Vein Medicine (Phlebology): Spider Veins and Varicose Veins
Varicose veins lead to heavy feet, especially after a long day; shoes no longer fit quite right in the evening; sometimes a stubborn case of athlete’s foot takes hold, or the skin of the lower leg feels tight, itches, and becomes discolored. Blue veins protrude.
Spider veins are small blue-red dilated vessels on the legs. They are often harmless and merely a cosmetic nuisance, but they can also be a sign of varicose vein disease.
So have your leg veins examined by ultrasound (Doppler sonography) in good time! Only then can varicose veins be detected and treated at an early stage – those who put off therapy for good risk late complications.
If your spider veins are not connected to varicose veins, they can be elegantly sclerosed with tiny injections or treated with a laser. With a special LED vein light, the roots of spider veins hidden deep below become easy to find and can be treated with precision.
Varicose Veins – a Purely Cosmetic Problem?
The German word for varicose vein, “Krampfader,” comes from the Old German krimpfan – to bend – and essentially means crooked veins. Varicose veins are dilated veins – the blood vessels that carry oxygen-poor blood back toward the heart. When the venous valves no longer close properly and the constant backflow of blood causes congestion, we speak of varicose veins.
The superficial leg vein system consists of two main trunk veins: the great saphenous vein runs from the inner ankle along the inside of the leg up to the groin, and the small saphenous vein from the mid-calf to the hollow of the knee. Both empty into the deep leg vein and are connected to each other via side branches, bridging veins, and perforator veins.
When the vein walls bulge outward, the valves can no longer prevent blood from sinking downward with gravity. The result is volume overload of the vein segments below: the vein walls are pushed further apart, congestion develops, and water is pressed into the surrounding tissue. This leads to edema – water retention in the legs and feet. After standing for a long time, the feet feel thick and heavy.
Varicose vein disease is therefore related not to arterial but to venous circulation problems. It affects more women than men; some sufferers additionally struggle with hemorrhoids and flat feet.
Varicose Veins – a Case Study
Ms. Germer, 39, comes in for skin cancer screening. The full-body examination reveals no suspicious moles – but the physician discovers spider veins on her legs. They have been there since her second pregnancy; the patient’s mother had full-blown varicose veins.
Physician: During pregnancy, increased abdominal pressure and the growing uterus impede the return flow of blood, and pregnancy hormones additionally dilate the vessels. With a corresponding genetic predisposition, this favors varicose veins – spider veins are varicose veins of the fine vessels. If you would like to become pregnant again, I recommend wearing class 2 compression stockings as a preventive measure.
Ms. Germer: Can you remove the spider veins for me?
Physician: Yes, that is quite feasible today. In sclerotherapy with the liquid Aethoxysklerol®, the injection causes the small vessels to contract reflexively and seal shut. Additionally or alternatively, spider veins can be treated very effectively with a long-pulsed Nd:YAG laser, whose pulses heat the red-blue vessels. With both methods, it takes a few weeks for the body to break down the closed vessels. First, however, we should clarify by ultrasound whether larger varicose veins are pressurizing the spider veins from below – in that case, the larger vessels are treated first, then the fine spider veins.
Pure spider veins without varicose veins are considered not pathological but a cosmetic issue. Varicose veins, on the other hand, should definitely be treated.
Until a few years ago, only surgical methods were available, such as stripping (pulling out the vein). Today there are far gentler procedures that can be performed under purely local anesthesia and without downtime: foam sclerotherapy and endovenous ablation by laser or the radiofrequency method using a probe inserted into the vessel; sometimes the methods are combined. Afterwards, wearing compression stockings for a few days to weeks supports healing.
It makes sense to treat early – even if the condition doesn’t hurt. The constant pooling of blood and the edema in the tissue activate fibroblasts, which produce connective tissue fibers: over the years, the tissue hardens and scars, the oxygen supply worsens, and free radicals form, causing further tissue damage and tissue aging. Those affected frequently show stubborn infections of the feet – warts, nail fungus, recurring athlete’s foot –, dry skin on the legs, stasis eczema, and ocher-colored deposits in the skin. After years, white discoloration (extensive scarring) and the dreaded open leg ulcer, ulcus cruris, loom. Today, it no longer has to come to that.
One exception: varicose veins that develop after deep vein thrombosis often cannot be treated, since they serve as important bypass circuits – here, compression stockings must be worn. All other varicose veins are treatable, and the body does not miss them, because there are numerous alternative venous pathways. By the way: calf cramps are not a typical symptom of varicose vein disease; magnesium deficiency, for example, could be the cause. Anyone suffering from heavy, tired, or aching legs should see a phlebologist (a specialist in vein disorders).
Varicose Veins – How Can You Prevent Them?
Vein-sealing medications made from horse chestnut seed or red vine leaf can counteract fluid leakage, but they do not improve the connective tissue. What matters is:
- don’t smoke,
- plenty of movement and exercise,
- avoid excess weight,
- put your feet up now and then,
- wear compression stockings when standing for long periods or on flights,
- cold showers and Kneipp water treading provide a training effect.