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Varicose Veins and Spider Veins

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					                                                                   Frequently Asked questions




                              Varicose
                                                                                  prevent blood from f lowing backwards
                                                                                  as it moves up your legs. If the valves
                                                                                  become weak, blood can leak back
                                                                                  into the veins and collect there. (This

                              Veins and                                           problem is called venous insufficiency.)
                                                                                  When backed-up blood makes the veins
                                                                                  bigger, they can become varicose.


                              Spider Veins                                        Spider veins can be caused by the back-
                                                                                  up of blood. They can also be caused by
                                                                                  hormone changes, exposure to the sun,
http://www.womenshealth.gov                                                       and injuries.
         1-800-994-9662       Q: What are varicose veins and spi-
                                 der veins?                                   Q: How common are abnormal leg
  TDD: 1-888-220-5446
                              A: Varicose (VAR-i-kos) veins are enlarged         veins?
                                  veins that can be blue, red, or f lesh-
                                                                              A: About 50 to 55 percent of women and
                                  colored. They often look like cords and
                                                                                  40 to 45 percent of men in the United
                                  appear twisted and bulging. They can
                                                                                  States suffer from some type of vein
                                  be swollen and raised above the surface
                                                                                  problem. Varicose veins affect half of
                                  of the skin. Varicose veins are often
                                                                                  people 50 years and older.
                                  found on the thighs, backs of the calves,
                                  or the inside of the leg. During preg-
                                  nancy, varicose veins can form around       Q: What factors increase my risk of
                                  the vagina and buttocks.                       varicose veins and spider veins?
                                  Spider veins are like varicose veins but    A: Many factors increase a person's chances
                                  smaller. They also are closer to the            of developing varicose or spider veins.
                                  surface of the skin than varicose veins.        These include:
                                  Often, they are red or blue. They can       	   •	 Increasing age. As you get older,
                                  look like tree branches or spiderwebs              the valves in your veins may weaken
                                  with their short, jagged lines. They can           and not work as well.
                                  be found on the legs and face and can
                                                                              	   •	 Medical history. Being born with
                                  cover either a very small or very large
                                                                                     weak vein valves increases your risk.
                                  area of skin.
                                                                                     Having family members with vein
                                                                                     problems also increases your risk.
                              Q: What causes varicose veins and                      About half of all people who have
                                 spider veins?                                       varicose veins have a family member
                              A: Varicose veins can be caused by weak or             who has them too.
                                  damaged valves in the veins. The heart      	   •	 Hormonal changes. These occur
                                  pumps blood filled with oxygen and                 during puberty, pregnancy, and
                                  nutrients to the whole body through                menopause. Taking birth control
                                  the arteries. Veins then carry the blood           pills and other medicines containing
                                  from the body back to the heart. As                estrogen and progesterone also may
                                  your leg muscles squeeze, they push                contribute to the forming of varicose
                                  blood back to the heart from your lower            or spider veins.
                   page 1         body against the f low of gravity. Veins
                                                                              	   •	 Pregnancy. During pregnancy, there
                                  have valves that act as one-way f laps to



                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                    Frequently Asked questions



