Learn the warning signs and why a proper diagnosis of varicose vein disease is so important.
Do you get cramps in your legs overnight or have restless legs? Are your legs often itchy for no apparent reason? The cause of your discomfort may have been misdiagnosed as neuropathy or another cause when the actual cause is varicose veins.
Some other medical conditions may present many of the same symptoms. A vein specialist has the experience and technology required for an accurate diagnosis.
The only way to accurately diagnose varicose vein disease is with a reflux ultrasound examination by an experienced vein specialist. When it comes to your vein health, a proper diagnosis is essential so that the issue isn’t over-treated or under-treated.
A Reassuring Word About Varicose Veins
Varicose veins are rarely a serious medical condition. In fact, millions of Americans have varicose veins. The Cleveland Clinic reports that 1 in every 3 adults has varicose veins. For many, they are purely an aesthetic problem. Other times, varicose veins cause annoying symptoms that will relieved by, but don’t require immediate medical attention.
Still, for some, varicose veins can cause chronic venous insufficiency. This is a dangerous medical condition related to blood circulation. The good news is a vein specialist can correctly diagnose and treat it.
More About Chronic Venous Insufficiency
Chronic venous insufficiency is not an uncommon problem for people who have varicose veins. Cleveland Clinic also reports that 1 in every 50 adults with varicose veins eventually develops chronic venous insufficiency.
Damaged veins cause chronic vein insufficiency. Leg veins keep blood flowing back to your heart. But when chronic venous insufficiency occurs, blood flows improperly or not at all.
With chronic venous insufficiency, veins can no longer open and close to properly regulate blood flow; blood pools in the veins instead of flowing toward the heart. Blood may even flow backwards.
The pooling blood creates extra pressure on the vein. The result can be uncomfortable swelling, ulcers, insufficient blood flow, and possible life-threatening blood clots.
This condition is most common in people over the age 50, with increasing risk as you further age.
Get an Accurate Diagnosis with a Reflux Ultrasound Examination
To properly diagnose your varicose vein condition, and even determine if you have varicose veins, it’s best to consult a vein specialist.
First, there will be a physical examination of your legs, looking for swelling or other developments. The doctor will ask questions about your leg pain experience.
Afterwards you should have a reflux venous ultrasound examination. It is important that a qualified physician and ultrasound technologist perform this exam.
With this imaging technology, the doctor can definitively determine if the veins in the legs are functioning properly. It will also identify where some veins may be having problems or need treatment.
This test is completely non-invasive and painless.
See what our vein specialist, Dr. Stuart Miller, has to say about the importance of an accurate reflux ultrasound examination.
At NJVVC, our vein doctor, Dr. Stuart Miller, specializes in properly performing and analyzing the results of a reflux ultrasound examination. It is imperative to administer and analyze this test properly to ensure accurate diagnosis and subsequent treatment. False negatives or false positives in this exam will lead to a vein condition being over-treated or under-treated—and can even lead to a wrong diagnosis altogether.
Common Symptoms of Varicose Veins
Leg Aches
Legs ache at the end of the day or after long periods of standing and/or sitting.
Physical Appearance of Veins
You see twisted rope-like bulges under the skin. They can look blueish or red. Sometimes you can’t see veins that are far below the skin’s surface.
Leg and/or Foot Swelling or Heaviness
Legs feel unusually heavy and make running or even walking uncomfortable or painful.
You often see swelling of feet and ankles.
Burning, Throbbing, Aching
Itching
You feel an itching sensation around the veins, or on your legs before veins are even visible.
Restless Legs or Leg Cramps at Night
Red Spots on Lower Legs/Shiny Legs
Red spots can be a sign of a burst vein.
Hyperpigmentation Around Ankles
Commonly seen with long-existing varicose veins.
Avoid These Complications of Varicose Veins with Proper Diagnosis
Blood Clots
Blood clots in veins can lead to serious swelling of the vein (thrombophlebitis) or deep vein thrombosis (DVT). DVT can lead to a life-threatening pulmonary embolism.
Bleeding
A varicose vein near the surface of the skin may bleed if you bump your leg. This bleeding can be difficult to stop. Elevate your leg and apply pressure; get immediate medical care if you cannot stop the bleeding.
