Skin Deep: Treatments for Varicose and Spider Veins
Even though all but the most severe venous problems are merely cosmetic, there are several treatment options to mitigate their effects. Varicose and spider veins may be another fact of life, but they’re not something we have to take lying down.
Varicose and spider veins are just another unavoidable part of getting older, however there are treatment options to reduce their appearance. According to the National Women’s Health Information Center (NWHIC), about 50 percent of people age fifty and older suffer from some sort of vein problem. They develop when the valves that pump blood back to the heart weaken, allowing blood to pool and, in the case of varicose veins, causing the vein to bulge. Neither condition is life-threatening, but both are still pesky and troublesome.
In the early stages of spider and varicose veins, sometimes the best course of action is to simply try slowing their progress. Wearing compression socks every day can prevent blood from pooling in the legs. Doctors also caution most patients in the early stages of venous disease to elevate their legs whenever they’re sitting down, and to avoid crossing their legs, which can hinder proper circulation. Maintaining a healthy weight is also important to minimize the load our legs have to bear, and regular exercise not only helps keep weight down, but also increases blood flow and supports proper blood pressure. For people with spider veins, prevention can be as simple as regularly wearing sunscreen.
If prevention doesn’t keep spider veins from darkening or varicose veins from growing, the next step is sclerotherapy, a common treatment that’s been in use since the 1930s. Sclerotherapy can treat spider veins anywhere they occur, as well as small varicose veins. A doctor uses a tiny needle to inject a chemical solution directly into the vein or blood vessel, which causes the lining of the vessel to swell and stick together. The vessel eventually shuts down, turns into scar tissue, stops carrying blood altogether, and fades from view. The American Academy of Dermatology estimates that although several injections are necessary, most people can expect up to 90 percent improvement in the appearance of their veins. No anesthesia is necessary for the procedure, and patients can get back to their normal activities right away.
For spider veins and smaller varicose veins, there’s also an option to treat them with laser surgery. A laser beam can destroy the problematic blood vessels under the skin without harming the skin’s surface with injections or incisions. Although laser surgery is noninvasive, it is generally considered more painful than sclerotherapy, and, as with sclerotherapy, multiple passes with the laser are necessary to completely destroy spider veins. The treatments last anywhere from fifteen to twenty minutes, and the NWHIC estimates that patients should expect to endure between two and five sessions. Laser therapy is not recommended to treat veins larger than three millimeters; for those larger varicose veins, an internal version of laser surgery, called endovenous ablation, is a possibility. In this procedure, a doctor inserts a catheter into the varicose vein, and through it uses a laser to shrink and constrict the vein. For large varicose veins that can’t be treated with external laser therapy or sclerotherapy, endovenous ablation is the least invasive option.
Surgical Vein Ligation or Ambulatory Phlebectomy
Large or troublesome varicose veins are candidates for surgical ligation. In this procedure, the vein is tied shut at the ends and removed completely. The surgery is performed through a series of incisions in the leg, and the veins are removed using small surgical hooks. Removing a vein completely doesn’t have severely adverse side effects. Like the noninvasive methods of vein surgery, it simply reroutes blood through other veins in the leg. The veins most likely to become varicose are the ones closest to the skin’s surface. The most important veins are located deep within the tissues of the leg and aren’t likely to become varicose in the first place.
Sometimes varicose veins become so inflamed that they begin to develop ulcers. These types of veins, while relatively rare, are candidates for endoscopic perforator surgery, in which the surgeon uses a video camera inserted through a catheter to visualize perforated veins and close them. This procedure requires higher levels of anesthesia than other vein surgeries—usually an epidural or a general anesthetic—so the recovery time is a few weeks longer than other options.
Many people benefit from a combination of therapies, depending on the severity of their varicose or spider veins, their tolerance for pain, their activity levels, and their tolerance of anesthesia. But no matter what procedure is performed, it’s likely that spider or varicose veins will reappear. Since venous disease is a genetic predisposition, it’s likely that new problematic veins will develop in the same place where the old ones were.
Unfortunately, since many spider and varicose veins are only a cosmetic problem, the procedures to eliminate them are not usually covered by health insurance. But the out-of-pocket price is worth it for those who find themselves living with troublesome veins. For most of us, varicose or spider veins may be inevitable, but that doesn’t mean they have to be permanent.