Unlike arteries, our veins contain one-way valves that channel oxygen-depleted blood back toward the heart. When one or more of those valves malfunctions, blood pools in the vein, often causing bulges, and resulting in varicose veins.
These appear mainly on the legs, and often show themselves as swollen, rope-like bulges on the surface of the skin, though they may cause symptoms before any bulging is visible. Symptoms, which are often made worse by prolonged standing, include feelings of fatigue, heaviness, and burning and aching in the legs (sometimes accompanied by swelling, itching and discoloration). Not everyone has symptoms, however. ‘People who maintain an active lifestyle may not experience significant discomfort or pain’ even in the presence of large, bulging veins, says Dr. Todd Corpus, a phlebologist with the Centre for Vein Care in Toronto. (A phlebologist is a doctor who specializes in veins and their disorders, and is experienced in diagnosing and treating them.) Problematic veins are investigated using ultrasound technology, to assess the function of the valves and examine the vein.
Myth: Crossing your legs causes varicose veins. Fact: ‘There’s no proof of this,’ says Hill. (However, leg-crossing can be unhealthy for other reasons).
Genetic predisposition is the most significant risk factor in developing varicose veins, according to Corpus. If both of your parents are affected by them, there is a 90 percent chance you will develop the condition. If only one parent is affected, females have a 62 percent chance, while for males it is 25 percent. If neither parent is affected, the risk drops to 20 percent. Other factors include obesity, pregnancy, old age, a sedentary lifestyle or a work situation that includes prolonged sitting or standing.
If you are genetically prone to varicose veins, it is important to adopt habits that will delay their development, such as maintaining a healthy weight. Says Corpus, ‘An active lifestyle that includes lots of walking is the best way to minimize the symptoms and development of varicose veins, as well as use of compression stockings when sitting or standing for long periods of time.’
Ask your doctor for a referral to a phlebologist. In the meantime, here is a primer on treatments.
Endovenous laser ablation (EVLA), which was approved by Health Canada in 2003, involves releasing heat via a tiny laser fibre inserted into the vein through a catheter. Dr. Doug Hill, a phlebologist and medical director with the Vein Treatment Centre in Calgary, was one of the first to introduce EVLA to Canada, and he now teaches the technique. (He also told Best Health that future treatments could include injecting steam or a medical glue into the vein; and injecting a hardening agent combined with mechanical irritation, which destroys the affected tissue.)
EVLA, which treats large varicose veins, is a safe, 95 percent effective and patient-friendly method of treatment that has quickly replaced the older surgical method in most clinics across Canada. EVLA may not be recommended in rare cases where the vein is tortuous or significantly large as determined by the phlebologist.
Other options for varicose and spider veins (which are small, appear close to the skin’s surface and most often occur on the legs and face) include radiofrequency, which also closes the vein with heat, and sclerotherapy, which involves injecting medication into the vein, causing it to close. Patients can resume normal activities (with the exception of strenuous exercise and prolonged standing) immediately after EVLA, radiofrequency and sclerotherapy treatments, but must wear compression stockings for at least a week, and often longer. Side effects such as bruising and soreness in the treated area generally disappear within one to two weeks.
Varicose veins can also be removed with a mini-phlebectomy, a minor surgical procedure using local anesthesia. And then there’s stripping, a surgery that involves tying off the vein and removing it. In some cases, such as when the patient is allergic to sclerosant (blood-hardening) medications, this surgery may be the only treatment. Surgical stripping is definitely more invasive than the other options, requiring general anesthesia and a longer period of recovery before normal activities can be resumed.
Myth: You don’t need treatment until the veins worsen. Fact: Talk to your doctor now about your options. If varicose veins are left untreated, pressure in the vein can increase, says Hill, causing worsening swelling and leg cramps, risk of phlebitis (inflammation and blood clot), and other complications.
Will the veins return? Spider veins can reappear, but varicose veins return after treatment in only 10 to 20 percent of cases, says Hill. Genetic predisposition means there is a high probability that new varicose veins may develop elsewhere’but again, maintaining a healthy and active lifestyle, as well as using compression stockings, will help.
As far as coverage, provincial health plans cover office consultations and surgical stripping treatment when deemed medically necessary. The average cost for sclerotherapy (the procedure of choice for spider veins) is $150 to $200 for both legs. EVLA costs $2,500 to $3,000 per leg; radiofrequency costs about the same. The cost of mini-phlebectomy depends on the size of the area ($750 to $2,000 per leg). Some third-party medical plans may cover specific procedures; check with your insurance provider.
Technically called telangiectasia, these are small (less than two millimetres in diameter) dilated veins near the surface of the skin that are common in both men and women. They are most often on the legs and face, and are caused by pressure from the circulation in your veins and by hormonal changes such as pregnancy. Experts caution that spider veins may be a sign of deeper venous insufficiency’meaning poor circulation’and so they should be checked by a physician. Spider veins are best treated with sclerotherapy. They can also be treated with lasers on the surface of the skin, and intense pulsed-light treatments. In both cases, the blood from the treated vein is rerouted through healthy veins, which will improve circulation.