What are varicose veins?
A: Varicose veins are swollen, twisted, and enlarged veins that you can see under the skin. They are often red or blue. They most often appear in the legs, but can also occur in other parts of the body.
How do varicose veins differ from spider veins?
A: Spider veins are similar to varicose veins, but they are smaller and closer to the surface of the skin. Dilated and elongated veins in the skin are known as telangiectasia (or spider veins). Dilated elongated veins below the skin are known as varicose veins.
- Spider veins have a small diameter, are red, purple, or bluish, and resemble a web.
- Varicose veins are larger, deeper veins that can protrude, resulting in a rope-like appearance.
What causes varicose and spider veins?
A: Veins are blood vessels that return blood back to the heart from all parts of the body. A major challenge for leg veins is that the blood in the legs needs to get back to the heart against the force of gravity when standing. In this position, muscle contractions pump blood upward when you walk. The leg veins have one-way valves to keep blood moving upward. When faulty valves do not close properly, they allow blood to flow backward in the veins when the calf muscle relaxes and cause blood to pool in the veins of the lower leg. This pooling leads to increased pressure within the veins, which causes them to dilate and elongate over time.
Spider veins can also be caused by blood backup in the body, hormone changes, sun exposure, and injuries.
Who gets varicose and spider veins?
A: Those with a family history of vein abnormalities are most likely to develop leg vein problems. Women tend to have varicose or spider veins at an earlier age, but the incidence in men is similar by the time they reach their 70s.
Other factors that may accelerate the appearance of varicose or spider veins include:
- Multiple pregnancies
- A lifestyle that includes prolonged standing or sitting
When should I contact a medical professional?
A: Call a vein disease specialist if:
- You experience leg pain, throbbing, fatigue, heaviness, swelling, or an aching feeling
- Symptoms get worse or do not improve with self-care, such as by wearing compression stockings or avoiding standing or sitting for too long
- You have a sudden increase in pain or swelling, fever, or redness of the leg
- You develop leg sores that do not heal
How are varicose and spider veins diagnosed?
Varicose and spider veins are diagnosed through a physical examination, medical history, and ultrasound.
The specialists at Weill Cornell Medicine’s Vein Treatment Center have extensive experience diagnosing and treating varicose and spider veins.
What leg vein treatments are available?
A: The treatment of varicose and spider veins depends on the underlying cause.
The physicians at Weill Cornell Medicine’s Vein Treatment Center first determine the cause of the varicose or spider veins, create a treatment plan to best improve the symptoms and appearance, carry out the procedure, and follow up as necessary so that patients achieve the lifestyle and appearance they desire.
What is sclerotherapy?
Currently, sclerotherapy is the treatment of choice for eliminating most unwanted leg spider veins and small to medium-sized varicose veins. Sclerotherapy is performed as an in-office procedure. Salt water or a chemical solution is injected directly into the abnormal veins with a small needle. The vein hardens and disappears. Following this 15 to 20-minute treatment, you can resume all activities. A support stocking should be worn during the daytime for a few days after the procedure to aid in the closure of the veins.
What are my conservative (non-surgical) leg vein treatment options?
A: A conservative treatment plan is best for women who are pregnant or for those who are unable to undergo medical therapy due to advanced age or illness. Your provider may suggest the following steps to help manage your varicose and spider veins:
- Wear graduated compression stockings to decrease swelling. These stockings gently squeeze your legs to move blood up towards your heart. Although the stockings will not rid your legs of existing varicose and spider veins, the symptoms associated with vein problems can be improved.
- Avoid sitting or standing for extended periods. Even moving your legs a little bit helps keep the blood flowing.
- Raise your legs above your heart three or four times a day for 15 minutes at a time.
- Care for wounds if you have any open sores or infections. Your provider can show you how.
- Maintain your weight as close to ideal as possible.
- Get more exercise, which can help you keep off weight and help move blood up your legs. Walking and swimming are good options.
What is microphlebectomy?
Microphlebectomy, also known as ambulatory phlebectomy, is a minor surgical procedure that can be used to eliminate larger varicose veins. This procedure is performed in the office using only local anesthetic. The veins are removed through tiny skin nicks and can be done at the same time as EVLT (endovenous laser treatment).
The procedure takes about one hour, no stitches are necessary, and the scars are barely visible. You should walk and resume most of your usual activities immediately.
