Varicose Veins

What are varicose veins?

Varicose veins are enlarged leg veins that bulge outward and often are associated with leg pain, aching and heaviness. Varicose veins can worsen over time and produce more leg discomfort, leg swelling, blood clots and skin pigmentation changes. We have found a strong correlation with restless leg syndrome (RLS), and many patients with varicose veins and RLS find significant relief after vin treatment.

Normally veins in the leg carry blood from the lower leg to the upper leg against the steady downward force of gravity. Small, fraglie one-way valves in the veins ensure the proper direction of flow up the leg. If these tiny valves are damaged or cease to function normally, the veins lose the ability to push the blood upwards, and the pressure of gravity causes pooling of venous blood in the leg. As this pressure is transmitted from the inner leg to the outer leg, the surface veins bulge, leading to varicose veins. The normally straight veins become overloaded with blood causing the swelling and twisting that you see at the surface of the leg.

Most varicose veins cause symptoms of aching, heaviness, fatigue, itching or swelling.

Patients are born with an overabundance of leg veins, and treatment of these varicose veins is extremely effective, easing the symptoms and improving the appearance greatly. You will never "run out" of leg veins, even if new veins require treatment.

What causes varicose veins in the leg veins?

Varicose veins are caused by venous insufficiency, which prevents the proper flow of blood and allows it to pool in the leg veins. This causes the bulging and symptoms described above. The normal flow of venous blood is up the leg, against the steady force of gravity. One-way valves in the veins propel blood in the proper direction, but if the valves weaken, the direction of flow reverses. This is known as reflux. Venous reflux leads to varicose veins.

The varicose veins that you see on the surface are much larger than normal leg veins and may have a bluish hue due to the increased volume of blood present. The veins may even feel warm to the touch because of the increased volume of blood present so close to the skin.

Genetics plays a big role in determining who is likely to develop varicose veins. In addition, multiple pregnancies, prior blood clots, obesity and leg trauma can lead to these protruding veins.

A duplex ultrasound scan is performed to establish an accurate diagnosis of varicose vein pain and facilitate an effective and durable treatment plan so that the risk of future leg vein problems is minimized.

What are the symptoms of varicose veins?
  • Aching legs, usually worse as the day progresses
  • Throbbing along the enlarged veins where pressure increases
  • Itching at the site of skin discoloration (dermatitis)
  • Swollen legs, especially in the lower legs when blood does not exit the leg normally
  • General discomfort
  • Restless legs, which often respond very well to varicose vein treatments
Who has the highest varicose vein risk?

Varicose veins will afflict approximately 20% of all adults by age 60. Varicose vein risk factors include the following:

  • Women are more likely to suffer from varicose veins than men, though men make up about 20% of our patients
  • Varicose veins may develop during pregnancy or as the result of hormonal changes during menopause
  • Family history can put you at higher varicose vein risk
  • Those suffering from obesity are more likely to have varicose veins
  • Occupational and lifestyle factors requiring long periods of standing can also lead to varicose veins, as can other vein diseases such as blood clots.
What’s the risk of not treating varicose veins?

Left untreated, varicose veins will increase in size and number. Symptoms may worsen and can lead to leg swelling, chronic skin changes such as dermatitis and discoloration – and in severe cases, non-healing ulcerations. These problems make it difficult to sit or stand for long periods of time, which in turn may affect a person’s activity level and quality of life.

What is Restless Legs Syndrome (RLS)?

Restless Legs Syndrome (RLS) affects up to 10% of the U.S. population. RLS is caused by unpleasant sensations in the legs that typically appear when lying down and relaxing or sleeping. People with restless legs experience an uncontrollable urge to move their legs to relieve these sensations. RLS occurs in men and women, though the incidence is twice as high in women. RLS sufferers are often unable to sleep, which negatively impacts many other aspects of life.

Varicose Veins are a form of Superficial Venous Insufficiency (SVI) occurring when valves inside the veins that help transport blood back to the heart become damaged or fail. When this happens, blood flows backwards (toward the feet) and pools in the unhealthy veins, causing them to bulge and protrude above the skin surface.

How are Varicose Veins related to Restless Leg Syndrome?

Recent studies have shown that some people affected by RLS also have a form of venous insufficiency such as varicose veins. Those same studies showed that treating the varicose veins also helps improve the symptoms of RLS.

