Duke Medicine HealthLine
Published: Feb. 20, 2008
Updated: Apr. 2, 2010
Undoing the Webs of Spider and Varicose Veins
D.C. doesn’t fit the stereotype of a varicose vein patient. First of all, he’s a man. He’s also a young graduate student and athlete who’s more likely to be hanging from a rock in the mountains than waiting tables or pursuing another vein-punishing occupation.
“Varicose veins began to form in my legs when I was in high school and worsened over the next 10 years,” he says. “Not only were the veins unpleasantly visible, but my legs often felt heavy, achy, and persistently itchy.”
He had trouble standing for long periods of time -- so much so that he was considering giving up one of his favorite activities: standing in the student section during Duke basketball games.
Duke vascular surgeon Cynthia Shortell, MD, says that too often, patients like D.C. who have painful veins just live with it. “Often physicians will tell patients that there’s nothing more that can be done for their problem,” she says.
Or, worse, physicians will dismiss varicose veins as a cosmetic issue that doesn’t warrant much attention. But spider veins, varicose veins, and other forms of venous disease can also cause serious medical problems such as dangerous blood clots (called deep vein thrombosis, or DVT), ulcers, and skin damage in addition to pain and discomfort.
In normal circulation, veins function as the body’s return service: after arteries deliver oxygen-rich blood to your tissues, veins return the spent blood to your heart for rejuvenation. As muscles contract, the blood is squeezed forward in the veins. When muscles relax, one-way valves within the veins shut to prevent blood from flowing backward.
If vein walls become weak or damaged, or if the valves are stretched or injured, the system stops working normally and blood flows backward when the muscles relax. This is what creates purple varicose veins, or their smaller, sometimes paler counterparts called spider veins.
The damage often results from the force of a person’s body weight, which is why it most often develops in pregnant women and in men and women who spend a lot of time on their feet. Shortell says that a person’s vulnerability to this damage is influenced primarily by his or her genetics.
The effects of backwards blood flow compound the damage to the veins: blood build-up creates unusually high pressure, resulting in even more stretching, twisting, and swelling of the veins. They can even become leaky, allowing fluid inside the veins to leak into surrounding tissue, which then causes swelling.
The result is legs that ache, feel heavy, or even itch. “Sometimes people are afraid to mention some of their symptoms to me because they think it’s silly,” says Shortell of problems such as night cramps and even some cases of restless leg syndrome. “But these symptoms are real.”
Varicose veins aren’t the only forms of venous disease, but they are the most common. The size of the vein has little to do with whether or not it causes pain and swelling, says Shortell, and the treatments for these conditions -- for either medical or cosmetic reasons -- are fast and often nonsurgical.
Spider veins and small varicose veins can be treated with injections called sclerotherapy, a chemical-based process that requires no surgery at all. “Even the most severe cases may not need surgery or anesthesia. There are no incisions, no terrible bruising, no possible nerve damage,” says Shortell.
Larger varicose veins and other venous diseases many need endovenous ablation, a popular treatment approach which can be done with a laser or a radiofrequency catheter. Both therapies seal the vein shut by, essentially, cooking it. “I tell my patients that the process is like closing a Ziploc bag,” Shortell says.
One patient who underwent ablation at Duke says the treatment made her realize how accustomed she’d become to living with painful legs. “Before my treatment, I could actually predict changes in the weather, because changes in barometric pressure in the air caused my legs to throb more than usual,” she says. “Now, unless I check the weather report, I have no idea that a storm is on its way.”
The Duke Vein Clinic answers some common questions about venous disease:
No, crossing your legs does not create enough pressure in your leg to cause your veins to become damaged.
No. Although a tight band can be uncomfortable to existing varicose veins, the stocking or sock band does not create enough pressure to damage a vein.
You may not be able to completely prevent varicose veins, but there are ways to decrease your chance of having them: improving your overall physical health, exercising to help pump blood back to your heart, and maintaining a healthy weight.
It depends -- a doctor can determine if your varicose veins signal an increased risk for blood clots in your deeper veins. “We do ultrasound to test the veins and see how severe the problem is and where it is,” says Shortell. “We also learn a lot from talking with the patient about her symptoms and any previous treatments.”