Ulcers
A leg ulcer or wound will need to be cleaned regularly and bandaged properly.
Contact us at the New Jersey Vein and Vascular Center (NJVVC) for non-invasive vascular imaging studies, second opinions of imaging studies, and minimally invasive endovascular services.
Fluctuating hormone levels caused by pregnancy, birth control pills, hormonal treatments, and aging, can play havoc with vein health.
Hormonal imbalances of progesterone and estrogen can lead to many physical problems, including the development or worsening of varicose veins.
Can changes in hormone levels cause varicose veins? You bet!
Estrogen’s Role in Vein Health
It is important that the estrogen and progesterone hormonal levels maintain a healthy balance.
Elevated levels of estrogen, especially during pregnancy, can encourage the development of varicose veins. Estrogen causes blood vessels to widen and increase blood flow. However, it also makes blood vessels weaker.
The heightened levels of estrogen increase the risk of blood clots and inflammation and weaken vein walls. Varicose veins also become more visible.
Progesterone’s Role in Vein Health
Progesterone can actually lessen some unwanted vein symptoms caused by increased estrogen. It relaxes blood vessels, smooth muscles and increases collagen production. Collagen strengthens vein walls. In fact, too little collagen has been associated with the development of both varicose and spider veins.
However, higher levels of progesterone can hurt the valves in the veins that are needed to control blood flow in the veins. If veins don’t function properly, blood will flow both ways, and will pool around the poorly functioning valve.
Higher progesterone levels can also dilate smaller veins, making them more visible to the naked eye.
Leg veins are more sensitive to progesterone than veins in other parts of the body. When hormone levels fluctuate, vein health is at risk.
Dr. Stuart Miller of The New Jersey Vein and Vascular Center (NJVVC) explains why imbalanced levels of progesterone are so dangerous to veins.
Progesterone Levels and Varicose Veins in Pregnancy
When a woman is pregnant, her hormones fluctuate. The potential dangers are compounded by changes to the woman’s vascular system and pressure from the expanding uterus. Not only does the woman gain weight, but blood volume in the veins increases. Progesterone and estrogen hormone levels both increase and fluctuate.
Progesterone levels begin to rise in the 9th week of pregnancy and continue to slowly rise until week 32. After the 12th week, the placenta makes progesterone.
It’s now believed that not only estrogen, but progesterone also plays a major role in the formation of varicose veins during pregnancy.
As reported by the Vein Clinics of Cleveland, a 2009 Croatian study showed that women who had higher levels of progesterone during pregnancy also had a higher incidence of varicose vein development. This caused the researcher to conclude that progesterone during pregnancy also contributes to varicose veins.
Progesterone levels in pregnancy also affect water retention and weight gain. Pressure on the veins increases and further contributes to pregnancy vein issues.
Progesterone relaxes smooth muscles, allowing for increased blood flow and can usually reduce pressure on veins. However, as reported by the National Institute of Health, during pregnancy this increased level of progesterone that inhibits smooth muscle contraction, can “[result] in disorders of the vein shrinkage, affecting the increase of their capacity and valvular insufficiency, and valvular edges are not in contact with each other due to the vasodilatation.”
After childbirth, many women see their varicose veins improve and disappear— although this is not always the case.
You can expect vein damage to increase with each subsequent pregnancy.
Some women are directed by their doctors to take birth control pills or supplements, containing progestin—a synthetic form of progesterone—to ease the effects of menopause. These women have an increased chance of developing varicose and/or spider veins. Progestin, like its natural counterpart, progesterone, will make the vein walls dilate and become more susceptible to damage.
It’s important that women talk to their doctors about the potential risks and benefits of these pills and/or supplements.
As women approach menopause, their hormonal levels of estrogen and progesterone drop and body weight increases. This can cause vein damage. Women often first notice varicose veins at this time. Or women who already have varicose veins may notice more bothersome symptoms or that the veins are becoming more visible.