                                     is a huge increase in the amount of       	   •	 Heaviness
                                     blood in the body. This can cause         	   •	 Swelling
                                     veins to enlarge. The growing uterus
                                     also puts pressure on the veins.          	   •	 Rash	that’s	itchy	or	irritated
                                     Varicose veins usually improve within     	   •	 Darkening	of	the	skin	(in	severe	
                                     three months after delivery. More                cases)
                                     varicose veins and spider veins usually
                                                                               	   •	 Restless	legs
                                     appear with each additional pregnancy.
                              	   •	 Obesity. Being overweight or obese
                                     can put extra pressure on your veins.     Q: Are varicose veins and spider
http://www.womenshealth.gov          This can lead to varicose veins.             veins dangerous?
         1-800-994-9662                                                        A: Spider veins rarely are a serious health
                              	   •	 Lack of movement. Sitting or
                                                                                   problem, but they can cause uncom-
  TDD: 1-888-220-5446                standing for a long time may force
                                                                                   fortable feelings in the legs. If there
                                     your veins to work harder to pump
                                                                                   are symptoms from spider veins, most
                                     blood to your heart. This may be a
                                                                                   often they will be itching or burning.
                                     bigger problem if you sit with your
                                                                                   Less often, spider veins can be a sign
                                     legs bent or crossed.
                                                                                   of blood backup deeper inside that you
                              	   •	 Sun exposure. This can cause spi-             can’t	see	on	the	skin.	If	so,	you	could	
                                     der veins on the cheeks or nose of a          have the same symptoms you would
                                     fair-skinned person.                          have with varicose veins.
                                                                                   Varicose veins may not cause any prob-
                              Q: Why do varicose veins and spider                  lems, or they may cause aching pain,
                                 veins usually appear in the legs?                 throbbing, and discomfort. In some
                              A: Most varicose and spider veins appear             cases, varicose veins can lead to more
                                  in the legs due to the pressure of body          serious health problems. These include:
                                  weight, force of gravity, and task of        	   •	 Sores or skin ulcers due to chronic
                                  carrying blood from the bottom of the               (long-term) backing up of blood.
                                  body up to the heart.                               These sores or ulcers are painful and
                                  Compared with other veins in the                    hard to heal. Sometimes they cannot
                                  body, leg veins have the toughest job of            heal until the backward blood f low
                                  carrying blood back to the heart. They              in the vein is repaired.
                                  endure the most pressure. This pressure      	   •	 Bleeding. The skin over the veins
                                  can be stronger than the one-way valves             becomes thin and easily injured.
                                  in the veins.                                       When an injury occurs, there can be
                                                                                      significant blood loss.
                              Q: What are the signs of varicose                	   •	 Superf icial thrombophlebitis
                                 veins?                                               (throm-bo-f li-BYT-uhs), which
                              A: Varicose veins can often be seen on the              is a blood clot that forms in a vein
                                  skin. Some other common symptoms of                 just below the skin. Symptoms
                                  varicose veins in the legs include:                 include skin redness; a firm, ten-
                                                                                      der, warm vein; and sometimes
                              	   •	 Aching	pain	that	may	get	worse	after	
                                                                                      pain and swelling.
                   page 2            sitting or standing for a long time
                                                                               	   •	 Deep vein thrombosis, which is
                              	   •	 Throbbing	or	cramping
                                                                                      a blood clot in a deeper vein. It can


                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                     Frequently Asked questions



                                     cause a “pulling” feeling in the calf,        used	to	see	the	veins’	structure,	check	the	
                                     pain, warmth, redness, and swelling.          blood flow in your veins, and look for
                                     However, sometimes it causes no sig-          blood clots. This test uses sound waves to
                                     nificant symptoms. If the blood clot          create pictures of structures in your body.
                                     travels to the lungs, it can be fatal.        Although less likely, you might have
                                                                                   a venogram. This test can be used to
                              Q: Should I see a doctor about vari-                 get a more detailed look at blood f low
                                 cose veins?                                       through your veins.
                              A: You should see a doctor about varicose            If you seek help for your varicose veins,
                                  veins if:                                        there are several types of doctors you
http://www.womenshealth.gov
                                                                                   can see, including:
                              	   •	 The	vein	has	become	swollen,	red,	
         1-800-994-9662                                                        	   •	 A	phlebologist,	which	is	a	vein	spe-
                                     or very tender or warm to the touch
  TDD: 1-888-220-5446                                                                 cialist
                              	   •	 There	are	sores	or	a	rash	on	the	leg	
                                     or near the ankle                         	   •	 A	vascular	medicine	doctor,	who	
                                                                                      focuses on the blood system
                              	   •	 The	skin	on	the	ankle	and	calf	
                                     becomes thick and changes color           	   •	 A	vascular	surgeon,	who	can	perform	
                                                                                      surgery and do other procedures
                              	   •	 One	of	the	varicose	veins	begins	to	
                                     bleed                                     	   •	 An	interventional	radiologist,	who	
                                                                                      specializes in using imaging tools
                              	   •	 Your	leg	symptoms	are	interfering	
                                                                                      to see inside the body and do treat-
                                     with daily activities
                                                                                      ments with little or no cutting
                              	   •	 The	appearance	of	the	veins	is	caus-
                                                                               	   •	 A	dermatologist,	who	specializes	in	
                                     ing you distress
                                                                                      skin conditions
                                  If	you’re	having	pain,	even	if	it’s	just	
                                                                                   Each of these specialists do some or all
                                  a	dull	ache,	don’t	hesitate	to	get	help.	
                                                                                   of the procedures for treating varicose
                                  Also,	even	if	you	don’t	need	to	see	a	
                                                                                   veins. You might start out by asking your
                                  doctor about your varicose veins, you
                                                                                   regular doctor which specialist he or she
                                  should take steps to keep them from
                                                                                   recommends. You also might check with
                                  getting worse (see How can I prevent
                                                                                   your insurance plan to see if it would pay
                                  varicose veins and spider veins?).
                                                                                   for a particular provider or procedure.

