Your veins have an incredibly important job: They carry oxygen-rich blood and nutrients from the body back to your heart. But like many things in life, time can take a toll on your veins.
Getting older is a risk factor for developing thin, wispy veins that are visible through the skin, known as spider veins. Aging also can bring on larger, bulging veins, known as varicose veins. Both types often show up on your legs. Whichever you start to notice, the idea of getting rid of them can be appealing. But when should you take medical action and when should you leave them alone?
“I get a lot of referrals for patients who have spider veins or varicose veins,” says William Marston, M.D. He’s a professor in the division of vascular surgery at UNC School of Medicine in Chapel Hill, North Carolina. “They don’t really bother the patient, but either their primary care physician or a family member has said something like, ‘Oh, you ought to get those looked at.’”
Before we dive into why and how spider veins and varicose veins may be treated, here’s some helpful background.
What Are Spider Veins and Varicose Veins?
Both types are damaged veins. The damage happens when tiny, one-way valves inside your veins weaken. Instead of pushing blood toward your heart, some of the blood flows backward and builds up in the vein. The extra blood puts pressure on the walls of that vein, which can cause it to further weaken and bulge.
With spider veins, it’s often just a cosmetic concern: Most of the time, they’re asymptomatic and unsightly, but they’re not a real medical problem, Dr. Marston says.
Spider veins — which can be blue, purple, or red and appear as thin lines, webs, or branches — may also be caused by sunlight exposure, hormonal changes, or an injury, according to the American Academy of Dermatology (AAD).
Varicose veins are a deeper dilation of the vein, Dr. Marston says. They’re not only larger and can appear more unsightly, but they can also cause pain and swelling. This can make it difficult to walk or maintain your normal activity levels. Some varicose veins can also raise your risk of blood clots.
The good news is that most varicose veins won’t become a problem in those over 65, Dr. Marston says.
“There’s a lot of misinformation on the internet and elsewhere saying that you have to get your varicose veins fixed or they’re going to cause a blood clot. But that’s not true,” Dr. Marston says. “We always talk to our patients about treating them based on how the leg is feeling and how it looks at that time. The idea that you’re going to treat a varicose vein to prevent it from getting worse is not a well-proven concept.”
To help decide what to do about your spider veins or varicose veins, Dr. Marston asks patients the following two questions:
1. Are your spider or varicose veins causing any symptoms? Even large varicose veins can be asymptomatic, meaning you don’t have any symptoms. “If there’s no pain, the leg isn’t swelling, and you’re able to be active without heaviness or aching, then we leave them alone,” Dr. Marston says.
2. Do you have a history of blood clots or other complications? A history of blood clots in a varicose vein may increase your risk of complications. If you answer yes, your doctor may want to discuss further examination or treatment options.
When to See Your Doctor
You should see your doctor or a vein specialist — and possibly consider treatment — if you have any of the following symptoms:
Significant pain. You may also have burning, throbbing, muscle cramping, or a feeling of heaviness in the leg.
Swelling in the leg. “It’s usually the ankle that swells first,” Dr. Marston says.
Bleeding from the vein. Vein bulges can become itchy, and when scratched they can easily bleed. Bleeding from varicose veins is a medical emergency, according to the National Heart, Lung, and Blood Institute. Seek help immediately if this happens.
Skin discoloration, called hyperpigmentation. “This usually occurs around the ankle area. It’s a brownish discoloration,” Dr. Marston says.
Skin scarring or thickening. These changes often occur between the ankle and lower calf, Dr. Marston says. “We look at that area pretty carefully to see if there are any changes that would indicate there’s more of a vein defect than just varicose veins.”
The severity of these symptoms will determine whether you need treatment to maintain mobility or reduce your risk of blood clots.
7 Treatment Options You Should Know About
1. Lifestyle changes: maintain a healthy weight, exercise regularly. This will help prevent new ones.
2. Compression Therapy: involves wearing compression socks, stockings, or bandages, applies steady pressure on the veins in the legs. It can help improve blood flow, reduce swelling, and lower the risk of blood clots. Compression therapy doesn’t correct underlying damage, but it helps relieve symptoms and prevent further spider or varicose veins.
3. Sclerotherapy: It involves injecting a chemical directly into the affected vein. This irritates the walls of the vein, causing them to stick together so that blood can’t flow through the vein anymore. This reduces swelling and causes the vein to shrink. Spider veins usually disappear within three to six weeks, while varicose veins take three to four months. You may need several treatments to get your desired results.
4. Laser Treatment: uses a laser to treat spider veins and very small varicose veins that are close to the skin’s surface. The laser light is applied directly to the skin, closing and shrinking the vein below. The vein will eventually dissolve. Small spider veins may disappear immediately after treatment, while larger spider veins and varicose veins can take up to three months to completely clear up. You may need more than one treatment for permanent results.
5. Endovenous Laser Therapy (EVLT) or Radiofrequency Ablation (RFA): involve making a small incision in the damaged vein and then inserting a tiny tube or catheter and applying heat in the vein using a laser fiber (for EVLT) or radiofrequency energy (for RFA). This causes the vein to collapse and seal off.
6. Surgery: generally not recommended for people over 65 unless there’s a serious issue, such as an aneurysm. That’s because no surgery is completely free of risk.
7. Medication: If varicose veins are causing you pain, your doctor may prescribe medication to help such as Diosmiplex (Vasculera®).
You Must Know First:
You Might Have to Pay Out of Pocket. If your procedure is purely for cosmetic purposes, you’ll likely have to pay for that yourself. As with any medical procedure, it’s a good idea to call the number on the back of your insurance card in advance to confirm exactly what is (and isn’t) covered. That way, you’re less likely to get any surprise bills.
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