Risk Factors that make you prone to developing varicose veins include:
Age
Being female— Women are more prone to developing varicose veins because they often have weaker vein walls and valves than men do
Pregnancy—effects of fluctuating hormones
Family history
Being overweight
Standing or sitting for long periods of time
Ways You Can Help Your Varicose Veins
If you’re suffering with varicose veins caused by fluctuating hormones or other causes, there are things you can do to help.
They are:
Exercise regularly and walk more to help blood circulation
Avoid sitting or standing for a long time
Elevate your legs to reduce swelling and help blood reach the heart
Wear compression socks to keep pressure on your lower legs
Stay at a healthy weight
Avoid hot tubs
Stay cool in the shade outdoors or in air conditioning
Make these dietary changes:
Take Vitamin C to help veins get stronger
Eat anti-inflammatory foods like blueberries or whole grains
Most people know the difference between spider veins and varicose veins. But what about spider veins vs. reticular veins? What’s the difference?
Veins are the structures that bring blood up from your legs and back to your heart. Three major vein issues that people commonly notice on their body are:
Spider veins
Reticular veins
Varicose veins
How Can I Tell the Difference Between Veins?
Spider Veins
Spider veins, also called telangiectasias, are the smallest veins measuring 1mm or less. They appear close to the surface of the skin and often take on a “tree-like” appearance with the veins looking like tree branches.
Spider veins mainly occur on the thighs, ankles, or calves
These veins can vary in color, ranging from blue/purple, to red or pink.
Usually, these veins don’t cause any physical symptoms unless they occur in larger clusters. Some people may feel slight discomfort in a heavily veined area.
Reticular veins
Reticular veins measure between 1mm and 3mm in diameter and are located just below the skin’s surface. They are slightly larger than spider veins.
Reticular veins exist a little deeper in the skin than spider veins, which run more along the surface. Unlike varicose veins, they don’t protrude from beneath the skin.
Reticular veins are found in the legs—commonly on the back or inner thigh—but can occur on the face, breasts, ankles, or knees.
These veins are usually not a medical problem. More often, people are concerned with the aesthetic issues they cause.
Since reticular veins feed into spider veins, they are also called feeder veins. You often see reticular veins right near spider vein clusters.
These veins are blue/green or purple. However, they can take on a ropey appearance and exist in clusters, giving the skin an unattractive marbled appearance.
Reticular veins, unlike spider veins, are often annoying or painful. The more reticular veins you have in an area, the more annoying they will become.
Common symptoms of reticular veins include:
Itching or irritation
Tenderness or pain
General discomfort in the area
Burning
Fatigue and heaviness
Spider veins and reticular veins are both referred to as superficial veins.
Let’s Not Forget About Varicose Veins
Varicose veins are the largest veins. They measure larger than 3mm in diameter. They often bulge out from the skin and usually are purple or blue. Varicose veins are most often found on thighs, calves, ankles, and feet.
Symptoms of varicose veins are similar to the symptoms of reticular veins.
What Causes Reticular Veins and Are They Dangerous?
Reticular veins:
Run in families
More commonly occur in women than men
Can be caused by obesity
Can develop during pregnancy
Develop with age, especially in people over 50 years old
Can be caused by sitting or standing for long periods of time
Can have no known cause
However, reticular veins often aren’t reason for concern except for cosmetic reasons. But it’s important to know that reticular veins do indicate that blood is not flowing as well as it could.
Reticular Veins and Venous Insufficiency
Venous insufficiency or prior blood clots cause reticular veins.
Venous insufficiency occurs when blood doesn’t properly flow back to the heart from the feet. Blood pools in the veins.
This, in turn, creates pressure around the veins as well a swelling within the veins. Over time, the walls of the vein become weak and bulge. Veins can twist and skin marbling occurs.
Signs of venous insufficiency are:
Visible varicose veins on the skin’s surface
Leg pain or cramps
Weak legs
Tightness in calves
Itchy legs
Swelling in legs or ankles
Leg ulcers
Aching or heaviness in legs
Skin that thickens or changes color on legs or around ankles
There are steps you can take to improve blood flow in reticular and other veins.
These at-home solutions for improving blood flow include:
Wearing compression socks or stockings
Elevating your legs periodically
Leaving legs uncrossed when sitting
Exercising
Avoid sitting for long periods of time
Maintaining a healthy weight
These steps may be enough to relieve your discomfort from reticular or varicose veins.
