PROCEDURES FOR SPIDER AND VARICOSE VEINS Reducing Symptoms and Improving Appearance
Understanding Leg Vein Problems Do your legs feel tired and achy at the end of the day? Are you unhappy about visible veins on your legs? You may have a vein condition that can be treated. Spider veins and varicose veins can affect your health and your self-image. Treating them can relieve discomfort. It can also help you feel better about how you look. What Are Spider Veins? Very small blood vessels just below the skin s surface can become damaged. They can then form webs of blue, purple, or red veins. These spider veins rarely cause serious symptoms. Because they are near the skin s surface, though, they can be seen. What Are Varicose Veins? Varicose veins occur when vein damage causes blood to flow in the wrong direction. Blood then pools in the veins. This causes them to swell. Varicose veins usually occur in the legs. They can cause symptoms such as leg tiredness, aching, heaviness, and itching. The veins may also bulge, twist, and stand out from the skin. 2
Who Gets Spider Veins or Varicose Veins? Both men and women can develop spider or varicose veins. Certain risk factors can make someone more likely to have problem veins. Standing or sitting all day is a risk. So is being overweight, having a leg injury, or not getting exercise. Problem veins are common in women during pregnancy. Other hormonal changes can also make them more likely. And problem veins tend to run in families. What Can Be Done About Vein Problems? In many cases, problem veins can be treated. Self-care can help relieve symptoms. Certain procedures or surgery may also be suggested. This booklet tells you more about treatment options. Use it as a starting point for talking with your doctor. 3
How Leg Veins Work A system of blood vessels sends blood from the heart to the rest of the body, then back to the heart again. The system has two parts: arteries and veins. Arteries carry oxygen-rich blood away from the heart. Veins return blood to the heart. Healthy Leg Veins The body has a vast network of veins. The smallest surface veins drain into the reticular system. This is a web of tiny veins just below the skin. Blood then flows into the larger superficial veins. Short perforating veins carry blood from the superficial veins to the largest deep veins. These veins carry blood back to the heart. Returning Blood to the Heart To get from the feet and legs to the heart, blood has to flow upward. The action of the calf and thigh muscles helps move blood upward against gravity. Valves (small flaps inside the veins) open to let the blood through. Then they close to keep it from flowing backward. Right leg Back view Side view Great saphenous vein Deep vein Small saphenous vein The great and small saphenous veins are the main superficial leg veins. The valve opens as leg muscles squeeze on the vein. This lets blood flow upward. Blood flow to heart Open valve Skin Reticular vein Superficial vein The valve closes as leg muscles relax. This prevents blood from leaking downward. Perforating vein Deep vein Blood drains from smaller veins close to the surface into larger, deeper veins. Closed valve 4
When Vein Problems Develop Most vein problems start when veins widen and stretch (dilate). When this happens, valves inside the veins can t close properly. Affected veins have trouble carrying blood back to the heart. Spider Veins When tiny blood vessels just below the skin widen, they can be seen easily. Clusters of spider veins can even look like a bruise. These veins are rarely harmful. However, the way they look can make you self-conscious. Spider veins can sometimes itch or cause a burning feeling. In rare cases, these vessels can bleed, causing more serious problems. Varicose Veins When a vein is dilated or its valves are damaged, blood moves the wrong way. It leaks down the leg vein and backs up. This is known as reflux. Reflux can cause the leg to ache or swell. The leg may also feel tired, heavy, or full. Problems with the saphenous veins can harm the side veins that drain into them. This can cause the smaller veins to dilate and become varicose as well. Varicose veins can cause bleeding, changes in skin color, and ulcers. If blood forms a clot in a varicose vein, the vein walls can inflame (superficial thrombophlebitis). Sudden pain, redness, or swelling may result. Spider veins occur when small blood vessels near the skin become enlarged. Damaged valve Weak vein wall Varicose veins occur when valves don t close well. Blood leaks back down the vein. The backup of blood can cause veins to bulge and appear ropy or twisted. 5