Treatment Options for Varicose Veins Related to Restless Leg Syndrome

The results of these studies strongly suggest that before initiating or continuing drug therapy, anyone suffering from RLS should be screened for venous insufficiency through the use of ultrasound imaging. If venous insufficiency is found, we would encourage a full review of the risks and benefits of treatment of the veins with the goal of curing the RLS. CVL offers the region's widest range of treatment options, including Microphlebectomy, Sclerotherapy, and VNUS Closure, which have shown to improve RLS symptoms.

Am I at higher risk for varicose veins during pregnancy?

Pregnancy is an exciting time, full of surprises and changes. At Capitol Vein & Laser Centers, we see many pregnant patients who are experiencing some unexpected changes in their legs and other areas. According to the American College of Phlebology, "pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins." These changes can result in the development of varicose veins.

See our Youtube video here to learn more about your varicose veins during pregnancy.

Common Leg Health Problems During Pregnancy

Swollen feet, tired aching legs, and a feeling of heaviness in the legs are among everyday symptoms that may be experienced as a result of varicose veins. These symptoms are more frequent when the woman:

  • has a history of varicose veins,
  • has a history of venous disease within her family,
  • was already experiencing a venous condition prior to the pregnancy,
  • sits or stands for prolonged periods of time,
  • does not exercise regularly during the pregnancy, or
  • has had more than one pregnancy.
What should I know about vaginal varicose veins during pregnancy?

Some women, especially those who have had prior pregnancies, develop large, tender vulvar varicose veins. Vulvar varicosities tend to get worse with each successive pregnancy and as you get older. The cause is usually due to some degree of pelvic vein reflux (backflow) exacerbated by the elevated estrogen and progesterone that occurs during pregnancy. Treatment options are limited during the pregnancy, though many of the vaginal varicose veins will regress soon after delivery.

Swollen vulva and leg veins often occur together and can be quite uncomfortable for the expectant mother, worsening with each trimester. For management and comfort, we recommend an evaluation and venous ultrasound to assess for venous insufficiency. This will allow us to understand the source of your bulging veins and better manage your care during the remainder of your pregnancy. We recommend the V2 Supporter to help ease discomfort from vulvar varicosities. The vulvar supporter can also help relieve other symptoms common during pregnancy including painful or swollen labia and perineum pressure.

What can I do post-pregnancy?

Though a vein specialist can provide recommendations on how to relieve your varicose vein symptoms during pregnancy, they should not provide treatment until after the baby is delivered. Even if the patient plans to have another baby, Drs. McNeill and Rosenberg advise seeking an evaluation and treatment between pregnancies. A vein specialist can evaluate the leg with duplex ultrasound and will likely use the Closure Procedure (VNUS Closure) or micro-phlebectomy as treatment. Both are in-office procedures done under local anesthesia, and most patients can return to normal activity the same day.

What are venous stasis ulcers?

Venous stasis ulcers occur on the lower legs and ankles. They appear because elevated pressures within the veins, due to reflux (backflow) is transmitted to the skin, causing damage, fragility and eventual breakdown. Varicose veins are a manifestation of the same reflux in veins under the skin.

The low level chronic inflammation of the subcutaneous tissues, in response to the elevated venous pressures, leads to breakdown of the normal tissue integrity with eventual ulceration in many patients.

Simple treatment of varicose veins and venous reflux can essentially eliminate the risk of developing venous ulcers as blood flow in the leg normalizes. This is done primarily by ablating incompetent saphenous veins with VNUS Closure, or removing surface veins with microphlebectomy. Both of these office based procedures are very effective at restoring your normal venous flow.

Once a venous stasis ulcer develops, we generally refer patients to the local wound care center for intensive wound management nurse or therapist trained specifically in wounds. We will evaluate our patients with venous duplex scans to assess the vein flow and the areas of reflux needing treatment. The vein treatment is often done while the ulcer is in its healing phase so we can speed the rate of healing and reduce the risk of recurrence.

We strongly advise patients with varicose veins, especially those who notice darkening of the ankle skin, to seek early evaluation so we can reduce the risk of venous stasis ulcer formation.

Spider Veins

What are spider veins?

Spider veins are capillary veins which are easily visible through the skin, and generally appear as tiny webs of red, blue, or purple lines. Spider veins can become quite noticeable when they accumulate in sufficient number. Because of their small size and superficial location, spider veins rarely account for any symptoms in the legs. Although they are rarely a medical issue, many of our patients seek to get rid of their spider veins to enhance the aesthetic appearance of their legs.

