There is a common misconception of what varicose and spider veins really are. It may be embarrassing for some to admit that they have varicose veins or they simply just think that they have spider veins. Although spider veins can be fed from varicose veins, they are simply not the same. Let’s start with spider veins… What are they? Spider veins are typically purple web-like veins that appear either scattered all over the leg or in clusters. Although they can be symptomatic, they are usually painless and are considered cosmetic. They lie almost, if not, flat on the skin and are often described as “unsightly.” Varicose veins on the other hand are bulgy. People describe them as snake or rope like or even like a little brain. Varicose veins protrude from the skin and are not considered a cosmetic condition, but rather a medical condition. They can also be either symptomatic or asymptomatic. To properly diagnose patients with either spider veins or varicose veins, a thorough consultation should be done to examine the patient’s legs and areas of concern. Sometimes, certain patterns of spider veins indicate that there may be an underlying vein condition. An ultrasound examination can be done to properly diagnose varicose veins and underlying vein conditions.
What is the difference between varicose veins and spider veins? Are they the same thing? Spider veins and varicose veins both refer to dysfunctional, dilated leg veins but the main difference is the size of the veins. Spider veins are small, thread-like veins at the surface of the skin. They often appear in clusters or can have a ‘starburst’ or spider-like pattern. Varicose veins, are larger veins that appear swollen, twisted cordlike veins that ‘bulge’ at the surface.
Both spider veins and varicose veins can cause pain and other symptoms like burning, aching and throbbing. Both can be treated without surgery.
#1 A feeling of heaviness or fullness in the legs that gets worse as the day progresses.
#2 Leg fatigue and tiredness in the legs, that also becomes worse by the end of the day and after prolonged standing or sitting. Some patients describes their legs as being ‘full of energy’ in the morning but are tired by the evening. For example, after a long day at work, disney land or the grociery store, you may feel like you need to run to a chair to recline and elevate the legs.
#3 Leg swelling, mostly affecting the ankles. Your legs may be normal in the morning but you notice swelling or that your shoes are tight by the end of the day.
#4 Leg pain. This can occur generally, or along a varicose vein, especially those that run on the outside of the leg or behind the knees. Some patients report localized pain along the vein that feels like burning or throbbing. Leg pain that is worse during exercise may indicate a different problem.
#5 Night cramps. These are cramps usually in the calf or thighs that occur only at night.
#6 Restless Legs: a feeling of restlessness during the night, that may interrupt sleep. You may have to get out of bed to walk around and move your legs.
#7 Noticeable bulging, twisted veins called varicose veins
La Jolla Vein Care’s Dr. Nisha Bunke presented a talk about the ‘Management of Non-healing wounds in venous disease’ at the Society for Vascular Medicine’s Annual Scientific Sessions this past weekend. She spoke about venous leg ulcers, which she described as being the most common type of chronic leg ulcer, how to make the correct diagnosis and how to heal the venous leg ulcers.
Other topics at the meeting included venous thromboembolism (DVT), diagnosing and treatments for DVT, atypical wounds, phlebectomy, managment of the diabetic wound, duplex evaluation of the lower extremities for DVT, doppler evaluation of the arterial system, lymphedema, lipedema and many other venous, arterial and lymphatic system topics.
In 1994 and 1950, E.J. Orbach introduced the concept of a macro bubble air-block technique to enhance the properties of sclerosant in performing macrosclerotherapy. Apparently, few vascular surgeons were interested in the subject and the technique languished. The work of Juan Cabrera and colleagues in Spain attracted attention of some vein specialists and interest in the use of foam technology in treating venous insufficiency was reawakened. Administration of foamed sclerosant was reintroduced in the early 1990s by Cabrerra, who summarized a broad experience in 1997. By the 1990’s, broad use of diagnostic ultrasound imaging made it possible to monitor foam distribution with ultrasound scanning. Some 40 years earlier, and before the development of ultrasound scanning, foam had been used in Germany to treat varicose veins. At that time, foam was made by special syringes and its distribution was assessed by touch, instead of ultrasound scanning. Tessari , prior to the year 2000 developed an easy way of making liquid sclerosant into foam using two syringes and a three-way stop cock. By 2000, Sica was able to report a three-year experience using foamed sclerosant in treating saphenous varices. Since that time, foam has appeared increasingly in general use. Around 2000, Dr. John Bergan began describing the utility and success of foam treatment to physicians in the United States and can be attributed to bringing its awareness to North America. Over the past decade foam has gained world-wide popularity for the treatment of varicose vein tributaries in place of surgery. Varithena foam was recently FDA approved to treat the great saphenous vein with foam sclerotherapy. Dr. Bergan predicted that microfoam sclerotherapy will eventually replace all other methods. Presently, it is most commonly used as an adjunct to endovenous ablation of the great and small saphenous veins or as a sole treatment for surface varicose veins.
