Varicose Veins
Varicose Veins
You Don't Have to Live
with Them
What woman doesn't hate varicose veins, whether they're small and spidery or bulgy blue ropes? varicose veins creep up the legs of over half of us after age 40, and they're a potent reminder of aging. All of a sudden, wearing shorts or a swimsuit isn't an automatic choice anymore.
What we call spider veins doctors call venous telangiectasia. They are actually dilated veins, often found on the upper calves and thighs. Both spider veins and varicose veins, which are usually found on the legs, are veins that are larger than they should be.
Although many women find spider veins just a cosmetic annoyance, larger varicose veins can be truly uncomfortable. Sometimes they cause a feeling of heaviness, tiredness and chronic aching in the calves. They can trigger night cramps and restless legs that disturb sleep and leave you dragging and worn out. Swollen veins often become itchy and sore. And although it's rare, varicose veins may indicate a clot in a deeper leg vein.
For Women Mostly
Where do they come from? Your genes, for starters. You can inherit the tendency to form varicose veins from either side of the family.
But the fact is that varicose veins are up to six times more common in women than in men, which leads scientists to believe that female hormones play a strong role in their formation.
One theory suggests that when a woman is pregnant, her greater blood volume increases vein pressure. At the same time, her higher levels of the hormone progesterone may help dilate veins. Add to this the weight of the uterus pressing on pelvic veins, which, in turn, transmits more pressure to leg veins. It's the blueprint for varicose veins.
Menstruation can also cause pressure on your veins because of the increase in blood volume just before you menstruate. It's why your legs may feel achy right before your period.
Lifestyle factors can also aggravate vein problems. If you smoke, varicose veins are much more likely to creep up on you, because smoking affects blood flow by interfering with the regulation of fibrin, a blood-clotting protein. Although being heavy doesn't cause varicose veins directly, being 20 percent over your ideal weight can coax out varicose veins in those who have hereditary tendencies toward them. Lifting very heavy weights and running on hard surfaces may also hasten the appearance of varicose veins.
Sometimes the underlying problem is physiological. People with varicose veins have an inherited weakness in the valves inside the leg veins. These veins normally prevent blood from leaking back down as it flows up to the heart. If a valve leaks, gravity forces blood into lower veins when you stand up. Once this process is repeated enough times, vein walls can become permanently stretched.
"Whenever you're standing or sitting with your legs below the heart, gravity's working against you," explains Malcolm O. Perry, M.D., professor and chief of vascular surgery at Texas Tech University Health Sciences Center in Lubbock.
Fallout from a Low-Fiber Diet
There's one thing doctors know for sure about varicose veins: They are not a natural part of aging. In fact, Glenn Geelhoed, M.D., professor of surgery and international medical education at George Washington University Medical Center in Washington, D.C., has studied varicose veins in populations around the world and has found that in some Third World cultures, varicose veins are all but nonexistent, even in women who have borne children. He has also found that when these people move to countries such as the United States and adopt our habits--mainly, a low-fiber diet and a sedentary lifestyle--they start to develop varicose veins.
Too little fiber produces constipation and straining on the toilet, and that may be where diet affects vein health most. Western populations on low-fiber diets pass smaller and harder stools than do Third World people, who have few varicose veins, Dr. Geelhoed notes. And when you strain in vain, that increases pressure in rectal veins, which in turn passes on more pressure to leg veins.
In fact, the famed Framingham Heart Study, which followed the lifestyles of residents of this Massachusetts town for over 40 years, found that the risk factors for varicose veins are the same as for heart disease--particularly being overweight and sedentary. The Framingham study also showed that compared with women without varicose veins, those with vein problems were more often obese, were less active, had higher blood pressure and were older at the onset of menopause.
Removing the Webs
Some women call them spider veins--those visible red lines that usually crop up on the legs, especially the thighs, and seem to resemble the fragile patterns of a spider's web. How do you get rid of them? If they're big enough, usually conventional sclerotherapy is the best bet, says Arthur Bertolino, M.D., associate clinical professor of dermatology at New York University Medical Center in New York City and a dermatologist in Ridgewood, New Jersey. "The optimal size for treatment is at least as large as the line you'd write on a piece of paper with an ordinary ballpoint pen," he says. "If they're too small, you can't put a needle in." If you have just a few tiny spiders, consider a cover-up makeup with a greenish base, which conceals red tones, Dr. Bertolino suggests. But for more than a few on the face or legs, sclerotherapy is usually very successful, he says. A tiny needle is inserted into the vein, and a solution is injected. You can actually see the red network disappear as the clear solution enters the vein, he says. Side effects? Occasionally, the solution will cause a temporary muscle cramp near the ankle or the back of the lower calf, which your doctor can massage away in a minute or two. Rarely, a skin ulcer may result from fluid that escapes a leaky vessel, or new spider veins called mats may form, he says. There may also be a brownish discoloration of the skin, which almost always fades completely on its own but can often be removed using a copper vapor laser. The pulsed-dye laser is also used by some physicians to remove dilated facial capillaries, says David Green, M.D., a dermatologist at the Varicose Vein Center in Bethesda, Maryland. The light waves emitted by the laser are absorbed by hemoglobin molecules in the blood. "This vaporizes the hemoglobin, which turns the light energy into heat energy and 'fizzles' the vessel wall," he says. "Current lasers are not great on veins or capillaries below the waist," Dr. Green says. "But they're great on those above the neck, particularly on the nose and cheeks." |
They're Not Inevitable
If varicose veins run in the family but haven't yet turned up on you, there are many things you can do to help forestall them.