Who is at risk for spider veins?

Spider veins are very common. In fact, most people eventually have spider veins on their legs. Generally, they develop more often in women (50-55%) than men (40-45%). We do not really know why spider veins develop. Most of the treatments we perform for spider veins are for our female patients.

Are spider veins a medical issue or just cosmetic?

Spider veins are rarely a serious health problem. Very rarely spider veins will become so large and fragile that they will bleed. This usually occurs in patients with very dense spider veins around the ankles. The ankles almost appear to be purple because of the density of the veins. Other symptoms that may be present in the area of spider veins usually cannot be attributed to the veins. These sensations or symptoms have explanations other than the spider veins.

Are spider veins related to varicose veins?

Spider veins occur independent of varicose veins and vice versa. Patients with severe varicose veins many not have any spider veins. People with terrible spider veins may have not one varicose vein. We consider the two types of veins to be independent of one another. When we treat patients with both varicose veins and spider veins we generally treat the varicose veins first so that the health of the leg is optimized.

What causes spider veins?

Spider veins can develop for a number of reasons, but the primary causes appear to be heredity and hormonal shifts. They can occur in both men and women of any age, but are typically not a serious health problem. Age and lifestyle can also play a role in the development of spider veins. You can help reduce your risk by following some simple lifestyle tips.

Can spider veins be prevented?

Since the predisposition to spider veins is mainly genetic and also linked with hormonal changes and environmental elements, there is really no way to prevent spider veins from developing.

Ways to Help Reduce Your Risk

  • Use sunscreen, even during the winter, and pay special attention to your face.
  • Limit your exposure to smoke.
  • Exercise regularly. This not only helps your leg health in general,
  • but improves overall circulation.
  • Walk around or stretch if you've been sitting or standing for a long period of time.

Hands, Face & Breast Veins

What are hand veins and how can I treat them?

Premature aging of the hands is an aesthetic issue for many women. Constant sun exposure, inadequate sun protection, and the general loss of normal tissue turgor as we age lead to discoloration, age spots, and prominent hand veins.

Women take great care in maintaining a youthful face and often consider IPL, botox and filler to look their best. The hands, however, are frequently neglected.

We have found that our patients are very excited about hand rejuvenation. Sclerotherapy, just as we perform on leg veins, can be easily done in the hand to allow your unsightly veins to shrink and be absorbed. The procedure is generally very tolerable and causes very little discomfort. As with the legs, several weeks are needed to allow these veins to resolve. Some larger hand veins can also be treated with phlebectomy (vein extraction), which is done under local anesthesia in the office with immediate return to normal activity. Both procedures require a brief period of compression and may be associated with some temporary bruising.

Filler, such as Radiesse or Restylane, can also be placed in the back of the hand for rejuvenation and this will help mask the prominent tendons and ligaments that appear with age.

You should be aware that large unsightly hand veins pose no medical risk and they will not bleed or clot if left alone. We only consider treatment of these veins if the patient specifically requests a cosmetic improvement in the hand appearance. There is also no medical consequence to not having these veins.

Women with prominent age spots on the back of the hand can greatly benefit from Intense Pulsed Light (IPL). This treatment uses a light source to improve the health and appearance of the pigmentation and give a more uniform appearance to the skin of the hands.

What are facial spider veins and how can I treat them?

Spider veins can be frustrating, especially when they appear on your nose and cheeks. The causes of facial spider veins are generally heredity, hormones, and free radicals, like sun exposure and smoke.

Though they pose no health threats, facial spider veins can cause anxiety since they are not easy to hide. Treatment for facial spider veins can be completed in office with minimal side effects.

Tiny veins are treated with VeinWave, a device that applies heat to these vessels, leading your body to absorb them. Occasionally a repeat treatment is needed for best results.

Slightly larger veins on the nose can be treated well with sclerotherapy. This involves using a tiny needle to inject a special medication into the veins, leading your body to shrink and eventually absorb them. The only aftercare necessary is to avoid strong sun exposure by using an effective sun screen.

To reduce your risk of developing facial spider veins, take care of your face by applying an SPF appropriate sunscreen when you're going to be outdoors, even during winter months. As heredity plays a role in your facial veins, we cannot change the likelihood of developing new vessels, but we can effectively treat what is currently present.