What are they? Many times people ask what the difference is between a varicose vein and a spider vein. A simple way is to look at the size and shape of the vein in question. Small, reddish or purplish veins clustered together are usually spider veins and they usually lie flat against the skin.
Varicose veins are larger( think at least the size of a garden worm), protrude from the skin surface, are squiggly, and are oftentimes blue or green. Sometimes they can look like a simple, soft bump in the skin.
As Sir William Osler, a famous surgeon, once said, varicose veins are the product of poorly choosing one’s grandparents. Another way of saying that having varicose veins is predominantly genetic; either you are lucky or you are not. Women are affected almost twice as much as men, in part due to hormones and pregnancies, and things typically only get worse with aging.
So what is actually going wrong that causes varicose veins? To answer this, you have to understand a little bit of the plumbing of the leg. What comes in must come out. In other words, arteries feed blood into the legs, and veins are built to return the used blood back to the body. Think of a circle or roundabout on the highway. When all the traffic is moving smoothly, in and out, there is no traffic jam. But what happens when cars are slow to exit the circle? There is a pileup. Varicose veins are the sign that there has been a pileup in your leg. Traffic is coming in OK, but it can’t get out fast enough because the veins inside of your leg are not working efficiently.
Looking closer into the situation, why has the outflow slowed down? Well, inside of the leg, the veins are built with little valves that typically only allow travel in one direction, that direction being up and away from your feet. They act as little turnstiles in the subway, allowing passengers(blood) to only go in one direction. What happens with varicose veins is that these valves break down over time, allowing blood to flow in both directions, up and down! Your muscles are trying to push the blood up and out, but this is being defeated by gravity, which is pulling blood back down the leg. This increase in back pressure flows into side veins which go to your skin surface and stick out as lumpy, bumpy varicose veins. Going back to the highway circle analogy, the circle(your circulation) is attempting to relieve this unexpected back pressure of traffic by allowing cars to exit out of the normal entry points.
How do we fix this? In the past, surgery would need to be performed called a “vein stripping” procedure, which physically removes the internal segments of veins with bad valves. A phlebectomy is a type of vein stripping procedure where only externally visible vein segments are pulled out. For the past decade, a procedure has been available called “endovenous laser ablation, “ which replaces the need for surgery by using laser energy to seal shut the bad vein segments with weak valves. The procedure is done in the office, takes less than 30 minutes with local numbing only, like a dental procedure, with minimal post procedure pain. Patients can return to normal activities, including work, the following day, just with no exercise for 1 week. Results of this technique are extremely effective and safe.