Treatment Options for Reticular Veins
If you continue to have discomfort from reticular or varicose veins, or desire cosmetic treatment for any vein issue, it’s time to see a vein doctor.
Your treatment options will depend on the size and location of your veins and the severity of the venous insufficiency.
Medical treatment of existing reticular veins often prevents the development of associated spider veins. Treatment of reticular veins can also cause nearby spider veins to disappear.
Ultrasound-Guided Sclerotherapy
The National Institute of Health states that “Sclerotherapy, when used with the correct technique, is the most effective method for the management of reticular varices and telangiectases.”
Ultrasound-guided sclerotherapy involves the injection of a sclerosing agent into the vein. The inner walls of the vein collapse and the vein seals itself shut. Blood is naturally directed to other healthier veins. Over the course of a few months, the body reabsorbs the old vein, and it disappears.
FDA-Approved Varithena™
At NJVVC, we use Varithena for this sclerotherapy treatment. It is an FDA-approved patented microfoam that is extremely well tolerated by patients having sclerotherapy treatment.
Don’t think that varicose veins are just a woman’s problem. They’re a guy thing too. When it comes to varicose veins in men—here’s what you should know.
Varicose veins are those unattractive, sometimes painful, bulging veins usually found on legs.
It’s true—varicose veins are often harmless. But sometimes they warn of an underlying health issue.
You’re Not Alone
According to the American Heart Association/American Stroke Association Journal (AHA/ASA) 11 million men aged 40-80 have varicose veins.
Many men go on to develop symptoms of chronic venous insufficiency, including venous ulceration.
So don’t be in denial! Sometimes it’s just plain foolish to ignore them.
Doctors Warn Against Ignoring Varicose Veins
If you’re a man, and you have varicose veins … don’t ignore them!
Dr. Stuart Miller of The New Jersey Vein and Vascular Center warns, “Most men won’t come in until there is ulceration or bleeding … or their wife makes them come in. Waiting is not the answer!”
Medical Problems Associated with Varicose Veins
Ignoring varicose veins may lead to these advanced varicose vein problems:
As men age, they produce less testosterone and HGH with each passing year. This slows the metabolism and causes weight gain.
Exercise helps ease this natural progression of weight gain in men. So, in case you needed more motivation to exercise, consider that fewer pounds mean less stress on veins and thus less tendency for vein problems.
Working out will also build healthy leg muscles. Calf muscles are especially important to vein heath because they help pump blood back to your heart more efficiently.
If you’re just starting an exercise regimen, choose an activity you might enjoy. But don’t over-do it. Walking, swimming, yoga, and other low-impact activities are all great to move your body.
High-impact sports, torn ACLs, or a popped hamstring won’t do much for leg and venous health.
Remember, sitting or standing in one position all day is your enemy. But that doesn’t mean you have to train for the Olympics.
Studies have shown that any amount of regular movement is helpful.
Anything from a brisk daily walk to just stepping away from your desk every so often is far better than nothing. Every little bit counts and will make a measurable difference.
Good Diet and Nutrition Fights Varicose Veins in Men
A healthy diet helps keep your weight down, powers your workout, and improves your mood.
Beyond that, dietary recommendations specific to venous health include:
Adding fiber to prevent absorption of unhealthy fats and cholesterol buildup
Boosting levels of vitamin C to aid the production of collagen and elastin, infrastructural tissues that literally support veins
Staying hydrated to help fiber flush your system and maintain electrolyte balance
Eating more rutin, an antioxidant flavonoid found in apple peels, asparagus, green tea, figs, cranberries, and citrus zest that reduces inflammation
Consuming less salt, thus decreasing water retention and vein pressure
Men Can Get Relief from Varicose Veins
Wearing compression socks and keeping legs elevated can help support veins and reduce pressure. And this reduced pressure can aid in the prevention of varicose veins, as does proper diet and exercise.
Sometimes varicose vein treatment is necessary to restore healthy blood flow to your legs. The presence of bulging and discolored veins or pain could mean clinical treatment is in order.
