Varicose veins come in all sizes, ranging from the red or blue dilated capillaries in the skin, commonly known as spider veins, to the big, bulging ropey veins beneath the skin. “Varicose” simply means dilated. The exact cause of varicose veins is unknown, but there are likely multiple contributing factors, including family history and genetics. In addition, women are much more likely to have varicose veins than men due to pregnancy and increased hormone levels of progesterone and estrogen.
Varicose veins can be asymptomatic or cause a variety of symptoms such as aching, throbbing, itching, burning, heaviness and tiredness. On rare occasions, large, bulging varicose veins can sometimes lead to chronic skin changes of pigmentation, thickening, and very rarely, ulceration of the skin.
Since many varicose veins are asymptomatic, they may not require any treatment at all. If a person is not bothered by symptoms, then observation (doing nothing/watchful waiting) is a perfectly reasonable treatment option.
The reason varicose veins cause symptoms is because they're stretched beyond their normal capacity. When a person with varicose veins stands, blood pools in the veins, causing them to stretch. This stretching may be intensified by hot weather or menstruation. In addition, the stretching can put pressure on a nearby nerve, which may also result in heightened symptoms. The goal of compression and elevation is to reduce or eliminate the swelling and stretching of the veins to relieve the patient's symptoms. Patients should elevate their feet higher than waist-level to allow gravity to drain the blood from the veins, and thereby, eliminate the stretching response. External compression, usually in the form of elastic stockings, exerts external pressure on the vein to counteract the internal pressure applied when the patient stands, causing blood to pool, and thereby, the vein to stretch. Compression stockings come in a variety of lengths; knee high, thigh high, and pantyhose style. In addition, they come in a variety of compression strengths, depending upon the severity of the varicose veins. While often effective in treating the symptoms, they do not eliminate the varicose veins. Unfortunately, the stockings are only effective when worn and they can be difficult to put on and take off.
Non-surgical options include laser treatments and sclerotherapy. Currently, external laser treatment is used primarily for spider veins. At Lahey Clinic, physicians in the Department of Plastic & Reconstructive Surgery perform laser therapy to treat varicose veins. Sclerotherapy involves injecting a solution into the vein that irritates the inside lining of its walls and eventually causes the veins to disappear. It is much more effective on small spider veins than on larger, ropey veins. Sclerotherapy is approximately 70 to 80 percent effective in eliminating spider veins, but must be regarded as a treatment and not a cure, as spider veins typically reappear during a patient's lifetime.
Presently, surgery is the best option for eliminating large, bulging varicose veins. These veins are part of the superficial venous system-those veins right beneath the skin. The primary superficial vein, which starts at the ankle and runs up the inner leg and thigh to the groin crease, is called the greater saphenous vein. The greater saphenous vein is often, but not always, involved when there are bulging varicose veins in the leg. Ultrasound testing is frequently necessary to determine the level of involvement with the greater saphenous vein. Surgical excision of varicose veins is called ligation and stripping, although a newer term is “stab phlebectomy.” The removal of bulging varicose veins involves making tiny skin incisions, grabbing the veins with small clamps or hooks, and pulling them out. If the saphenous vein is involved, it may be removed by stripping, which requires an incision in the groin to pull the vein out at knee-level. A newer, less invasive procedure seals the greater saphenous vein closed by using a catheter to generate heat. Although effective, this method is not appropriate for everyone with varicose veins. Surgery for varicose veins is performed on an outpatient basis and can be conducted under general, spinal, or sometimes local anesthesia. Postoperative disability recovery varies with the patient and the extent (invasiveness) of surgery. Surgical complications are few, but may include bleeding, infection, deep vein blood clots, skin numbness and recurrent varicose veins. For further information, please contact the Department of Vascular Surgery at 781-744-8577.