If These Legs Could Talk

I remember staring at the gnarled blue varicose veins that bulged behind my high school gym teacher’s knees. I didn’t really know what they were but thought he shouldn’t be so cavalier about sporting them in broad daylight. Shouldn’t he see a doctor? They had to be painful!

Fast-forward about 20 years and three children later, and I am now on a first-name basis with my own road map of varicosities. It wasn’t until my third pregnancy that I got any of the bulging, painful kind. Prior to that it was a few spider veins, the small red or blue ones that are close to the surface of the skin and look like small tree branches or spider webs with their short jagged lines.

The bumpy blue and purple patch on my right calf was warm to the touch and throbbed at the end of a long day of chasing after my other two boys. Although religious about not crossing my legs at the knees, exercising and putting my feet up every chance I got, the veins just got worse until the birth of my third child. Slowly the angry patch receded and faded to a nest of spider veins. While thankful my legs don’t look like my mother’s motley blue gams (yet), I still long for the day of blemish-free legs as I hopefully rub sunless tanning lotions on them.

You’re not alone
Sound familiar? According to the Mayo Clinic, about 50 to 55 percent of women and 40 to 45 percent of men in the United States suffer from some type of vein problem. Varicose veins affect half of people 50 years and older.

Varicose veins are found most often on the thighs, backs of calves or the inside of the leg, but during pregnancy they can form around the vagina and buttocks. Spider veins are much smaller and closer to the surface of the skin. They are found on the legs and face and can cover either a very small or large area of skin.

What causes varicose veins? Contrary to popular belief, crossing your legs is not the culprit, but rather weak or damaged valves in the veins. The heart pumps blood to the whole body through arteries. Veins then carry the blood back to the heart. As your leg muscles squeeze, they push blood back to the heart from your lower body against gravity. There are one-way flaps inside the veins, or valves, that stop the blood from flowing backwards as it moves up your legs. If the valves weaken, blood can leak back in the veins and collect there. This problem, also known as venous insufficiency, makes the veins bigger when the blood backs up.

Spider veins, on the other hand, can be caused by a number of things, including backup blood. Hormone changes, sun exposure and injuries can also cause spider veins.

Treatment options
Varicose vein treatments range from minimally invasive to complex surgical procedures. Most people receive a combination of therapies in order to achieve optimal results. Here’s an overview of what is currently available:

Sclerotherapy/Microsclerotherapy
Sclerotherapy may be used to close small- and medium-sized varicose veins. The physician injects the veins with a solution that causes a scar to form in the vein, which forces the vein to close and the blood to reroute through healthier veins. The procedure does not require anesthesia and can be done as an outpatient procedure. This treatment for varicose veins is used most commonly, but it may require several treatments to be effective.

Microsclerotherapy is a newer type of sclerotherapy that uses improved solutions and injection techniques that increase the success rate for removal of spider veins. A solution is injected into a vein using a very fine needle, which forces the vein to close and the blood to reroute through healthier veins.

Laser surgery
In laser surgery, heat from a laser beam destroys the targeted veins without harming the skin. Laser surgery works most effectively on small veins. For leg vessels, laser surgery is often less effective than sclerotherapy and may have side effects that include bruising, blistering or discoloration.

Surgical vein stripping
Surgical vein stripping may be an option for treating larger varicose veins that have leaking valves. Vein stripping, the standard procedure for treating varicose veins for many years, involves removing a long vein (the great or the small saphenous vein) through small incisions at the groin, knee and ankle. This procedure is typically an outpatient treatment, and patients typically are able to resume normal activities within two weeks.

Endovenous thermal ablation
Endovenous thermal ablation is a newer minimally invasive surgery, performed to treat larger varicose veins as an alternative to vein stripping. In the procedure, the surgeon inserts a very thin tube (catheter) into the vein and applies heat through the tip of the catheter. When the catheter is withdrawn, the heat causes the vein to collapse (ablate) and scar shut, and the blood reroutes through healthier veins. The energy source of heat applied through the catheter may be radio frequency waves or lasers. Patients are able to resume activities within a few days.

Coil embolization
In coil embolization, local anesthesia is used with ultrasound and X-ray as guides. A catheter is inserted into a larger vein in the leg or calf. A small coil is placed into the catheter and into the vein. Alcohol is injected into the vein as the catheter is withdrawn. The alcohol irritates the lining of the vein and causes it to close and scar.

Ambulatory phlebectomy
In ambulatory phlebectomy, the physician removes varicose veins through a series of tiny skin punctures. The procedure is usually used to remove larger varicose veins in the leg. The patient is given local anesthesia. Scarring is generally minimal.

Endoscopic perforator vein surgery
Endoscopic perforator vein surgery is used only when the patient has advanced to the stage of having leg ulcers. Through a small incision, the doctor inserts a thin video camera to visualize and close perforating veins — veins that connect superficial veins (those located near the skin) to deep veins in the leg.

Results
Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. 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. Ongoing treatment can help keep this problem under control.

But if you’re serious about slowing down the development of new varicose veins, experts agree that wearing gradient compression stockings as much as possible during the day is the most important thing you can do.

Hmmmm … compression stockings and summer in San Antonio. Somehow I think I’ll be making regular visits to the doctor.