                              Q: How are varicose veins diag-                  Q: How are varicose and spider
                                 nosed?                                           veins treated?
                              A: Your doctor may diagnose your vari-           A: Varicose veins are treated with lifestyle
                                  cose veins based on a physical exam.
                                                                                   changes and medical treatments. These
                                  Your doctor will look at your legs while
                                                                                   can:
                                  you’re	standing	or	sitting	with	your	legs	
                                  dangling. He or she may ask you about        	   •	 Relieve	symptoms
                                  your symptoms, including any pain            	   •	 Prevent	complications
                                  you’re	having.	Sometimes,	you	may	have	
                                                                               	   •	 Improve	appearance
                                  other tests to find out the extent of the
                                  problem and to rule out other disorders.         Your doctor may recommend lifestyle
                   page 3
                                                                                   changes	if	your	varicose	veins	don’t	
                                  You might have an ultrasound, which is



                                        U.S. Department of Health and Human Services, Office on Women’s Health
                                                                   Frequently Asked questions



                                  cause many symptoms. If symptoms are            with healing and decrease swelling.
                                  more severe, your doctor may recom-             This treatment is very effective when
                                  mend medical treatments. Some treat-            done correctly.
                                  ment options include:                           Possible	side	effects	include:
                                  Compression Stockings                       	   •	 Stinging,	red	and	raised	patches	of	
                                  Compression stockings put helpful                  skin, or bruises where the injection
                                  pressure on your veins. There are three            was made. These usually go away
                                  kinds of compression stockings:                    shortly after treatment.
                              	   •	 Support	pantyhose,	which	offer	the	      	   •	 Spots,	brown	lines,	or	groups	of	fine	
                                     least amount of pressure. These also            red blood vessels around the treated
http://www.womenshealth.gov
                                     often are not “gradient” or “gradu-             vein. These also usually go away
         1-800-994-9662              ated.” That means they provide                  shortly after treatment.
  TDD: 1-888-220-5446                pressure all over instead of where it
                                     is needed most.                          	   •	 Lumps	of	blood	that	get	trapped	
                                                                                     in the vein and cause inf lamma-
                              	   •	 Over-the-counter	gradient	compres-              tion. This is not dangerous. You can
                                     sion hose, which give a little more             relieve swelling by applying heat and
                                     pressure. They are sold in medical              taking aspirin. Your doctor can drain
                                     supply and drugstores.                          the trapped blood with a small pin-
                              	   •	 Prescription-strength	gradient	                 prick at a follow-up visit.
                                     compression hose, which offer the            There is a type of sclerotherapy called
                                     greatest amount of pressure. They            ultrasound-guided sclerotherapy (or
                                     are sold in medical supply and drug-         echo-sclerotherapy). This type of
                                     stores. You need to be fitted for            sclerotherapy uses ultrasound imaging
                                     them by someone who has been                 to guide the needle. It can be useful
                                     trained to do this.                          in treating veins that cannot be seen
                                  Sclerotherapy                                   on	the	skin’s	surface.	It	may	be	used	
                                  Sclerotherapy (SKLER-o-ther-a-pee) is           after surgery or endovenous techniques
                                  the most common treatment for both              if the varicose veins return. This
                                  spider veins and varicose veins. The            procedure	can	be	done	in	a	doctor’s	
                                  doctor uses a needle to inject a liquid         office.	Possible	side	effects	include	skin	
                                  chemical into the vein. The chemi-              sores, swelling, injection into an artery
                                  cal causes the vein walls to swell, stick       by mistake, or deep vein thrombosis (a
                                  together, and seal shut. This stops the         potentially dangerous blood clot).
                                  f low of blood, and the vein turns into         Surface Laser Treatments
                                  scar tissue. In a few weeks, the vein           In some cases, laser treatments can
                                  should fade. This treatment does not            effectively treat spider veins and smaller
                                  require anesthesia and can be done in           varicose veins. This technique sends
                                  your doctor's office. You can return to         very strong bursts of light through the
                                  normal activity right after treatment.          skin onto the vein. This makes the vein
                                  The same vein may need to be treated            slowly fade and disappear. Not all skin
                                  more than once. Treatments are usually          types and colors can be safely treated
                                  done every four to six weeks. You may           with lasers.
                   page 4         be asked to wear gradient compression           No needles or incisions are used, but
                                  stockings after sclerotherapy to help           the heat from the laser can be quite



                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                     Frequently Asked questions