Ultrasound guidance is used to insert a thin heat-producing laser fiber into the vein. The procedure results in the vein closing. Your body then reroutes blood flow to a nearby healthy vein.
This procedure relieves pain caused by the varicose vein. There is little or no scarring. There is minimal recovery time.
Varithena
Varithena is an FDA approved injectable foam therapy. This non-surgical procedure uses a sclerosing agent that causes the vein to collapse and close. Blood is displaced into a healthy vein.
ClariVein
ClariVein is a non-thermal treatment that closes a targeted vein. This easily tolerated procedure is highly effective.
You’ve seen them before. And now you’re seeing them again! Those pesky, unattractive spider veins.
Perhaps you originally had them around your ankles or on your thighs and you sought treatment.
Now they seem to have reappeared, and you’re asking, can spider veins come back after treatment?
About Spider Veins
Spider veins are those thin red or blue veins on your skin’s surface.
You will commonly find spider veins on thighs and calves. They also appear on the face and breasts.
Spider veins can be itchy and annoying, or cause legs to feel slightly tired. But they are rarely painful and are almost always harmless.
Today, doctors consider sclerotherapy the best treatment for the removal of spider veins. But this isn’t always the medical procedure performed.
Reasons Spider Veins Return
There are several reasons spider veins return, or at least seem to return.
But what happens most often is that new spider veins develop in the same area after treatment.
So, it’s not that the spider veins that were treated are returning. Rather, new spider veins show up and are mistaken for the original veins.
Reasons spider veins return in the same area include:
A person has venous insufficiency, so deeper, untreated veins are causing the development of new spider veins
A person’s body doesn’t properly regulate new vein formation
The person continues with activities that cause spider veins, such as long periods of sitting or standing, or staying obese
Saline or skin laser was improperly used to treat them
Genetics
Venous Insufficiency
Venous insufficiency is a progressive vein disease. A vein specialist can treat it, but venous insufficiency will not go away on its own.
If a person has venous insufficiency, the underlying varicose veins combined with an increase in venous pressure encourage the development of new spider veins.
So new spider veins form.
It seems like the old ones are returning, but they’re not.
Doctors can diagnose venous insufficiency with a simple, painless ultrasound of your legs. This will show whether your vein valves are working correctly, and whether you have this condition.
Spider vein treatment should be delayed until this test is performed. If the cause of the spider veins is indeed venous insufficiency, the underlying veins need to be treated first.
If the underlying problem remains untreated, the spider veins are sure to return.
And venous insufficiency needs to be treated for health reasons.
Endovenous laser ablation (EVLT) or Varithena, a micro-foam sclerosant, are favored ways to treat venous insufficiency.
The spider vein won’t be under pressure once the varicose vein receives treatment. At that time, sclerotherapy can treat the spider veins successfully.
If spider veins recur after sclerotherapy, they usually come back in a much less severe form. This happens quite some time after the sclerotherapy procedure.
Genetics and Hormones
If your genetic makeup is encouraging the development of spider veins, trying to get rid of them is an uphill battle.
How do you know your spider veins are caused by genetics?
The easiest way to find out is to ask immediate family members if they’re developing spider veins, too. If they are, you have your answer!
If they aren’t, your spider veins may still be genetic. But the good news is that spider veins caused by genetics are no reason for any health concerns.
Hormonal changes such as pregnancy or menopause can also encourage the development of spider veins.
Laser Therapy
Some doctors use laser therapy as a treatment for spider veins.
Many patients find this procedure to be painful since heat is applied directly to the skin. It also takes a longer time to treat a small area.
Lasers can also cause hypopigmentation—a loss of melanin in the skin.
But most discouraging is that if the laser doesn’t produce enough heat to seal the vein, the procedure will fail. For this reason, you will need additional treatments.
Sclerotherapy
Sclerotherapy is the state-of-the-art treatment for spider veins.
It is considerably more effective and faster than laser treatment. And you don’t feel pain.
During sclerotherapy, the doctor injects a solution or sclerosing agent into the vein.
This causes the vein to scar and collapse. Eventually, you can no longer see the vein since it is resorbed by the body.