Evaluating Your Vein Problem Before you move on to treatment, your doctor will evaluate you. Your doctor must also rule out more serious problems with the deep vein system. You may have certain tests. These are meant to find the causes and extent of the problem. Your Medical History The doctor will ask about your medical history, including: Any family history of vein problems. Your symptoms. Your job and activities. Medications you re taking, especially blood thinners. Whether you ve had a blood clot in a deep vein. Current or previous pregnancies. Previous leg injuries. Your Physical Exam Your doctor will examine your legs during one or more office visits. The abnormal veins may be photographed to record their size and location. During your exam, a Doppler scanner may be used to check for signs of reflux. This scanner is used to listen to the sounds of blood flow. Duplex Ultrasound Duplex ultrasound is a test that uses sound waves to create pictures of veins and blood flow. This helps show areas of reflux. The test can also show if valves are leaking. It can help the doctor rule out more serious vein conditions. A duplex ultrasound test can assess vein health and locate problems. 6
Your Treatment Plan After your evaluation, you ll work with your doctor to set up a treatment plan. This plan will be tailored to your needs. You may have several treatment options. Learn the benefits and risks of each option. Be sure to ask your doctor any questions you have. Together, you and your doctor can decide on a plan that meets your needs. Treatment Options Treatment focuses on destroying or removing problem veins. Then other veins take over carrying blood. Treatment options include: Injections (sclerotherapy). Minimally invasive procedures (which require only small incisions or punctures). Surgery. You can also use self-care to help manage your symptoms. Compression stockings are likely to be part of any treatment plan. What to Expect from Treatments There are some things that treatment can and cannot help with. Be aware that vein treatments: Can decrease or eliminate symptoms. Can improve your appearance. Cannot guarantee problem-free veins in the future. This can be a recurring condition. The underlying causes may still exist. Cannot make your legs look perfect. Your doctor will strive for the best result possible, though. If You re Pregnant Varicose veins often develop or worsen during pregnancy. Keep in mind that: Self-care can help relieve symptoms. See pages 8 and 9 to learn more about self-care. Abnormal veins often improve after pregnancy. Your veins can then be re-evaluated to see if treatment is needed. You can seek treatment before you re finished having children. In fact, getting treated after you give birth can reduce vein problems during future pregnancies. 7
Self-Care for Your Problem Veins 8 Proper care of your legs can help reduce the symptoms of problem veins. Any self-care you do can help. The more you do, the better your results are likely to be. Follow the plan outlined by your doctor. Work with your doctor to get help making lifestyle changes. Compression Stockings Gradient compression stockings fit snugly around your legs. They put more pressure at the ankle than at the top. This moves blood upward and helps keep it from pooling in the legs. These stretchy stockings come in a variety of styles, lengths, and sizes, including maternity sizes. They also come in different degrees of pressure. Your doctor will prescribe stockings in a safe and effective pressure for you. In general, stockings up to 40 mmhg pressure are safe. Check with your doctor before buying or wearing any compression stockings. He or she will help you choose ones that feel comfortable and are effective. Tips for Using Compression Stockings Make sure to wear stockings correctly. Pull them to the designated height and no farther. Don t let them bunch up at the top, as this can restrict circulation. Don t leave any folds or wrinkles. Replace your stockings when they start to become loose. This is often after 4 to 6 months. Don t sleep in stockings unless you are told to do so. Wear the length and pressure prescribed by your doctor. Wear them for the amount of time recommended by your doctor. If you have trouble pulling stockings on, wear thin rubber gloves. This helps improve your grip and prevents tearing. You can also use an aid such as a stocking donner to help put them on.
