Ask the expert: Varicose veins and spider veins

Varicose and spider veins may be unsightly, but are they harmful to those who have them and what treatment options are available? William Morgan, MD, is a board-certified general surgeon with Atlantic Surgical Associates and serves as chief of Staff at Frisbie Memorial Hospital in Rochester, New Hampshire. He has more than 20 years of experience performing a wide range of surgical procedures, with a specialized focus on minimally invasive options to treat vein conditions. Here, Dr. Morgan explains the differences between varicose and spider veins, and the importance of treating both.

What are varicose and spider veins and what is the difference between them?

Varicose veins are superficial, bulging veins, usually found in the legs, that may be tender and painful. They are larger than spider veins, which are characterized by a blue or red, fern-like pattern that resembles a spider web. Both varicose and spider veins are physical signs of venous insufficiency, a chronic condition in which veins have difficulty moving blood from the body back to the heart.

What causes varicose and spider veins?

Arteries are the body’s mechanism for carrying blood away from the heart, and veins are the vessels that return blood to the heart. Small valves in veins open and close to help pump blood back to the heart. If they break down and become weak, blood can pool backwards into the body, resulting in increased pressure in the veins. The veins then become varicosed, meaning they are enlarged, twisted, and easily visible beneath the skin.

Spider veins are a milder form of varicose veins caused by the same type of damage to the valves, but in smaller capillaries. Both varicose and spider veins most commonly occur in the legs, resulting from the pressure of walking and standing.

Who is most likely to develop them?

Risk factors for varicose and spider veins include:

• Age – As people age, the small valves in veins are at greater risk of weakening.
• Sex – Varicose and spider veins are more common in women as a result of hormonal fluctuations prior to menstruation and during pregnancy.
• Weight – Being overweight increases the risk of developing varicose and spider veins.
• Family history – Those with a family history of varicose and spider veins are at greater risk of developing them.
• Prolonged standing or sitting – People who sit or stand for long periods of time are at higher risk of developing venous insufficiency.

When should I seek a medical diagnosis for varicose and spider veins?

While some people think of varicose and spider veins as a common nuisance, treatment is necessary for more than cosmetic reasons. Venous insufficiency is a potentially dangerous condition. Anyone experiencing one or more of these symptoms should consult with their doctor for treatment options:

• A heaviness or uncomfortable feeling in the legs
• Pain or swelling in the legs
• Breakdown of skin tissue near the site where blood is pooling within the vein

Delaying treatment may result in more serious ailments, including:

• Lipodermatosclerosis, a painful hardening of the skin in the lower legs
• Venous statis, a painful leg ulcer that is difficult to heal
• Superficial phlebitis, an acute clotting of the superficial veins that may lead to rupture
• Deep vein thrombosis (DVT), a serious, life-threatening condition where blood clots form deep within the veins

What types of treatments are available for varicose and spider veins?

Decades ago, the standard treatment for varicose and spider veins was to “strip” the veins in a procedure that was often painful and damaging to the surrounding soft tissue. Today, newer outpatient surgical procedures make it possible to achieve even better results. Patients typically go home the same day and resume normal activities within one to two days.

Dr. Morgan specializes in the following options:

• Specialized catheters using radiofrequency or laser energy ablation – This is an especially effective treatment for larger varicose veins. A thin tube, called a catheter, is inserted into the vein and heat generated by radiofrequency or laser energy causes the vein to collapse and close. Blood then naturally begins to flow through alternate veins in the legs.
• Microphlebectomy – This procedure is used on smaller varicose or spider veins using a series of tiny incisions through which the vein is removed. No sutures are needed and scarring is minimal. Following the removal of the vein, blood immediately begins to flow through other veins.

In both catheter and microphlebectomy procedures, patients are awake or gently sedated. Following either procedure, the leg is wrapped with a simple dressing, and patients return two or three days later to remove the dressing and have an ultrasound of the site. Both radiofrequency or laser ablation and microphlebectomy are low risk, minimally invasive surgeries with high rewards for patient outcomes. In fact, most patients experience no adverse symptoms following their procedure.

For more information or to schedule a consultation with Dr. Morgan, please call (603) 332-3355.