Not in vain — Treatment options for varicose and spider veins

Even the best looking legs want to run and hide when unsightly spider and varicose veins start to make themselves at home. Cosmetic appearances aside, some veins can be painful and even cause other complications. Fortunately, there are excellent treatments available to give you the confidence to show your legs again.

Some people with varicose veins don’t have symptoms, and some who do have symptoms are able to manage with lifestyle changes such as weight loss, frequent movement, leg elevation and/or compression stockings. Persistently symptomatic cases require medical treatment.

Varicose veins  

Vascular surgeon Patrick Geraghty, MD, with the Washington University Vein Center says, “ Varicose veins are enlarged, superficial veins that often have a bulging, twisted or coiled appearance.  Varicose veins affect millions of Americans and can cause aching, ankle swelling, night cramps or feelings of leg fatigue or heaviness after prolonged periods of standing. Varicose veins often form as a result of failure of the delicate one-way valves in the main superficial veins (the saphenous veins) that empty the venous blood from the leg.

Varicose veins can occur at any age – even starting in adolescence. Pregnancy, weight gain, long periods of standing, and a family history of varicose veins are all risk factors for this disease. If left untreated, varicose veins and accompanying saphenous vein reflux  can progress to cause skin damage including darkening of the skin or even ulcers. Varicose vein symptoms typically worsen over time.”

Varicose vein treatment

If non-surgical methods don’t help, treatment can include two components:

Radiofrequency ablation (RFA) is a minimally invasive procedure performed under mild sedation.  The doctor makes a needle puncture into the saphenous vein, and the slender radiofrequency catheter is positioned within the vein under painless ultrasound guidance. The catheter is used to apply radiofrequency energy to the walls of the vein, sealing it off from the inside. This minimally invasive procedure has replaced the old surgical technique of saphenous vein stripping.  A stocking or supportive wrap is usually worn for 48 hours after the procedure.

Micro-incision venectomy may be performed if after a patient has RFA, a portion of the painful or unsightly varicose vein remains. The outpatient procedure is performed under mild to moderate sedation. The varicose veins are extracted through a series of small incisions. The treated area of the leg is wrapped with a compressive dressing, which can be removed in 24-48 hours. Most patients are able to return to work within two to seven days after the procedure.

Spider veins

Dr. Geraghty explains, “Spider veins are tiny, but engorged veins under the surface of the skin. They look like a nest of fine blue or red lines. Spider veins are not usually a serious medical problem, but they can be a cosmetic concern, and they can cause symptoms of aching or burning pain, or itching.

Most people will develop spider veins as they age, and these spider veins are often more prominent for women. Spider veins are progressive, and new spider veins will continue to occur over time.  It is rare, but spider veins can bleed.”

Spider vein treatment

Injection sclerotherapy is the injection of FDA-approved agents into the spider veins using tiny needles. The injection is painless and destroys the lining of these small veins. The outpatient procedure can be done with minimal discomfort, and no sedation is required.

Use of compression hose in the weeks after the procedure helps minimize pigmentation changes in the surrounding tissue. For most patients, the veins are significantly improved but often the same area will need to be treated two to three times to obtain the best results.

Because treatment of spider veins is almost always considered to be cosmetic, it is not covered by insurance. The only exception is if the spider vein has been bleeding.

To make an appointment with the Washington University Vein Center, please call 314-362-5347 (362-LEGS).

Heart and Vascular Center
Center for Advanced Medicine
4921 Parkview Place, Suite 8A
St. Louis, MO 63110

Barnes-Jewish West County Hospital
Medical Building One
969 N. Mason Road, Suite 140
Creve Coeur, MO 63141

Center for Advanced Medicine – South County
5201 Midamerica Plaza, Suite 2300
St. Louis, MO 63129