Understanding two of the most common venous conditions Varicose & Spider Veins

The Vascular System

The human vascular system is composed of three main parts: the arterial system, the venous system and the lymphatic system. While arteries carry oxygen to cells, veins carry deoxygenated blood back to the lungs and heart. Veins are elastic and unlike arteries, depend on one-way valves and muscle contractions to propel blood back toward the heart against the pull of gravity. Calf muscle contractions, such as when walking, are especially important in moving blood through the veins of the legs. This is called the “calf muscle pump.” Medical Compression Stockings (MCS) work in tandem with the calf muscle pump to improve circulation.

Calf muscle pump

The Calf Muscle Pump

In healthy veins…

  • When the calf muscle contracts, valves open and blood is propelled in one direction toward the heart.
  • When the calf muscle relaxes, valves approximate (tighten to close) and prevent blood from moving backwards in the vein.

Diagnosis

Spider and Varicose veins must be diagnosed by a physician. The assessment usually involves a visual exam of the legs as well a non-invasive ultrasound test. The ultrasound determines if venous valves are functioning normally or if there is any evidence of venous reflux. Generally, depending on the amount of reflux found, a physician will determine the appropriate steps of care. This may include self-care, such as wearing compression garments or in more severe cases, the doctor may recommend one of various vein procedures available.

Varicose Veins

Varicose veins often appear as twisted, enlarged or bulging veins, dark purple or blue in color. Symptoms of varicose veins may include:

  • Achy, tired or heavy feeling in legs
  • Burning or throbbing
  • Muscle cramping
  • Swelling in lower leg
  • Pain that is worse after sitting or standing for a period of time
  • Itching

Spider Veins

Spider veins appear as a network of thin, red, blue or purple lines on the surface of the skin. They are often painless, but sometimes may cause:

  • Swelling
  • Burning or throbbing
  • Leg cramping
  • Leg fatigue

It is also important to note, one can experience symptoms without the outward appearance of varicose veins. Venous reflux can exist without physical signs. If a person experiences one or more of the above symptoms, it is always recommended to get an assessment by a physician.

Spider & Varicose Vein Risk Factors

  • Family History (Heredity) – There is a greater chance of developing CVD if a family member had CVD
  • Age – Older age can cause wear and tear on the vein valves causing them to become incompetent
  • Pregnancy – Increased blood volume and additional weight from the growing baby can add extra pressure on the veins. Hormonal changes during pregnancy are also know to affect the veins
  • Obesity – Being overweight adds a lot of additional pressure on the venous system
  • Surgery/Trauma – This can cause physical damage to one or more veins. Limited movement post-surgery can also contribute to the development of venous reflux
  • Gender – Women are more likely to develop spider or varicose veins. Hormonal changes during pregnancy, menstruation and menopause can all have an effect on the vein walls causing them to become more elastic and dilate.
  • Immobility – Standing or sitting for prolonged periods of time. Especially when traveling for 4 or more hours at a time
  • Smoking – Smoking affects blood circulation, which can increase your risk for spider or varicose veins
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CVD Progression

CVD is systematically categorized into a classification system called CEAP. The “C” in CEAP stands for the clinical presentation of a limb at a point in time.

C1: Spider Veins
Spider veins is one of the most common manifestations of CVD and is generally located in the thigh, legs, inner ankle and feet. Spider veins appear as a network of thin, red, blue or purple lines on the surface of the skin.

C2: Varicose Veins
Varicose veins are another common manifestation of CVD and are generally located in the thigh, legs, inner ankle and feet. They appear as twisted, enlarged or bulging veins, dark purple or blue in color. Often, varicose veins are not painful, however when there are symptoms, they may include:

  • Achy, tired or heavy feeling in legs
  • Burning or throbbing
  • Muscle cramping
  • Swelling in lower leg
  • Pain that is worse after sitting or standing for a period of time
  • Itching

C3: Edema
Edema (swelling) is caused by excess fluid trapped in the tissue of the body. Edema secondary to CVD slowly worsens throughout the day with prolonged sitting or standing and resolves overnight or with the legs elevated. Edema that persists is called chronic edema and results in chronic inflammation that can change the way the skin looks and feels, making it become progressively thicker or firmer (fibrotic). This is a sign that the delicate lymphatic system is damaged and these areas of skin are more susceptible to infection.

