spider veins pose a problem for people who are on their feet for prolonged periods, such as teachers, hair stylists, factory and retail workers and nurses. Lack of movement is another factor as is obesity or a history of blood clots. A genetic element is also involved. Anything that increases pressure in the abdomen, including constipation, tumours and even tight-fitting garments can increase the level of risk. Previous trauma or surgery of the legs or the veins and exposure to ultraviolet rays may also contribute to the development of varicose and spider veins.

Causes for varicose and spider veins

Both spider veins and varicose veins are caused by failures in their internal mechanism. When the heart pumps, arteries carry blood to various parts of the body. Once the tissues absorb the nutrients and oxygen from the blood, it is returned to the heart to be sent to the lungs and the digestive system to refuel.

Veins are the blood vessels that return blood to the heart and lungs. Of all the veins in the body, those in the legs have to work the hardest because they have to pump up blood all the way from the foot to the heart against gravity. Leg movements and the resulting squeezing of the calf muscles give the veins a literal leg up in doing their job. In some people, these veins begin to malfunction.

Veins have internal valves, which ensure that blood flows only in one direction, towards the heart. With age, these valves may become faulty, allowing some blood to move in the wrong direction. When blood in the legs moves in the wrong direction, varicose veins and spider veins can result.

Blood pooling in varicose veins causes them to swell, weakening their walls. Pressure builds up, and the affected veins rise to the skin surface like uneven tunnels. While varicose veins can occur anywhere in the body, they are most prominent and commonly found in the legs, ankles and feet.

When valves of smaller or medium sized veins malfunction, they are called spider veins. Tiny veins collect blood and become medium sized veins, then progressively larger veins. Because the distribution of small and medium veins is specific, the spider web formations are localised, unlike the more far-reaching varicose veins.

Reasons for choosing to have a leg vein treatment

Though unattractive, spider and varicose veins do not cause most people any discomfort or ever need to be treated.

In a few cases, however, these faulty veins lead to swollen legs and other medical complications. Varicose veins can cause aching or cramps in the legs. Sufferers describe the affected areas as throbbing, burning or tingling. Severely inflamed veins are tender to the touch. They reduce circulation, which in turn can cause itchiness and swollen ankles. Inflamed veins can also lead to chronic skin and tissue changes, including sores and skin discoloration, especially near the ankles.

Varicose veins can also lead to superficial thrombophlebitis, blood clots that form in a vein just below the skin. You can recognise them by redness of the skin and a firm, tender and warm vein, sometimes with pain and swelling.

Deep vein thrombosis, a blood clot occurring in a deeper vein, is a serious matter. A “pulling” feeling in the calf, warmth, pain, redness and swelling are the usual symptoms. They can also occur without any significant symptoms. A deep vein thrombosis can travel in the body and do significant damage. If it reaches the lungs, for instance, it can be fatal.

If a vein becomes swollen, red, tender or warm to the touch, or if you develop sores or a rash in the leg or near your ankle, contact your physician immediately. If the skin on the ankle and calf become thick and change colour, or if varicose veins begin to bleed, see a doctor at once.

On a lighter note, see a doctor if your leg symptoms get in the way of your daily activities, or if the look of your veins causes you distress.

When people seek treatment for spider veins and varicose veins purely for aesthetic reasons, they are considered cosmetic treatments. Treatments can include both lifestyle changes and medical treatments. The goal of treatment is to relieve symptoms, prevent complications and improve the appearance of the legs.

People without many symptoms may just need a change in lifestyle. Staying away from overly tight clothes, not crossing the legs when sitting down and a diet rich in fibre to avoid constipation are recommended. Elevating the legs at bedtime to 10 to 20 centimetres above the heart level may also help. Seeking alternatives to birth control pills is another possible change.

What to expect

Medical treatments for varicose and spider veins include wearing compression garments, sclerotherapy and surface laser treatments. Endovenous techniques such as radio frequency and laser are used to treat deeper veins.

Compression stockings

Compression stockings put helpful pressure on your veins. They provide overall pressure instead of gradient or graduated pressure, which is necessary in more serious cases. Over-the-counter gradient compression hose provide a bit more pressure and may be available from a chemist. The best form of compression stockings is prescription-strength gradient compression hose. Fitting them requires a trained professional.

Compression stockings can be recommended on their own or as supportive treatments following other procedures.

Sclerotherapy

Sclerotherapy is the most common way to treat both spider veins and varicose veins. If done right, it is very effective. Your doctor injects a liquid chemical into the faulty vein, the walls of the injected vein swell, stick together and become sealed shut. This action stops the flow of blood through the vein, which then turns into scar tissue. Within a few weeks the appearance of the vein will fade. Other veins in the leg will take over the job of the faded veins.

Sclerotherapy can be performed without anaesthesia in your doctor’s office. You should be able to resume normal activities immediately.

With sclerotherapy, the same vein may need to be treated more than once. Usually treatments are scheduled every 4 to 6 weeks. It may be necessary to wear gradient compression stockings afterwards to support healing and reduce swelling.