                                  painful. Cooling helps reduce the pain.             connected veins can be treated with
                                  Laser treatments last for 15 to 20 min-             sclerotherapy or other techniques.
                                  utes. Generally, two to five treatments             Surgery
                                  are needed to remove spider veins in                Surgery is used mostly to treat very
                                  the	legs.	Laser	therapy	usually	isn’t	              large varicose veins. Types of surgery
                                  effective for varicose veins larger than            for varicose veins include:
                                  3 mm (about a tenth of an inch). You
                                                                              	       •	 Surgical ligation and stripping.
                                  can return to normal activity right after
                                                                                         With this treatment, problem veins
                                  treatment.
                                                                                         are tied shut and completely removed
                                  Possible	side	effects	of	lasers	include:               from the leg through small cuts in
http://www.womenshealth.gov
                              	   •	 Redness	or	swelling	of	the	skin	right	              the skin. Removing the veins does
         1-800-994-9662              after the treatment that disappears                 not affect the circulation of blood
  TDD: 1-888-220-5446                within a few days                                   in the leg. Veins deeper in the leg
                              	   •	 Discolored	skin	that	will	disappear	                take care of the larger volumes of
                                     within one to two months                            blood. This surgery requires general
                                                                                         anesthesia and must be done in an
                              	   •	 Burns	and	scars	from	poorly	per-                    operating room. It takes between one
                                     formed laser surgery, though this is                and four weeks to recover from the
                                     rare                                                surgery. This surgery is generally safe.
                                  Endovenous Techniques                                  Pain	in	the	leg	is	the	most	common	
                                  (Radiofrequency and Laser)                             side effect. Other possible problems
                                  These methods for treating the deeper                  include:
                                  veins of the legs, called the saphenous         	      •	 A	risk	of	heart	and	breathing	
                                  (SAF-uh-nuhs) veins, have replaced                        problems from anesthesia
                                  surgery for most patients with severe
                                  varicose veins. These techniques can be         	      •	 Bleeding	and	congestion	of	
                                  done	in	a	doctor’s	office.                                blood. But, the collected blood
                                                                                            usually settles on its own and
                                  The doctor puts a very small tube,                        does not require any further
                                  called a catheter, into the vein. A small                 treatment.
                                  probe is placed through the tube. A
                                  device at the tip of the probe heats up         	      •	 Wound	infection,	inf lammation,	
                                  the inside of the vein and closes it off.                 swelling, and redness
                                  The device can use radiofrequency or            	      •	 Permanent	scars
                                  laser energy to seal the vein. The proce-
                                                                                  	      •	 Damage	of	nerve	tissue	around	
                                  dure can be done using just local anes-
                                                                                            the	treated	vein.	It’s	hard	to	avoid	
                                  thesia. You might have slight bruising
                                                                                            harming small nerve branches
                                  after treatment.
                                                                                            when veins are removed. This
                                  Healthy veins around the closed vein                      damage can cause numbness,
                                  take over the normal f low of blood.                      burning, or a change in feeling
                                  The symptoms from the varicose vein                       around the scar.
                                  improve. Usually, veins on the surface
                                  of the skin that are connected to the           	      •	 A	deep	vein	blood	clot.	These	
                                  treated varicose vein will also shrink                    clots can travel to the lungs and
                   page 5         after	treatment.	If	they	don’t,	these	                    heart. The medicine heparin may




                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                     Frequently Asked questions