Signs and symptoms:

  • Swelling of the legs directly under your skin
  • Skin often appears shiny or stretched
  • When pressed for several seconds, skin will imprint (pitting edema)

Unresolved venous edema can lead to a more serious condition known as phlebolymphedema, a combination of venous hypertension and a failing of the lymphatic system. Once the lymphatic system is compromised, swelling generally does not resolve overnight.

C4: Skin Changes
Skin changes due to CVD often present as skin discoloration, known as hemosiderin staining. Lower legs may appear rusty or dark purple in color. This type of staining represents pressure so high in the venous system that red blood cells are forced out of the blood capillaries and into the skin tissues. The red blood cells release iron deposits, called hemosiderin, which stain the skin. If left untreated, CVD may lead to skin breakdown, infection, and chronic inflammation. This often results in the formation of a Venous Leg Ulcer (VLU).

C5: Healed Venous Leg Ulcers
Healed VLUs are a serious manifestation of CVD. Healed VLUs start as painful, open wounds on the lower leg and ankle. These shallow wounds can become large and drain copious amounts of fluid. VLUs may take weeks or months to heal and are a heavy burden on patients. VLU treatments may include weekly visits to a wound care facility, wound debridement, wound dressing changes, compression bandaging, and can often severely impact a person’s quality of life.

C6: Active Venous Leg Ulcers
Active VLUs are another serious manifestation of CVD. Active VLUs present as painful, open wounds on the lower leg and ankle. These shallow wounds can become large and drain copious amounts of fluid. Active VLUs may take weeks or months to heal and are a heavy burden on patients. VLU treatments may include weekly visits to a wound care facility, wound debridement, wound dressing changes, compression bandaging, and can often severely impact a person’s quality of life.

Prevention

While there is no way to completely prevent spider or varicose veins, it is possible to slow the progression by living a healthy lifestyle.

  • Move – Change positions as often as possible while sitting or standing for prolonged periods of time
  • Manage Weight – Being overweight can add a lot of extra pressure on the venous system
  • Exercise – Regular exercise increases blood flow
  • Eat a Healthy Diet – A balanced diet can prevent unhealthy weight gain, protecting against excess venous pressure
  • Elevate Legs – Leg elevation can relieve venous pressure buildup as well as relieve symptoms of CVD
  • Wear MCS – Make compression a daily part of your wardrobe
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Treating spider veins

Treatment

  • Self-care – This includes regular exercise and wearing compression stockings
  • See a vein specialist – People often choose to visit a vascular or vein specialist because varicose or spider veins are of cosmetic concern. However, it is important to visit a specialist if you are experiencing mild or more advanced symptoms of CVD. Proactive management and early intervention with corrective vein procedures may deter serious complications of CVD.
  • Chiesa R, Marone EM, Limoni C, Volonté M, Schaefer E, Petrini O. Chronic venous insufficiency in Italy: the 24-cities cohort study. European journal of vascular and endovascular surgery. 2005 Oct 1;30(4):422-9.
  • Hamdan A. Management of varicose veins and venous insufficiency. Jama. 2012 Dec 26;308(24):2612-21.
  • https://www.mayoclinic.org/
  • Kaplan RM, Criqui MH, Denenberg JO, Bergan J, Fronek A. Quality of life in patients with chronic venous disease: San Diego population study. Journal of vascular surgery. 2003 May 1;37(5):1047-53.
  • Rabe, Eberhard, et al. “Indications for medical compression stockings in venous and lymphatic disorders: An evidence-based consensus statement.” Phlebology (2017): 0268355516689631

What causes Varicose & Spider Veins?