Varicose Veins & Other Vein Diseases: Symptoms and Treatment

While the term venous disease may not be familiar to many Americans, millions of them live with one.

According to Kristen Steidler, a certified nurse practitioner with Baystate Vascular Services, venous disease refers to a group of conditions that affect the veins and the blood vessels that carry blood back to the heart. These conditions include spider veins, reticular veins, and varicose veins.

“Roughly 2.5 million US adults have varicose veins,” says Steidler. “That’s 23% of the adult population. If you add in spider and reticular veins, the percentage jumps to a whopping 80 to 85%.”

While varicose veins, spider veins, and reticular veins are unique conditions, they’re caused by the same basic issue and lead to visible veins on the surface of the skin.

Causes of Venous Diseases

Sometimes referred to as chronic venous insufficiency, venous disease occurs when the veins in your legs can’t push blood back up to the heart.

Steidler explains, “When you have a healthy vein in the leg, blood is pushed upward with each heartbeat. Between beats, valves in the vein keep the blood from flowing down. But, when those valves get damaged, blood can flow backward and pool in the veins.”

While women are more prone to venous disease, other risk factors that contribute to the weakening of the valves in leg veins include:

• Age
• Having obesity
• Smoking
• Pregnancy
• Genetics
• Traumatic injury to the leg
• Being sedentary

Symptoms of Venous Disease

The main symptoms of vein disease include:

• Pain while standing
• Swelling in legs or ankles
• Feeling like you’re walking through concrete
• Aching or heaviness in the legs
• Skin changes, such as dryness, discoloration, or itching
• Restless leg syndrome (a strong urge to move your legs)

Symptoms specific to different venous diseases include:

Varicose Veins

• Visible, twisted, wormlike veins, often purple or blue
• Aching or heavy feeling in legs
• Burning, throbbing, or muscle cramping
• Discolored patches of skin around the varicose veins
• Itching around affected veins

Spider Veins

• Thin, red lines or weblike networks of blood vessels on skin surface
• Usually appear on legs and feet
• May cause mild discomfort

Reticular Veins

• Blue or purple veins, most often on the backs of the knees, inner thighs, or near the ankles

Complications of Venous Disease

While issues with blood flow are never good, not all venous diseases lead to health complications.

For example, spider veins and reticular veins are largely considered cosmetic issues. That said, they can be early signs of venous insufficiency and should be monitored to make sure they don’t progress to more serious conditions.

Varicose veins, however, can result in complications including:

• Ulcers: Caused by pressure in the veins, ulcers can form under the skin, causing hard, painful veins. If they become infected, they can take a long time to heal due to poor circulation.
• Blood clots: Formed in blood that pools in the legs, clots may appear red or feel warm to the touch. They can cause throbbing or cramping pain, especially when walking or standing.
• Phlebitis: A swelling of veins, phlebitis can cause pain, tenderness, or swelling in the affected area as well as warmth and itchiness, red or thickening skin, throbbing or burning in the leg, or pain that worsens when the leg is lowered.
• Deep vein thrombosis: While varicose veins don't usually cause blood clots, people with the condition may have a higher risk of developing DVT.

Diagnosing and Treating Venous Disease

According to Dr. Y. Avery Ching, an endovascular surgeon with Baystate Vascular Services, venous disease is diagnosed using a combination of clinical evaluation and non-invasive imaging tests.

“Patients are often referred to us by their primary provider or come on their own after living with the discomfort of their condition or noticing a change in the appearance of their legs,” he explains.

Using information gathered through an exam and a patient’s medical history, Dr. Ching and his colleagues look to determine the potential cause of any swelling or discoloration.

“There are over 200 potential causes for leg swelling,” he says, “so it’s important to get to the root cause. It may be a venous issue, but it may also be the result of certain medications, an injury, arthritis, heart failure, or even a nutritional deficiency.”

If a venous condition is diagnosed, the standard go-to treatment is compression stockings.

“Essentially tight-fitting socks that apply gentle pressure to the legs, compression stockings help blood flow back to the heart and prevent pooling in the legs,” explains Dr. Ching.

Compression stockings come in medical-grade and over-the-counter types, each offering different levels of compression. Patients prescribed medical-grade stockings are measured for them by their provider and their prescription can be filled at a medical supply store.

Once patients have worn socks for several weeks, they return to the doctor for an evaluation, which may include an ultrasound.

“The ultrasound shows us how well the valves in the leg are or aren’t working,” says Dr. Ching.

“A patient’s condition is then graded using an A to F scale based on how long the valves stay open. An A grade is considered normal and healthy. Most patients in the B to C range typically are advised to stick with the stockings and to maybe begin taking an herbal supplement known as Butcher’s Broom. But for D- and F-graded patients, we look to surgical options as the next step.”

Surgical Treatments for Venous Disease

Several minimally invasive surgical options are available for addressing chronic venous insufficiency. The recommended treatment is based on the severity of the patient’s condition and overall health.

Ablation

Ablation is a reliable option for treating varicose veins and, in some instances, spider veins. Performed in the doctor’s office using local anesthesia and sometimes a mild sedative, the procedure takes an hour or less to complete.

“Ablation can be performed using radiofrequency, a laser, or glue to essentially seal off a vein,” says Dr. Ching. He explains, “A catheter is inserted into the affected vein. Then, radiofrequency, laser, or glue is sent up the catheter to the top of the vein and then drawn back down. As it comes down, it seals the vein either by scar tissue resulting from damage caused by the laser or radiofrequency or, the glue sealing the vein shut.”

Ablation provides immediate results with minimal side effects. “Patients may feel a little bit of tightness in the vein but the majority return to work quickly without any activity restrictions.”

Stab Phlebectomy

A minimally invasive performed in the doctor’s office, stab phlebectomy involves making tiny cuts (or stabs) in the skin directly over the vein. A thin, hooked instrument is inserted and the affected portions of the vein are extracted in sections. Complications are rare and the procedure dramatically improves cosmetic appearances and provides immediate relief. Most patients return to normal activities in 1 to 2 days.

Sclerotherapy

Sclerotherapy also involves inserting a catheter into the affected vein. A chemical is injected into the vein, causing it to collapse and become scar tissue. Like ablation, sclerotherapy is performed in the office under local anesthesia. Most patients experience a reduction of 50 to 70% of visible spider veins, but never 100%.

Managing Venous Disease

Both Dr. Ching and Steidler note that varicose veins don't heal naturally and typically require medical intervention for improvement.

However, there are things you can do to reduce your risk of developing venous conditions and ease discomfort. “To begin with,” says Steidler, “avoid salty foods, keep your weight in a healthy range, and avoid being sedentary. If you have a desk job, get up every hour or so and move around.”

She also encourages regular exercise, which works to improve circulation in your legs.

If you have a diagnosed venous disease, elevating your legs can help relieve pain and reduce swelling. Steidler says, “Elevating your legs decreases the pressure on your veins. Elevating them so your feet are above the heart keeps blood from pooling in the lower legs. But if that’s not possible, stretching them out on a couch or a footstool will provide some relief and benefit.”

However, she notes, “Relief is not the same as treatment. Untreated venous disease can lead to a worsening of pain and other symptoms, cause skin damage, increase the risk of complications like ulcers, and negatively impact quality of life. If you experience symptoms like leg swelling, heaviness, aching, visible varicose veins, or skin changes on your legs, talk to your doctor or contact Baystate Vascular Services to schedule a consultation.