Varicose veins are abnormally enlarged superficial veins usually seen in the thigh and leg. In many patients they are a sign of a more serious underlying problem of the venous system. These veins often are branches of the superficial set of veins (great and small saphenous veins), which have leaking valves. As many as 35-40 million adults in the USA may be affected by significant superficial venous insufficiency (saphenous vein and branches) and may have an easily treatable problem. Early evaluation and scientific investigation with modern duplex ultrasonography is the standard of care.
Venous insufficiency is more of an “umbrella” diagnosis, which refers to leakiness of the one-way valves within the veins that results in increased pressure in the veins in the legs. Superficial venous insufficiency involving the saphenous veins accounts for the majority of patients with vein related complaints. The increased pressure may cause bulging varicose veins, leg swelling, cramps or achiness of the calves, restless legs, spider veins, discoloration and thickening of the skin of the lower leg, and eventual bleeding or ulceration.
Varicose veins are enlarged “ropey” veins that are swollen and raised above the surface of the skin often appearing wormlike under the skin. They are the direct result of increased venous pressure of the deeper veins secondary to incompetent valves (insufficiency)communicating through small connector veins to the varicose veins. Varicose veins can be found on any part of the lower extremities although there are fairly classic distribution patterns found in most patients. Varicose veins can be painful and unsightly and may lead to more serious problems and complications such as thrombosis(clotting) which can progress to deep vein thrombosis and in rare cases pulmonary embolism(blood clot which travels to the lungs). The may also bleed externally as a result of an seemingly minor trauma such as bathing or shaving. Varicose veins are a sign of an underlying disease of the valves and are not a disease in and of themselves. Duplex ultrasound testing is performed to determine the exactly which veins are insufficient and to stratify the degree of insufficiency. All patients with varicose veins should undergo clinical evaluation and ultrasound investigation as the natural history of untreated venous insufficiency in patients with varicose veins is uncertain and may lead to thrombosis of the superficial and deep venous systems.
Spider veins, also known as telangiectasia, are similar to varicose veins, but are smaller and closer to the surface of the skin. They usually appear red, blue or purple in color. They can look like short fine lines, a twig, tree branches or a spider like web pattern. They typically appear on the legs but can become visible on the face, especially on the nose and cheeks. Spider veins pose no threat to a person’s health, but can bleed in rare cases which is often frightening to patients and family and are easily treatable with injection sclerotherapy. Depending on the location and appearance of the spider veins an ultrasound of the venous system may be performed to determine if a deeper valve problem exists prior to injection sclerotherapy. Doing so will allow your physician to give you a more accurate prognosis in terms of chances of success with sclerotherapy.