Keeping skin moist prevents dryness and itching. Exercise Exercising your calf and thigh muscles helps move blood upward. Having toned muscles may help with blood flow even when you re sitting or standing. To get the most benefit: Choose exercises that work your leg muscles. Walking, swimming, and cycling are great choices. If you re new to exercise, start slowly and build up. Try to do at least 30 minutes of exercise, most days of the week. Ask your doctor which exercises are best for you. If you sit most of the day, get up and walk from time to time. Just changing position may offer some relief. Try wiggling your toes for a minute every hour. Elevation Raising your legs lets gravity help blood flow back to the heart. Sit or lie with your feet a few inches above your heart for 15 minutes, 2 to 3 times a day. If this is not practical, do as much as you can. Any elevation can help. Evaluating Your Lifestyle When sitting or standing for long periods, try working your calves by rising on your toes. Are you overweight? If so, losing weight will help relieve some of your symptoms. Talk to your doctor about how to reach a healthy weight. Is your diet a factor? Eating too much salt can make you retain water. This can make vein problems more likely. Ask your doctor for advice on adjusting your diet. 9
Sclerotherapy This technique involves injecting the problem vein with a chemical. This causes the blood vessel to close up and dissolve. Sclerotherapy is the main treatment option for spider veins. It s also used for treatment of certain varicose veins. It is performed in a short office visit. It causes little to no pain. How It Works Using a very fine needle, your doctor injects a special chemical into the blood vessel. The chemical causes inflammation. This makes the walls of the vessel stick together. As a result, the treated vessel can no longer hold blood. It shrivels and is eventually absorbed by the body. In some cases, the injections are guided by an ultrasound image. Your Experience Spider vein being treated Over time, the treated blood vessel fades and disappears. Your doctor may ask you not to use cream or lotion on your legs on the day of treatment. No other special preparation is needed. During your first session, your doctor may give you a few injections to test how you respond to the chemical. Based on your response, the amount of the chemical may be adjusted. You may have multiple sessions for different parts of the leg. Many veins can be treated in one session. In most cases, there is little or no pain during treatment. You may feel a slight burning or itching, though. When the treatment is finished, your leg will be wrapped in a compression bandage or stocking. Your doctor will tell you how long you should leave this on. 10
What to Expect Afterward You will most likely feel back to normal soon after the procedure. You can return to your normal routine, including work, right away. You are likely to see some bruising, but it is usually not severe. It may take up to 8 weeks for veins to disappear. In rare cases, some veins may need to be treated more than once. Blood may become trapped in some spider veins. If so, your doctor can remove it with a small puncture. Aftercare Follow all of your doctor s instructions. Also, keep these points in mind: Wear compression stockings or bandages as directed. Elevate your legs as directed. Avoid high-impact activities as advised by your doctor. Walk every day. Avoid hot baths, saunas, and other hot environments as advised. Protect the treated area from sunlight. Cover up or use sunscreen. Avoid aspirin, ibuprofen, and other medications for a few days if instructed. Risks and Complications Risks and possible complications of sclerotherapy include: Bruising or discoloration (usually temporary) along the treated vessel Allergic reaction to the injected chemical Blood clot Scabbing or scarring Small skin ulcers Growth of new blood vessels around the treated area When to Call Your Doctor Call your doctor if you have any of the following: Persistent or increasing pain in the legs or feet Persistent itching, bleeding, or oozing Swelling Fever of 100.4 F (38 C) or higher Chest pain 11
Endovenous Ablation Endovenous ablation uses heat to treat a varicose vein. Closing off a problem vein reduces pressure on smaller, side-branch varicose veins. Endovenous ablation involves only needle punctures, not incisions. You can go back to your normal routine soon after the procedure. How It Works Your doctor punctures the vein with a needle. A heat source is delivered by a catheter (thin tube) into the vein. This heat source is either radiofrequency (RF) or a laser. Ultrasound is used to help position the heat source in the vein. The heat source is then drawn backward. This ablates (destroys) the tissue and closes the vein behind it. Over time, the body absorbs the treated vein. Treated portion of vein RF catheter (heat source) Your Experience Treated portion of vein Laser (heat source) Catheter With endovenous ablation, a heat source is used to seal off a problem vein. This procedure can be done in the doctor s office, a hospital, or a surgery center. Your doctor will tell you if you need to do anything special to prepare. You may be awake and able to talk to your doctor during the procedure. You will be given medication to control pain and help you relax. Afterward, pressure or a bandage is applied to the puncture site to stop bleeding. A compression bandage or stocking is then put on your leg. 12