Dr. Fronek was recently invited to discuss vein disorders with the Family Medicine Residency Program at Scripps Chula Vista. The doctors-in-training were excited to learn about the variety of problems that patients have with their veins – including spider veins, varicose veins, blood clots, and leg ulcers. Primary care doctors see patients with vein disorders every day, and yet very few medical schools or residency training programs include any information about these common problems. Dr. Fronek and Dr. Bunke-Pacquette are committed to sharing their expertise with colleagues and are frequently asked to speak at medical meetings. Primary care doctors, in particular, can often start patients with vein disorders on conservative treatment, including graduated compression stockings and regular exercise (walking is usually the best exercise for vein disorders), as well as certain supplements such as horse chestnut seed extract, that can alleviate the symptoms that many patients with vein disease suffer from. Informed primary care doctors can also refer patients to a vein specialist when symptoms aren’t diminished with conservative treatment, if the varicose veins worsen while a patient is using compression and exercise, or if the patient suffers from a venous leg ulcer.
Patients sometimes tell us that they feel isolated or alone as a result of their varicose veins. The fact is, however, that they are not alone- one in four Americans have some form of vein disorder. Olympic athletes get varicose veins too! Olympic swimmer and gold-medalist, Summer Sanders shares her story of suffering with varicose veins. “As a life-long athlete and Olympic swimmer, I never thought a condition like varicose veins or chronic venous insufficiency (CVI) would affect me. It soon hit me that, even though I was active, I was starting to get my mother’s legs.
It’s important for people to realize that varicose veins and CVI can happen to anyone and they are more than just a cosmetic issue. But you don’t have to live with the uncomfortable and painful symptoms. There are minimally-invasive treatments available that are covered by many insurance plans.
It’s time to Rethink Varicose Veins. I’m glad that I did.” Read all of Summer’s story at www.rethinkvaricoseveins.com
Patients with varicose veins often report a feeling of restless legs, especially at night when in bed. In our study, about 30% of patients with varicose veins complained of restless legs. Restless legs syndrome (RLS) is a sensorimotor movement disorder characterized by uncomfortable sensations in the legs and an urge to move them. There are other causes of restless legs syndrome such as, neurological disorders, anemia, and kidney disease to name a few and is often treated with medication. Venous insufficiency is often neglected as a cause of Restless Legs Syndrome. However, when recognized, it is easily treatable leading to resolution of symptoms.
Treatment is aimed at correcting the underlying venous insufficiency. This usually is accomplished by removing the varicose veins or incompetent veins by new, minimally invasive, non-surgical methods. In our study, 98% of the patients with venous insufficiency and restless legs, had resolution of symptoms following treatment.
In another study, by Hayes, CL et. al, 35 patients with RLS and superficial venous insufficiency underwent endovenous ablation of refluxing superficial veins and ultrasound-guided sclerotherapy of varicose veins. 89% of patients reported alleviation of symptoms.
If a patient has restless legs symptoms and evidence of varicose veins of the legs, a work-up for venous insufficiency should be considered. The work-up involves a duplex ultrasound evaluation of the leg veins. This may eliminate the need for medication for RLS.
It’s hard to believe that immigrants entering the United States through EllisIsland, in the early 1900’s could be considered as unfit if they had varicose veins. But, historical documents suggest that Doctors had only seconds to examine each passenger, checking for 60 symptoms, from anemia to varicose veins. Each person was then asked a set of 29 questions, sometimes over and over again, and by a series of different inspectors. ‘If the immigrant’s papers were in order and they were in reasonably good health, the Ellis Island inspection process would last approximately three to five hours. The inspections took place in the Registry Room (or Great Hall), where doctors would briefly scan every immigrant for obvious physical ailments. Doctors at Ellis Island soon became very adept at conducting these “six second physicals.” By 1916, it was said that a doctor could identify numerous medical conditions (ranging from anemia to goiters to varicose veins) just by glancing at an immigrant.
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