Sodium chloride is no longer considered an acceptable sclerosing agent. It can be painful for the patient and can cause serious complications.
Eighty percent of spider veins treated by visual sclerotherapy usually disappear in three to six weeks. So even one treatment of sclerotherapy will create noticeable results.
Patients may need new treatments every few years if new spider veins appear.
How Can You Keep Spider Veins from Recurring?
Are there things you can do after treatment to keep more spider veins from developing?
The answer is yes.
They include:
Exercising your legs regularly
Staying at or getting to a healthy weight
Eating a balanced diet
Wearing compression stockings or socks
If you want to learn more about spider veins, read:
Many people with varicose veins wonder if genetics played a role in their development—or if it destines them to get varicose veins if a parent has them. Is the answer all in your genes? And if it’s true that genetics plays a role in varicose veins, is there anything you can do to help?
To quote Sam Kean, an American science writer, “Genes are like the story, and DNA is the language that the story is written in.” But can you change your story?
According to the National Human Genome Human Research Institute, a genome is another name for the entirety of your DNA. Your DNA determines your specific genetic code and all the information needed to build and develop the one and only you! Each person has their own unique genome.
Learning about your own genome will provide insights into your own health and help you make healthful choices throughout your life.
So, there are things you can do, and good choices to make, to help yourself stay healthy. This applies to vein health as well.
First, A Word About Varicose Veins
If a person has chronic venous insufficiency, they will develop varicose veins. Chronic venous insufficiency is a condition that makes it difficult for blood to flow back up to your heart easily. This occurs due to a problem with the tiny valves in the veins, or a weakening of the vein walls.
Chronic venous insufficiency (CVI) usually affects veins in the legs. Blood flows in both directions and pools in the legs. The veins enlarge. We easily seen these enlarged veins since they usually bulge out of the skin. These veins are varicose veins.
Is Chronic Venous Insufficiency Caused by Genetics?
Varicose veins are more likely to occur as a person ages. But what role does genetics play? Do gender, hormones, and ethnicity play a role?
Let’s see what the studies say.
Researchers have reported that they believe genetic factors play a big role in the development of varicose veins.
If both parents had varicose veins, the risk for children of developing them was 90%.
If one parent had varicose veins, the risk for children developing them was 25% for males and 62% for females.
When only one parent had varicose veins, there seemed to be no correlation between the sex of the affected parent and the varicose veins in children.
They concluded their findings excluded a sex-linked pattern of inheritance.
Women have a greater chance of developing varicose veins than men do. How much genetics plays a role in this, and which genes are involved, is still to be determined.
Ethnicity and Varicose Vein Development
In a study of 2,211 people, chronic vein disease (the earliest stage is spider veins) “appeared to be more common in non-Hispanic whites than in Hispanics, African-Americans, and East Asians.” However, the study went on to say that these results were most likely linked with social habits; they did not seem to be linked to genetics.
Varicose veins were present in 33% of woman and 17% of men, with no ethnic differences
It concluded that the presence of varicose veins varied by gender but not by ethnicity.
Hormones and Varicose Vein Development
Today, it is an accepted fact that women’s hormones can play a role in the development of varicose veins. During pregnancy, elevated hormonal levels of estrogen and progesterone can thin the walls of veins, making pregnant women more susceptible to chronic venous insufficiency. Estrogen can also cause damage to the valves inside veins.
Menopause also will affect the health of women’s veins, but in the opposite way. During this time, a woman’s hormone levels decrease. This makes the walls of the veins thicker, less flexible, and more constricted.
How To Help Prevent Hereditary Varicose Veins
Clearly, there are some things about varicose veins that are out of our control—they are written somewhere in your DNA! But there are things you can do to help prevent them.
Keep at a healthy weight
Exercise—walking is great for vein health
Try to avoid sitting or standing still for long periods of time
Wear compression socks or stockings
Eat a healthy diet, including complex carbs and protein
Avoid salty food
Drink lots of water
If you have varicose veins . . .
If you have varicose veins that are simply unattractive, or that are causing you discomfort, make an appointment to see us at NJVVC. At our state-of-the-art vein center, you can have a complete vain evaluation, and receive treatment for your varicose veins.
