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Venous insufficiencies are conditions that create vein damage. Veins carry deoxygenated blood back to your heart from your organs and tissues (in contrast to arteries, which carry oxygen-rich blood to your organs and tissues from your heart). There are numerous venous insufficiencies. At TMSC, we treat three of them: spider veins, reticular veins, and varicose veins. Here’s what they are:
Spider veins (<1mm diameter): Spider veins are small, damaged veins typically spotted on the legs. Usually they are not painful or harmful. In rare cases, they cause pain and discomfort in the respective area. Spider veins are more common in women than men. Most people wish to treat them for cosmetic reasons.
Reticular veins (1-2mm diameter): Reticular veins are veins that are seen below the surface of the skin, but they do not protrude and cannot be felt. For the most part, they are a cosmetic concern. In some cases, they can cause discomfort and aching. The most significant difference between reticular and spider veins is the size. One can have both reticular and spider veins. The former can even act as a “feeder” to the latter. It’s not uncommon to see spider veins extending from reticular veins.
Vericose veins (>2mm diameter): Varicose veins are twisted, often bulging (protruding) veins, and the affected person can feel them on the surface of the skin. These veins are visible under the skin surface and are more often than not simply a cosmetic concern. However, in certain cases they do cause pain and discomfort.
Spider veins: Spider veins can appear blue, purple, or red. They appear in the form of thin lines resembling webs (hence the name “spider” veins) or branches. They’re most common on the thighs, ankles, and calves.
Reticular veins: Similar to spider veins, reticular veins can appear blue or purple. They typically appear on the backs of knees, inner thighs, and near ankles. They can sometimes be painful or uncomfortable. In addition, in rare cases they may lead to burning, itching, redness, swelling, or tenderness.
Varicose veins: Varicose veins can appear twisted and bulging, looking not unlike cords in the legs. They’re usually dark purple or blue in color. Varicose veins can occur anywhere in the body, but generally they occur in the legs due to frequent standing and walking, activities which increase pressure in these veins. Varicose veins are often not painful at all, but when they are, symptoms may include aches, heaviness in the legs, burning, throbbing, muscle cramping, swelling, worsened pain following extended sitting or standing, itchiness, or skin discoloration around the affected area.
Venous insufficiencies occur when veins cluster below the surface of the skin and their valves stop functioning correctly, leading to discolorations. Essentially, veins are meant to carry blood back to your heart. They contain a one-way valve that closes once the blood has passed through in order to prevent it from flowing backwards. In addition to that, your veins are working against gravity to return blood to the heart. If the valve weakens or damages for any reason, it begins to malfunction, preventing regular blood flow and resulting in pooling of blood inside the veins. This then creates a bulge in the vein, which branches out to form spider veins, reticular veins, and/or varicose veins. Varicose veins in particular usually occur due to reflux in the greater and lesser saphenous veins.
Risk factors that can lead to spider veins, reticular veins, or varicose veins include, genetics, pregnancy, being female, age, obesity, hormonal changes, extended sitting or standing, previous blood clots or vein damage, sun damage, and extended standing or sitting as being in the same position for a long time restricts proper blood flow
At TMSC, our highly experienced vascular surgeon treats all three venous insufficiencies.
We treat spider veins via transcutaneous laser therapy or sclerotherapy injection. Transcutaneous laser therapy involves the application of a laser impulse through the skin that selectively “attacks” the affected veins, leading to their denaturation and coagulation followed by resorption and disappearance. One of the primary advantages this treatment allows is that it does not require any incisions or punctures to the skin.
Sclerotherapy injection, on the other hand, is a procedure that involves injecting a solution (usually a salt solution) into the affected veins. The lining of the vein is irritated by the solution, which causes it to collapse and stick together, forming a blood clot. Then, over time, the vein turns into a scar tissue which fades away. Sclerotherapy is a highly reliable procedure being used since the 1930s.
At TMSC, we use sclerodex, a low dose sclerosing agent that avoids staining. It is injected using a very fine needle. The number of veins injected vary on a case-by-case basis. The sclerotherapy injection procedure itself takes approximately 15-30 minutes to perform.
In many cases, sclerotherapy injection can be used to treat reticular veins, especially if they are confined to the cutaneous and subcutaneous tissue. If sclerotherapy injection is not a viable option—which is sometimes the case when the veins are larger and deeper—then ablative therapy is required. Typically, an ultrasound is necessary to determine the type of treatment required. Ablative therapy involves using heat to damage tissue, which forms scar tissue. The scar tissue then closes the vein.
Although varicose veins usually occur due to reflux in the greater and lesser saphenous veins, an ultrasound is required to confirm the reflux and the necessary treatment. Usually the treatment of varicose veins consists of ablative therapy, which uses heat to damage tissue, which then forms scar tissue. Finally, the scar tissue closes the vein.
Venous insufficiencies can be uncomfortable, cause pain or make you feel self-conscious. If your veins are bothering you, our vascular surgeon can answer any questions you may have and guide you through your path to recovery.