Possible side effects of sclerotherapy include:

• Stinging, red and raised skin patches or bruises near the injection site. These will disappear over time.
• Brown lines, spots or groups of fine red blood vessels near the treated vein. These too will disappear.
• Lumps of blood getting trapped in the vein and causing inflammation. This is harmless and can be relieved by taking an aspirin or applying heat to the site. If necessary, your doctor can drain the trapped blood.

A method called ultrasound-guided sclerotherapy or echo-sclerotherapy uses ultrasound imaging to guide the needle to the veins needing treatment. It is used in treating veins far from the skin surface. It may also be used following endovenous techniques or surgery if the varicose veins return. Skin sores, swelling and deep vein thromboses are potential side effects.

Surface laser treatments

Spider veins can be treated with surface lasers or intense pulsed light (IPL). The strong bursts of light make the veins slowly fade and disappear. Only people with certain skin types and skin colours can be treated with this technique.

The heat from the lasers can be painful and cooling compresses will be soothing to the skin. Between two to five treatment sessions, each lasting 15 or 20 minutes can help remove spider veins. Larger veins (those over 3mm) cannot be treated with this method.

You can resume normal activities immediately after surface laser treatment sessions for leg veins.

Surface laser treatments may cause redness and swelling in the treated area. This will disappear within a few days. Skin may become discoloured, but that will disappear within one or two months. Burns and scars are possible if unskilled personnel do the treatment. It is best to obtain this treatment in a facility under medical supervision.

Endovenous techniques (radiofrequency and laser)

Endovenous techniques using radiofrequency and laser can be used for treating the deeper veins of the legs. They have for the most part replaced surgery for people with severe varicose veins. These treatments can be performed in a doctor’s office using local anaesthesia.

A tiny probe inserted into the vein produces heat that closes the vein off. The heat may be produced by either radiofrequency or laser energy. Slight bruising may occur at the treatment site.

There will not be any issues with normal blood flow, as other veins take over the work. After treatment, the varicose vein symptoms will improve. Veins closer to the skin may also shrink following treatment. If they do not, sclerotherapy or other methods can be used to treat them.

Surgery

Surgery is mostly used in treating very large varicose veins. A number of techniques are commonly used. These include surgical ligation and stripping, PIN stripping and ambulatory phlebectomy.

• Surgical ligation and stripping – Problem veins are tied off at both ends (ligation), and then completely removed using tiny cuts in the leg skin (stripping). It does not affect circulation of blood in the leg. Ligation and stripping is performed using general anaesthesia in an operating room.
  Recovery takes anywhere from one week to a month.The most common side effect in this leg vein surgery is leg pain. Other risks and complications specific to this procedure include permanent scars, nerve tissue damage around the treated veins and deep vein blood clots. Damages to small nerve branches may occur when larger veins are removed. Nerve damage during legation and stripping can cause changes in sensation, burning sensation in the area or numbness. Blood clots in deep veins can travel to the heart and lungs and are potentially deadly.
• PIN stripping surgery for leg veins gets its name from the instrument used during the procedure. The tip of a PIN stripper inserted into a vein pulls the vein out of the body. PIN stripping can be done under either local or general anaesthesia and may be performed in an operating room or on an outpatient
  basis.
• Ambulatory phlebectomy is a surgical technique that uses tiny cuts made in the skin to pull the vein out of the leg using hooks. An affected vein can be removed in one treatment session. Only very small scars will remain, even after removing very large varicose veins with ambulatory phlebectomy.The procedure is done under local anaesthesia. Normal activities can be resumed the day after treatment. Slight bruising and temporary numbness may occur.

Before and after

There are several things you can do to prepare for any surgery and these apply to leg vein surgeries as well.

There are general steps that can speed up the healing process after surgery.
Follow these and your surgeon’s instructions carefully to ensure speedy healing and a good outcome.

The side effects of each type of surgery or treatment are explained in the What to Expect section of this article. You will be given pain medications to manage any pain.

A set of postoperative instructions will be given to you by your surgeon to help reduce the risk of complications during the recovery period. Make sure to follow those instructions to the word. If there are any doubts, clarify the matter with your surgeon or his/her practice staff.

Some surgical techniques may require you to wear compression stockings during the recovery period.

Possible risks and complications

As with any surgical procedures there are risks involved in each type of leg vein surgery. You should be fully aware of potential risks and complications involved in any surgical procedure before you elect to go through with it. It is always better to err on the side of caution.

Specific complications that may occur during or after each type of leg vein surgery have been explained above, in the What to Expect section of this article.

Just as you would discuss potential benefits before surgery, it is always advisable to ask your surgeon to address the potential risks as they apply to you and advise you on how to avoid or minimise some types of risk.

Rough costs involved

The cost of a leg vein treatment will vary depending on the surgeon or doctor you choose, the facilities used and the exact procedure performed. Your doctor or surgeon will help you estimate potential costs after a consultation.

You may receive Medicare rebates for treatment of varicose veins with ultrasound-guided sclerotherapy and endovenous laser ablation. These small rebates may depend on your individual Medicare circumstances (Safety Net Threshold).

Spider veins are considered a cosmetic procedure and are not covered by Medicare.

This information is correct as of 2019.