                                        be used to reduce the chance                   strength. Focus on exercises that work
                                        of these dangerous blood clots.                your legs, such as walking or running.
                                        But, heparin also can increase the      	   •	 Control	your	weight	to	avoid	plac-
                                        normal amount of bleeding and                  ing too much pressure on your legs.
                                        bruising after surgery.
                                                                                	   •	 Don’t	cross	your	legs	for	long	times	
                              	   •	 PIN stripping. In this treatment,                 when	sitting.	It’s	possible	to	injure	
                                     an	instrument	called	a	PIN	stripper	              your legs that way, and even a minor
                                     is inserted into a vein. The tip of the           injury can increase the risk of vari-
                                     PIN	stripper	is	sewn	to	the	end	of	               cose veins.
                                     the vein, and when it is removed, the
http://www.womenshealth.gov          vein is pulled out. This procedure         	   •	 Elevate	your	legs	when	resting	as	
         1-800-994-9662              can be done in an operating room or               much as possible.
                                     an outpatient center. General or local     	   •	 Don’t	stand	or	sit	for	long	periods	
  TDD: 1-888-220-5446
                                     anesthesia can be used.                           of time. If you must stand for a long
                              	   •	 Ambulatory phlebectomy. With                      time, shift your weight from one
                                     ambulatory phlebectomy (AM-byoo-                  leg to the other every few minutes.
                                     luh-TOHR-ee fluh-BEHK-toh-                        If you must sit for long periods of
                                     mee), tiny cuts are made in the skin,             time, stand up and move around or
                                     and hooks are used to pull the vein               take a short walk every 30 minutes.
                                     out of the leg. Only the parts of          	   •	 Wear	elastic	support	stockings	and	
                                     your leg that are being pricked will              avoid tight clothing that constricts
                                     be numbed with anesthesia. The                    your waist, groin, or legs.
                                     vein is usually removed in one treat-
                                                                                	   •	 Avoid	wearing	high	heels	for	long	
                                     ment. Very large varicose veins can
                                                                                       periods of time. Lower-heeled shoes
                                     be removed with this treatment while
                                                                                       can help tone your calf muscles to
                                     leaving	only	very	small	scars.	Patients	
                                                                                       help blood move through your veins.
                                     can return to normal activity the day
                                     after	treatment.	Possible	side	effects	    	   •	 Eat	a	low-salt	diet	rich	in	high-
                                     of the treatment include slight bruis-            fiber foods. Eating fiber reduces the
                                     ing and temporary numbness.                       chances of constipation, which can
                                                                                       contribute to varicose veins. High-
                                                                                       fiber foods include fresh fruits and
                              Q: How can I prevent varicose                            vegetables and whole grains, like
                                 veins and spider veins?                               bran. Eating less salt can help with
                              A: Not all varicose and spider veins can                 the swelling that comes with vari-
                                  be prevented. But, there are some steps              cose veins.
                                  you can take to reduce your chances of
                                  getting new varicose and spider veins.
                                  These same things can help ease discom-       Q: Can varicose and spider veins
                                  fort from the ones you already have:             return even after treatment?
                              	   •	 Wear	sunscreen	to	protect	your	skin	       A: Current treatments for varicose veins
                                     from the sun and to limit spider               and spider veins have very high success
                                     veins on the face.                             rates compared to traditional surgi-
                                                                                    cal treatments. Over a period of years,
                   page 6     	   •	 Exercise	regularly	to	improve	your	
                                     leg strength, circulation, and vein



                                       U.S. Department of Health and Human Services, Office on Women’s Health
                                                                  Frequently Asked questions



                                however, more abnormal veins can                  this problem under control.
                                develop because there is no cure for              The single most important thing you
                                weak vein valves. Ultrasound can be               can do to slow down the development
                                used to keep track of how badly the               of new varicose veins is to wear gradi-
                                valves are leaking (venous insufficien-           ent compression support stockings as
                                cy). Ongoing treatment can help keep              much as possible during the day. n


                              For more information
http://www.womenshealth.gov   For more information on varicose and spider veins, call womenshealth.gov at 1-800-994-
                              9662 or contact the following organizations:
         1-800-994-9662
  TDD: 1-888-220-5446         National Heart Lung and Blood                 American Society for Dermatologic
                              Institute (NHLBI)                             Surgery
                              Phone	Number:	301-592-8573                    Phone	Number:	847-956-0900
                              Internet Address: http://www.nhlbi.nih.gov    Internet Address: http://www.asds.net

                              The American College of Phlebology            The American Venous Forum
                              Phone	Number:	510-346-6800                    Phone	Number:	978-744-5005
                              Internet Address: http://www.phlebology.org   Internet Address: http://veinforum.org

                              American Academy of Dermatology               Society of Interventional Radiology
                              Phone	Number:	847-240-1280;	Toll-Free:	       Phone	Number:	703-691-1805;	Toll-Free:	
                              866-503-SKIN	(7546)                           800-488-7284
                              Internet Address: http://www.aad.org          Internet Address: http://www.sirweb.org


                                  Reviewed by:
                                  Robert J. Min, M.D.
                                  Chairman of Radiology
                                  Weill Cornell Medical College

                                  Melvin Rosenblatt, M.D.
                                  Chairman,	Public	Education	Committee
                                  American	College	of	Phlebology

                                  All material contained in this FAQ is free of copyright restrictions, and may be copied,
                                  reproduced, or duplicated without permission of the Office on Women's Health in the
                                  Department of Health and Human Services. Citation of the source is appreciated.

                                  Content last updated June 2, 2010.

                   page 7




                                     U.S. Department of Health and Human Services, Office on Women’s Health

				
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