Healthy skin centre

Varicose veins and spider veins

Varicose veins are large, raised, swollen blood vessels that twist and turn. They usually develop in the legs and can be seen through the skin.

Spider veins (also called thread veins) are smaller, red, purple and blue vessels that are also twisted and turning. Spider veins are easily visible through the skin as well. They are also most often seen on the legs and face.

Causes of varicose veins and spider veins

A number of factors predispose a person to varicose veins and spider veins. These include:

• Heredity.
• Occupations that involve a lot of standing.
• Obesity.
• Hormonal influences during pregnancy, puberty and menopause.
• The use of contraceptive pills and hormone replacement therapy (HRT).
• A history of blood clots.
• Conditions that cause increased pressure in the abdomen including pregnancy, tumours, constipation and externally worn garments like girdles.

Other reported causes include trauma or injury to the skin, previous vein surgery and exposure to ultraviolet rays.

Other risk factors for varicose veins and spider veins

Varicose veins and spider veins develop more often in women than in men. They increase in frequency with age. An estimated 30% to 60% of adults have varicose veins or spider veins.

Symptoms of varicose veins and spider veins

Many patients with varicose veins complain of pain, described as an aching or cramping in the legs. Other common symptoms include tiredness, restlessness, burning, throbbing, tingling or heaviness in the legs. Pain caused by varicose veins is usually relieved by elevating the legs or by wearing compression stockings.

In women, symptoms may be worse during certain parts of the menstrual cycle or during pregnancy. Patients also may develop swelling, ulcers (large sores) and an increase in the pigmentation or darkening of the colour of their skin, especially in the ankle region. Occasionally, varicose veins and spider veins can form a painful blood clot with inflammation of the vein called thrombophlebitis.

Treatment options for varicose veins and spider veins

There are a number of forms of treatment for varicose veins and spider veins. Some treatments for varicose veins are available on the NHS, but this varies in different parts of the country. You should check with your doctor about availability of this treatment and what the right treatment is for you.

1. Compression stockings or tights. The most conservative approach is simply to wear properly-fitting support stockings, especially when the veins cause painful or uncomfortable symptoms. These stockings can generally be purchased at pharmacies, but sometimes can be prescribed by your GP. They come in below-the-knee, above-the-knee and tights styles. Compression tights are not available on prescription.
   
2. Lifestyle changes. Good skin hygiene, weight loss (if needed) and walking can help to improve varicose veins and spider veins.
   
3. Sclerotherapy. This procedure, which has been available since the 1930s, is another treatment option for some women. This technique uses a chemical solution that is injected directly into the vein. Pressure pad dressing and compression bandages or stockings are then applied, obliterating the vein, which will gradually disappear over three to six weeks. The procedure is simple and can be performed in an outpatient setting.
   
4. Endovenous laser treatment. A procedure in which a small laser fibre is inserted into the vein. Pulses of laser light are delivered inside the vein, which causes the vein to collapse. The procedure is done as an outpatient under local anaesthesia and you may notice some bruising.
   
5. Radiofrequency Ablation. A small catheter is inserted into the vein which delivers radiofrequency energy to the vein wall, causing it to heat, collapse and seal shut. The procedure is generally done as an outpatient or in a specialist’s consulting room and may be done under local anaesthesia.
   
6. Surgery. Surgical techniques to treat varicose veins include ligation (tying off of a vein) and stripping (removal of a long segment of vein). Another procedure, ambulatory phlebectomy, allows for the removal of large surface veins through very small incisions that do not need stitches. Surgery may be performed using local, spinal or general anaesthesia. Most patients return home the same day as the procedure. Surgery is generally used to treat large varicose veins.
   
7. Transilluminated powered phlebectomy. During this procedure, one or two small incisions are made in your leg. Your surgeon will place a special light, called an endoscopic transilluminator, underneath your skin to see which veins are to be removed. The affected veins are cut and removed through the incisions using a suction device. Transilluminated powered phlebectomy can be carried out under general or local anaesthetic. You may notice some bruising afterwards.
   

Not all patients need treatment for their varicose veins or spider veins. Many people have no pain or other symptoms. For these individuals, no treatment is necessary, unless they want the veins removed for cosmetic reasons.