By submitting a question to VascularDoc and selecting “I agree”, I am stating that I agree that all answers from VascularDoc are written in general terms and that this information should be used only as background material for discussions with my own physicians and surgeons. I agree that answers written by VascularDoc are not opinions about my condition or treatment and should never replace consultation with my own physicians. By selecting "I Agree" below, I am also stating that I agree that my question may be used as a source of information and education for other readers. I understand that none of my personal information (including my e-mail address) will ever be published or shared with any other party.
This is a very common condition affecting the veins of the lower extremities in millions of people in the USA. Women are affected nearly twice as frequently as men but it is not at all uncommon for men to be affected. The anatomy of the veins of the leg is basically that of two parallel systems that extend from the foot to the groin. The “deep veins” are located within the muscles of the legs. The “superficial veins” are located just beneath the skin. The main superficial veins are called the "greater saphenous vein" (on the inside of the thigh) and the "lesser saphenous vein" (behind the knee and extending down the back of the calf). These veins are not required for the normal functioning of the leg. In fact, these are the veins that are removed from the leg when they are needed to create a "bypass" for blocked arteries in the heart or some other portion of the body.
When these superficial veins become large, bulging, and tortuous, they are called “varicose veins”. The condition results from a weakness of the valves within the veins. This weakness can be hereditary, or acquired due to occupations associated with prolonged standing, or due to an injury to the valves within the veins of the leg (see Video #13).
Varicose veins can be relatively mild in appearance (although even the “mild” form can be painful) such as what are called “telangiectasias” or “spider veins (see photo 1), or they can be huge veins which are easily visible – sometimes being so large that they can be seen bulging through a pair of pants (see photo 2).
In addition to the cosmetic considerations associated with varicose veins, there can be very significant leg symptoms associated with varicose veins. These symptoms include:
Over the course of years, varicose veins can lead to leg swelling ("edema"), brown discoloration of the skin of the leg around the ankles (called "stasis pigmentation"), or actual breakdown of the skin (called "stasis ulceration").
The swelling of the lower legs or “edema” is caused by leakage of fluid (essentially water) out of the varicose veins because these bulging veins are under high pressure.
With prolonged pressure associated with untreated varicose veins, there is actual leakage of blood cells into the tissues of the lower leg. The skin becomes brown in color due to deposition of hemoglobin within the tissues. This “stasis pigmentation” can be associated with itching and thickening of the skin (see photo 3). With time, the skin can become so damaged and fragile that actual “stasis ulceration” can occur (see photo 4). This condition can be extremely painful and, although it rarely leads to limb loss, it is a cause of significant disability and discomfort.
Since the superficial veins in the legs are usually not necessary for normal functioning of the lower extremities (this is the vein that is removed for bypass of blocked arteries in the heart, for example), these veins can be removed without any consequence. One situation where superficial varicose veins of the lower extremities cannot be removed is when the deep veins of the leg are blocked due to previous episodes of phlebitis. In this instance, the superficial veins should not be removed because this may result in significant swelling of the lower extremity. Prior to removing varicose veins of the legs, the patient's surgeon should evaluate the deep system of veins (usually by ultrasound evaluation) to be certain that the deep system is not blocked. Most varicose vein surgery can be performed in the outpatient setting. The following outlines some of the most common treatment options for lower extremity varicose veins:
This is a non-surgical treatment used to eliminate small varicose veins and spider veins. It involves injecting a sclerosant solution into the vein which causes the vein to collapse and disappear. This procedure is performed in the office and generally requires several visits since most people have multiple areas of spider veins on their lower extremities.
Laser treatments can be used for removing spider veins of the lower extremities. This involves no injections and is performed in an office setting.
Endovenous laser treatment is performed under local anesthesia in an office setting. During this procedure, a laser catheter is inserted into a large varicose vein in the thigh and laser energy is used to seal the vein closed. This is a variant on surgical phlebectomy (in which a large saphenous vein of the thigh is actually removed from the patient). The advantage of the laser treatment is that it can be performed in the office under local anesthesia and recovery is faster than if the vein is “stripped” using surgical techniques.
This is a surgical procedure in which small clusters of varicose veins are removed through tiny (1/8 inch) incisions under local anesthesia in the office setting. It is frequently used in conjunction with EVLT of the saphenous vein in the thigh.