Shed some weight. If you are significantly overweight, a gradual, healthy weight loss plan can be your veins' biggest ally, says Alan Kanter, M.D., medical director of the Vein Center of Orange County in Irvine, California. Extra pounds put unnecessary pressure on your legs.
Fiber up your diet. Make sure your diet is high in fiber to keep bowels healthy and stools soft. This will prevent straining due to constipation, Dr. Kanter says. Fiber is found in abundance in fruits, vegetables and whole grains.
Drink water. Another way to soften stools is to be sure you're well hydrated by drinking at least eight glasses of water a day, says Dr. Kanter.
Don't smoke. Or if you do, stop, says Dr. Geelhoed. Smoking increases your risk of developing underlying vein disease, which can contribute to varicose veins, he says.
Lift weights wisely. Weight-lifting exercise will help with weight control, but you need to do it right to avoid encouraging a vein problem, says Dr. Kanter. Use smaller weights and do more repetitions rather than straining with heavy weights, he says. Ask a trainer to set up a program for you.
Jog on gentle ground. Plan your running route along soft surfaces such as dirt, grass or cinder track whenever possible, Dr. Kanter suggests. The impact of running on pavement can aggravate vein swelling.
Keep moving on the job. Don't sit for two or three hours straight while you work, says Dr. Perry. Be sure to get up and move around often to keep blood circulating. The Framingham study found that women who spent eight or more hours a day in sedentary activities, sitting or standing, had a much higher incidence of varicose veins.
Home Treatment for the Ones You Have
If you already have a few varicose veins developing, here's how to keep them under control.
Sleep on a slope. Put six- by six-inch blocks under the foot of your bed and leave them there, says Dr. Perry. This keeps blood from pooling in your legs at night. You can quickly adapt to the tilt.
Wear support hose. For a few small veins, choose high-quality support hose from a good clothing store and wear them regularly, says Dr. Perry. Support hose are available in knee-high, stocking and panty-hose styles. The slight compression will help keep the veins down, he says. For more or larger veins, you may need to use gradient compression stockings, available over the counter in most drugstores.
Try gradient stockings. If the veins you have are fairly large, even good-quality support hose aren't enough, says Dr. Perry. Ask your doctor to prescribe custom-fitted gradient compression stockings instead. "They're hot and heavy, but they help," he says. Most women opt to wear them under pants for work and save the more sheer support hose for special occasions.
The Big Cover-Up
There are two basic medical treatments available for varicose veins: sclerotherapy (injection) and surgical removal (stripping).
The latest advance in both sclerotherapy and vein surgery is the use of sound wave technology, called duplex ultrasound imaging. The ultrasound equipment is used to locate deeper problem veins and to guide injections precisely, says Dr. Kanter. And ultrasound is both painless and safe.
Sclerotherapy involves injecting a solution into a vein, causing the vein's walls to be absorbed by the body. No anesthesia is needed, and "you can be up and about your business right afterward," says David Green, M.D., a dermatologist at the Varicose Vein Center in Bethesda, Maryland. A few weeks to months later, the vein shrivels to an invisible thread of scar tissue under the skin.
If you have had large varicose veins treated with sclerotherapy, you will need to wear gradient compression stockings for up to six weeks afterward, Dr. Green says.
The cost usually ranges from around $100 to several hundred dollars, depending on the number of injections needed. Multiple treatments may be required if you have many affected veins.
Who's a candidate? Virtually anyone, as long as you are not pregnant and have no history of blood clotting disorders, Dr. Green says. But although the procedure is simple and effective, there are potential side effects. If the solution escapes the vein, it can cause an ulcer on the skin. And in up to 20 percent of patients, a brown line appears on the skin, following the course of the vein. In greater than 90 percent of these patients, the discoloration fades completely over months or a year or two, Dr. Green says.
Lasers can remove the discoloration when wielded by a physician skilled in using the copper vapor laser. One Australian study showed that 11 of 16 patients treated with copper vapor laser therapy for discoloration caused by sclerotherapy had significant improvement after three months.
Surgical stripping is sometimes recommended for severe varicose veins. Although some patients can undergo the surgery with local anesthesia, most surgeons prefer a light general anesthesia, Dr. Perry says. Many patients have the surgery as outpatients, going home late the same day. Compression stockings are worn for several weeks to months afterward.
Even though the affected veins are completely removed, there is no risk to your circulation, because other vessels can easily compensate for the loss of the superficial veins, Dr. Perry says.
While some scarring usually results from surgery, often long lengths of vein can be removed through several tiny incisions.
What are the advantages of surgery? Many vein specialists say that even large varicose veins can be effectively treated with sclerotherapy. But some vascular surgeons point out that there is a high rate of recurrence with the injection treatment, and multiple visits are often required if you have many affected veins. However, when ultrasound imaging is used to help guide the surgery, preliminary results show a higher success rate in fewer visits.