What is endovascular laser ablation treatment?
Endovascular laser ablation (EVLT or ELA) is a minimally invasive technique to eliminate varicose veins. The leg is sterilized; a small catheter and laser fiber are inserted into the vein that needs to be treated. When the laser is turned on, it generates heat that seals the vein closed permanently. The procedure is performed in the office with only local anesthetic, little to no pain or scarring, and a short recovery period.
The procedure takes about one hour and patients are instructed to immediately walk after the procedure and to resume most of their usual activities. If microphlebectomy is needed, it may be performed at the same time as EVLT.
What about Venaseal™ and other non-thermal venous closure treatments?
Venaseal™ is a new FDA approved technique that uses a medical adhesive to treat varicose veins by sealing closed the abnormal great saphenous vein (GSV). The procedure is performed by placing a thin IV-like tube inside the GSV with local anesthetic and positioning it appropriately with ultrasound guidance. Once positioned, 0.1 ml aliquots of the adhesive are delivered along the length of the GSV followed by vein compression to seal it closed.
The entire procedure takes about one hour to complete and requires no anesthesia. You can return to normal activities immediately and do not need to wear graduated compression stockings afterward.
What is mechanicochemical ablation (ClariVein™)?
ClariVein™ is a new, FDA-approved technique that uses a special delivery catheter to deliver an irritant drug (sclerosant) to the vein intended to be closed. Anesthesia is not needed, the entire procedure takes about one hour, and you can return to your normal activities immediately.
What is Polidocanol Injectable Foam (Varithena™)?
Varithena™ is a prescription medicine used to treat varicose veins caused by problems with the great saphenous vein (GSV) and its related veins. It is delivered through the placement of ultrasound-guided, small IVs and injected under ultrasound guidance for targeting of the abnormal veins. The entire procedure takes about 30 minutes, and you can return to normal activities immediately. The lack of heat leads to less post-procedure discomfort and less potential risk to surrounding nerves.
How do non-thermal venous closure treatments like Venaseal™, Clarivein™, and Varithena™ differ from thermal ablation like EVLT?
The lack of heat—as is used with EVLT—means no injections of numbing medications along the length of the treated vein, less post-procedure bruising and discomfort, and less potential risk to surrounding nerves or other structures. The tissue adhesive is a formulation of cyanoacrylate that has been used to close vessels in the body for many years. Closure of the vein has been found to be as successful and durable as thermal ablation at the two-year follow-up.
How should I prepare for my procedure?
- Eat a regular breakfast or lunch before coming to our office.
- You do not need to have anyone come with you to the procedure.
- If you take any blood thinner, including Aspirin, clopidogrel (Plavix), ticlopidine (Ticlid), warfarin (Coumadin), Dabigatran (Pradaxa), or Rivaroxaban (Xarelto), please let us know as soon as possible BEFORE the procedure so we can discuss what needs to be done.
- Take all your regular medications on the day of the procedure.
What should I bring to my procedure?
- Bring the stocking that was prescribed at the time of your consultation. Do not wait until the day of the procedure to purchase the stocking since they may have to order your size.
- For EVLT or microphlebectomy, thigh-high open toe 30-40mmHg (or Class 2) compression is recommended.
- For sclerotherapy, the stocking should be a 20-30mm Hg (or Class 1) panty hose or thigh high stocking with either toes or open toes.
- Bring a pair of flip-flops or casual sandals with you to the office, so you do not have to walk around our office barefoot.
- You may want to bring a warm sweater or top, as the room is often cold. We will use a brown iodine soap to clean your leg before the procedure, and light clothes and underwear may get stained. Bring clothing that you would not mind getting stained.
- You may bring a personal music player to listen to during the procedure; however, most patients pass the time by chatting with us.
What should I expect during my procedure?
- If you are having an EVLT and/or a micriphlebectomy, expect to be in the office for about two to three hours. This includes the procedure, as well as discussion before and after. You should also allow one more hours to walk after these procedures are completed; you do not need to return to the office after your walk.
- Sclerotherapy injection sessions typically take 30 minutes in the office. Be prepared to walk outside for 20 to 30 minutes after the sclerotherapy to promote healing.
Can varicose and spider veins return even after treatment?
Current treatments for varicose veins and spider veins have very good success rates. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.
The single most important thing one can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.