Enlargement of veins over legs is called varicose veins. They are found on thighs and inside and back of legs. Spider veins is another commonly occurring leg vein condition in which the veins look just like varicose veins but are smaller in size. Their appearance resembles the webs of a spider or branches of a tree.
Most of the leg vein disorders are caused by damage to the walls or valves of blood vessels. They affect as many as 40-45 % men and 50-55% women all over the world. Their occurrence is common in older individuals due to weakening of blood vessels and its valves, as the age advances. Patients having family history of leg vein disorders are more prone to suffering from them. They may also occur at puberty and menopause. Use of birth control pills is a predisposing factor for varicose veins. Obesity is another factor responsible for development of varicose veins due to increased pressure exerted over the walls of veins while standing and walking. Exposure to sun can lead to the development of spider veins. They are common in pregnancy also.
The symptoms of varicose veins include pain in legs that is aggravated on standing for long time or walking. There can also be swelling and heaviness in legs along with rash over the skin of legs. Spider veins do not pose any danger to the general health of patients but can be painful. However, varicose veins can be dangerous and can cause ulcers over skin due to back pressure in leg veins. This happens as a result of malfunctioning valves in the blood vessels. Superficial thrombophlebitis can also occur as a complication of varicose veins. Proper treatment of these leg veins is needed for alleviating the symptoms and for prevention of complications.
Diagnosis of these disorders is based on the clinical examination. The typical symptoms and appearance of the veins can be helpful in the accurate diagnosis of these conditions. Use of ultrasound technology can be done for checking the structure of veins and valves and for detecting the presence of clots. Venogram can be done for more detailed understanding of flow of blood through veins. Depending upon the results of these investigations, the mode of treatment suitable for the patient can be selected. Treatment of leg vein disorders can be done by vein specialists who are called phlebologists. Consultation of vascular medicine specialist may also be needed for focusing on problems in the circulatory system. Patients can consult a vascular surgeon if any surgical intervention is needed for the treatment of these conditions.
Treatment of leg vein disorders should be aimed at relieving the symptoms, preventing complications and for improving the appearance of skin over the veins. The treatment includes healthy changes in lifestyle along with the use of medications. The different treatment options for leg vein disorders are mentioned below:
They can be used for exerting pressure over the veins. Three different types of compression stockings are available that are described below:
Support pantyhose offer the least pressure over veins and are not graduated or gradient. Hence, they exert pressure over all the parts over which it is applied and not on any specific region.
Compression hose that are with a gradient, can give comparatively more pressure. They are available at any drug store.
Gradient compression of prescription strength can be helpful in exerting highest pressure and are available at all medical stores. They need to be fitted over the affected part by an expert trained for it.
This is a common mode of treatment for spider veins and varicose veins. The therapy consists of injection of chemicals into the veins. These chemicals cause swelling of veins that stick together and are seal shut. This results in stoppage of blood flow in the vessels making the veins turn into scar tissue. The procedure is done under local anesthesia. The treatment needs many sessions that are spread over the duration of 4-6 weeks. Patients may need to use compression techniques after sclerotherapy for better healing and for decreasing swelling. The treatment yields very good results if done in a proper manner.
Patients may develop some side effects after this procedure like raised red patches over the skin along with stinging pain. These symptoms tend to disappear few hours after the therapy. Some patients may develop brown lines and spots along with a group of small blood vessels over the treated region after the therapy. There can also be trapping of blood in the vein causing inflammation. This can be relieved by taking Aspirin or by applying hot fomentation over the part. Making a small pinprick by the physician can drain the trapped fluid.
Another type of sclerotherapy that is very effective for the treatment of leg vein disorders called ultrasound guided Sclerotherapy can also be performed in patients. This therapy makes use of ultrasound imaging for guiding the needle through the affected part for performing sclerotherapy. This procedure is particularly useful for treating those veins that are not easily visible. The side effects of this procedure are soreness and swelling of skin and deep vein thrombosis. Injection of scerotherapy agent in a wrong vessel is also possible in this technique, causing few side effects.
Surface Laser Treatments:
Laser treatment can be used for effective treatment of spider veins and varicose veins. Strong beams of light are used in this procedure that are passed through the skin towards the affected veins. This results in fading of the veins, leading to their disappearance. However, this procedure cannot be used for patients with all types of skin and skin color. The procedure is non-invasive and does not involve the use of injections and needles. However, the heat produced in the procedure can cause mild discomfort to the patient. The treatment can be completed in 15-30 minutes. Patients usually need 2-5 sessions for successful treatment of spider veins. Varicose veins that are larger than 3 mm in size cannot be effectively treated with this therapy.
Patients can resume their daily routine activities immediately after the treatment. The side effects of this therapy are swelling and redness of skin over the treated veins. There can also be discoloration of skin. Most of the above mentioned side effects disappear spontaneously within few hours after treatment. Some patients may develop burning and scarring of skin over the treated part.
Endogenous Procedures by using Laser and Radiofrequency:
Disorders of deeper veins of legs like saphenous veins can be done with the help of this procedure. This procedure is a good replacement option for surgical procedures in patients suffering from severe varicosity of veins. The procedure can be conducted at the clinic of a doctor. In this procedure, a small tube called catheter is inserted in the veins. Then, a small device called probe is passed in the catheter. The device present at the tip of probe causes heating of inner part of veins resulting in its closure. This procedure is done under local anesthesia. There can be slight burning of skin following the therapy.
After this procedure, the normal vessels surrounding the treated vein take over the blood supply to the part that was previously being supplied by the diseased veins. Slowly the symptoms of varicose veins begin to alleviate. Then, the smaller veins connected to the treated veins shrink. If this doesn’t happen, these smaller veins need to be treated by other techniques like Sclerotherapy.
Surgical procedures used for the treatment of leg vein disorders are stripping and surgical ligation. In surgical ligation procedure, the affected veins are ligated and are removed completely from the leg by taking small cuts through skin. The procedure does not affect normal blood circulation in the legs. Deeper veins in legs compensate for the blood supply to the parts that were supplied by the blood vessels removed in the surgery. The procedure is done under general anesthesia. Patients may need 1-4 weeks to recover after surgery. The procedure is harmless. However, patients may develop mild pain in legs after the therapy. Usual side effects of general anesthesia like breathing problems and risk to cardiac functions can also occur during the procedure. There can also be inflammation, swelling and redness of treated part with or without infection. Formation of permanent scars is also common after the procedure. There can be damage to smaller blood vessels or nerves during the procedure. Damage to nerves can cause numbness or change in sensation around the region. Formation of blood clots in deep veins can occur after the procedure. These clots can travel to other parts of body like heart or lungs through blood flow. Use of heparin can help in prevention of these complications. However, it should be kept in mind that heparin can cause thinning of blood and can pose a danger of increased bleeding and reduced clotting during the surgical procedure leading to severe blood loss.
In this procedure, a device called pin strip is passed in the vein. Then, the tip of this device is ligated to the end of affected vein and the device is pulled out. The affected vein comes out along with it. The procedure can be done on an out patient basis or in an operation theater. Local or general anesthesia is needed for this procedure.
In this, small cuts are made over the skin and the veins are pulled out with the help of hooks. The procedure can be done under local anesthesia by numbing only that part which is to be pricked. The treatment can be done in 1 session and it can be helpful in the management of large veins also. The treatment does not leave big scars. Patients can resume their normal activities immediately after the treatment.