Just in time for Halloween--those "scary-looking" spider veins. (photo credit)
- Family history
- Standing for long periods of time
- Common symptoms that should be elicited include leg heaviness, exercise intolerance, pain or tenderness along the course of a vein, pruritus, burning sensations, restless legs, night cramps, edema, skin changes, and paresthesias.
- Common symptoms of telangiectasia include burning, swelling, throbbing, cramping, and leg fatigue. Pain associated with larger varicose veins usually is a dull ache that is worse after prolonged standing
- Pain caused by venous insufficiency is often improved by walking or by elevating the legs in contrast to the pain of arterial insufficiency, which is worse with ambulation and elevation.
- The Perthes maneuver is a traditional technique intended to distinguish antegrade flow from retrograde flow in superficial varices. Antegrade flow in a variceal system indicates that the system is a bypass pathway around deep venous obstruction. This is critically important because, if deep veins are not patent, superficial varices are an important pathway for venous return and must not be sclerosed or surgically removed.
- The Trendelenburg test can often be used to distinguish patients with superficial venous reflux from those with incompetent deep venous valves.
- Doppler examination is an adjunct to the physical examination that can directly show whether flow in a suspect vein is antegrade, retrograde, or to-and-fro.
Sclerotherapy is the introduction of a foreign substance into the lumen of the vein to cause thrombosis and subsequent fibrosis.
- Glycerin--for use in veins less than 1 mm in diameter
- Polyiodinated Iodine
- Hypertonic-saline 11.7% --for use in veins less than 1 mm in diameter
- Sodium morrhuate
- Sodium tetradecyl sulfate, 0.25% used in veins less than 1 mm in diameter; 0.25-0.5% used in 1-4 mm veins; and 1-3% used in veins 4-10 mm in diameter
- Ethanolamine oleate
- Polidocanol foam, 0.5 % used in veins less than 1 mm; 0.5-1% used in veins 1-4 mm; and 2-5% used in veins 4-10 mm in diameter
The procedure was pioneered in 1999 by Dr. Robert Min and Dr. Luis Navarro in conjunction with Diomed. The technique continues to be refined and enhanced today reflecting Diomed’s ongoing commitment to the science and practice of vein management. EVLT® is a minimally invasive, clinically proven alternative to surgical vein stripping that effectively and safely treats varicose veins using a diode laser fiber to occlude the vein. (photo credit)
Some problems, such as large varicose veins, may call for ligation, a procedure in which the connections between the damaged veins and the normal vein systems are interrupted. Saphenectomy with saphenofemoral ligation is a traditional approach that is most often performed using an internal stripping tool and an invagination technique.
- Complications of varicose disease include venous ulcers, variceal bleeding, and venous thromboembolism.
- Potential complications of treatment include anaphylaxis, changes of pigmentation, ulcerations, paresthesias, arterial injury, and venous thromboembolism.
- Pregnant patients and those with a strong family history of varicose disease may prevent, delay, or ameliorate the problem by wearing 30-40 mm Hg gradient compression hose whenever standing.
- Constant use of compression hose can prevent the worsening of existing varicose disease that cannot be treated immediately
Varicose Veins and Spider Veins--Women's Health.gov
Varicose Veins and Spider Veins by Craig Feied, MD--eMedicine Article
No More "Spider Veins" by Michel P Goldman, MD--Plastic Surgery Products Newsletter, October 2007
Varicose Veins--Mayo Clinic
Spider Veins (Sclerotherapy),Diminishing Unsightly 'Spider Veins'--American Society of Plastic Surgeons
Minimally Invasive Venous Intervention Procedure (OR-Live)--Morristown Memorial Hospital (requires media player, 1 hour program)
Treatment of Varicose Veins through Laser Surgery (OR-Live)--Nebraska Medical Center (requires media player, 1 hour program)
Site with good before and after photos--Veintec Varicose Vein Clinic