Venous Disease 101

Venous disease can range from cosmetic issues to potentially life-threatening conditions. Varicose and spider veins are some of the most common symptoms of venous disease. At one time, these and other vein conditions were treated mainly using surgery. However, there are now many minimally-invasive vein treatments to help your legs look and feel better.

Types of venous disease
Some of the most common types of venous disease include…

  • Small, red or blue veins near the surface of the skin that look like spider webs or tree branches. These are caused by blood backing up in the veins. They often occur on the legs and face.
  • Varicose veins. Swollen, twisted veins near the surface of the skin. These are caused by blood backing up in the veins due to weak or damaged vein walls or valves. They most often occur on the legs.
  • Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux, which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs.
  • Superficial thrombophlebitis. A blood clot in a vein near the surface of the skin. It is often the result of injury, surgery, or being inactive for a long time.
  • Deep vein thrombosis. A blood clot in a deep veins in the leg. This can be caused by injury or surgery, sitting or lying down for a long time, or a condition that causes blood to clot more quickly.

Causes of venous disease
Each type of vein disease has its own cause, although some have similar causes:

  • Weak or damaged valves in the veins. Valves in the veins act like a one-way flap to keep blood from flowing backwards. When the valves don’t work properly, blood flows backwards, which increases pressure in the vein. This dilates the vein walls leading to further improper valve functioning. This occurs in varicose veins and chronic venous insufficiency.
  • Pooling of blood in the veins. Blood also pools in spider veins, although these are caused by exposure to sunlight, hormone changes, and injuries.
  • Blood clot. This is semisolid coagulated blood that develops in the arteries or veins to stop you from bleeding if you cut yourself. If a blood clot occurs in a superficial vein, it slows the flow of blood and is called superficial thrombophlebitis. If a blood clot forms in a deep vein (also called a DVT or deep vein thrombosis), DVT’s can break loose and can flow to the lungs. This is called a pulmonary embolism and can be a life-threatening condition. DVT’s are treated with medicines that prevent further clots from forming while the body dissolves the clot.

Risk factors for venous disease
Several factors increase your risk of developing varicose or spider veins:

  • Increasing age
  • If you have had other vein diseases in the past
  • If one or more members of your family have similar vein problems
  • Hormone changes that occur during pregnancy, puberty, and menopause
  • Pregnancy
  • Being overweight or obese
  • Sitting or standing for long periods
  • Exposure to the sun

Risk factors for superficial thrombophlebitis and deep vein thrombosis, both of which involve clotting, include the following:

  • Sitting or lying for long periods, such as during bed rest or while traveling
  • A personal or family history of blood clots
  • Injury or surgery in the pelvis or legs
  • Having another condition that causes your blood to be thicker or clot more quickly, such as certain types of cancer or autoimmune diseases
  • Obesity
  • Pregnancy
  • Cigarette smoking
  • Taking estrogen or using birth control pills, especially if you smoke
  • Increasing age

Minimally-invasive treatments for venous disease
Several minimally invasive treatments are available for varicose and spider veins and chronic venous insufficiency. Treatments are not necessarily a permanent cure for these conditions, and new varicose or spider veins may form later. When a vein is closed off, blood will naturally flow through other healthy veins in the leg.

Treatments Include the following approaches:

  • Compression stockings. These apply pressure to the legs to push blood in the veins of the leg toward the heart. They can relieve symptoms, but they are a conservative approach that is often combined with other treatments.
  • Sclerotherapy. A liquid or foam chemical is injected into the vein with a small needle to cause the vein to collapse. Over time, the vein will fade away.
  • Endovenous ablation. A small tube (catheter) is inserted into the vein. Radiofrequency or laser energy is used to heat and collapse or close the vein.

Surgical treatments for venous disease
Although minimally invasive treatments for varicose and spider veins are more common, surgery is still needed for certain cases:

  • Vein stripping. The varicose vein is tied off and removed through small cuts in the skin. This procedure has become less common as endovenous thermal ablation has replaced it in most cases.
  • Ambulatory phlebectomy. The vein is removed using a small hook through small cuts in the skin. This procedure is often combined with other treatments.