What to Expect Afterward You ll be able to go home soon after the procedure. You can resume normal activities, including work, in 1 to 2 days. You may have some bruising, but little or no swelling. If you have pain, take over-thecounter medications as instructed. Your legs may look and feel better right away. Or it may take 1 to 2 weeks after the procedure for you to see improvement. Aftercare Follow all of your doctor s instructions. Also, keep these points in mind: Wear elastic stockings or bandages as instructed. Elevate your legs from time to time throughout the day. Avoid heavy exercise, lifting, or prolonged standing for as long as advised. Walk every day. Avoid hot baths, saunas, and other hot environments as advised. Return for follow-up appointments with your doctor. Risks and Complications Risks and possible complications of endovenous ablation include: Swelling or redness Severe bruising or bleeding Temporary skin numbness Infection Skin burn Blood clot in a deep vein Blood clot moving to the lung When to Call Your Doctor Call your doctor if you experience any of the following: Increasing pain Persistent bleeding or oozing Numb feet Swelling Fever of 100.4 F (38 C) or higher Chest pain Shortness of breath You may be able to return to gentle exercise very soon after your procedure. 13
Surgery to Remove Leg Veins In some cases, surgery is needed to remove varicose veins. Surgery may be done in the doctor s office, a surgery center, or a hospital. Your doctor can tell you how long surgery is likely to take. You can expect to go home within a few hours after it is complete. Preparing for Surgery Tell your doctor about any medications, vitamins, herbal remedies, or other supplements you take. You may be asked to stop taking some or all medications before surgery. Anesthesia will be used to prevent you from feeling pain. The medication may make you relaxed and drowsy, but awake. Or you may be in a state like deep sleep. Do not eat or drink anything before the procedure as instructed. Arrange to have an adult family member or friend drive you home after surgery. Microphlebectomy This minimally invasive procedure is usually done on small varicose veins. Your leg is numbed. Small incisions are made over or beside the affected vein or veins. These are made with a needle or small puncturing tool. The surgeon uses a special hook to gently remove one or more veins. Incisions are closed with stitches or small strips of tape. This procedure can be done alone, or along with another vein procedure. After surgery is finished, your leg is then wrapped in a bandage or compression stocking. You can get up and walk soon and go home in about an hour. You can expect to get back to work and your normal routine in a day or two. Vein to be removed Hook Magnified view of vein and hook 14
Ligation with Stripping This surgery can be used to remove large superficial veins. Small incisions are made at the top and bottom of the vein to be removed. The vein is closed (ligated) at the top and bottom. The surgeon then removes (strips) the vein. After surgery, the legs are wrapped in compression bandages. You may go home in a few hours. Pain medication is likely to be prescribed. You should be able to resume your normal routine as soon as you feel well enough. Recovering from Surgery Take pain medications as prescribed. Keep your legs elevated when sitting or lying down. Walk frequently, starting the day after surgery. Even short walks help. Wear compression stockings or bandages as directed. To help blood flow, draw the letters of the alphabet in the air with your feet. Risks and Complications Risks and possible complications of these surgeries include: Bleeding Swelling Infection Numbness in legs Blood clot in a deep vein Complications of anesthesia Follow your doctor s directions for wearing compression stockings or bandages after surgery. When to Call Your Doctor Call your doctor if you have any of the following: Severe bleeding or swelling Increasing leg pain Numb feet Fever of 100.4 F (38 C) or higher Chest pain Shortness of breath 15
Also available in Spanish After Vein Treatment Is Finished Treatment for spider and varicose veins can help you feel better and look better. For the best results, keep follow-up appointments with your doctor. Use self-care to help with recovery and reduce symptoms. Get ready to show off your legs again! TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit www.kramesurvey.com to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2015 The StayWell Company, LLC. www.kramesstore.com 800.333.3032 All rights reserved. Made in the USA. 12210 1508