varicose veins and spiders

What Causes Varicose Veins?


Who gets varicose veins and why.

Both women and men can develop vein disorders at any age.  It can affect the healthiest of individuals, but there are some conditions that increase your risk of developing varicose veins.  They are mostly inherited; if both of your parents had varicose veins, you have a 90% chance of also having them.  Other factors that increase your chance of developing vein disorders include being female, hormonal changes, pregnancy, getting older, having a job that requires many hours standing or sitting, being overweight, and a history of leg injuries.

  • Increasing age. As you get older, the valves in your veins may weaken and not work as well.
  • Heredity. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have varicose veins have a family member who has them too.
  • Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
  • Pregnancy. The hormones during pregnancy greatly influence the leg veins. Varicose veins can even be a symptom of pregnancy and can show up during the first trimester. As pregnancy progresses, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus  also puts pressure on the veins. Varicose veins usually improve within 3 months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
  • Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
  • Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
  • Leg Injuries
spider veins lateral knee

What Causes Spider Veins?

Spider veins refer to the abnormally enlarged, bluish or red-colored small blood vessels at the surface of the skin. They often appear in clusters, where they get the name ‘spider veins’ because of their spider like appearance. They also may appear in a starbust pattern. Spider veins, also known as telangiectasias, occur when blood pools in veins near the surface of the skin. They can be caused by heredity, being female, obesity, trauma, and fluctuations in hormone levels. In many cases, the exact cause is not known. They tend to become more numerous with age, and are common among people over 30 and in pregnant women.

Spider veins can be cosmetic, but may indicate an underlying condition. When spider veins appear around the inner ankle and inner thighs, this may indicate an underlying problem, called venous reflux in saphenous vein which are not visible to the naked eye. Ultrasound can determine if there is underlying venous reflux. Spider veins may also cause symptoms. Itching is a common symptom. Some patients complain of burning, stinging and pain sensations. The reason for the itching and other symptoms is because spider veins can be associated with inflammation. The inflammation in turn, can cause symptoms. Spider veins are most commonly treated with sclerotherapy.

before and after varicose veins

¿Qué Es La Enfermedad Por Reflujo Venoso?

¿Qué Es La Enfermedad Por Reflujo Venoso?

La enfermedad por reflujo venoso también es conocida como estasis venosa o insuficiencia venosa. La enfermedad por reflujo venoso se refiere a las “válvulas dañadas” en las venas de las piernas. El reflujo puede ocurrir en las venas profundas y/o superficiales de las piernas. Las venas profundas son aquellas que se encuentran en el interior del músculo; retornan al menos el 80-90% de la sangre de las piernas al corazón. Las venas superficiales se encuentran por fuera del músculo y debajo de la piel. Las principales venas superficiales son la Vena Safena Mayor que recorre la mitad del muslo y la pantorrilla y la Vena Safena Menor, que recorre la parte posterior de la pantorrilla. Normalmente, existen válvulas unidireccionales dentro de las venas de las piernas, que ayudan a dirigir el flujo sanguíneo en una dirección: hacia el corazón. Esto significa que la sangre realiza su recorrido contra la gravedad. El músculo de la pantorrilla también ayuda a movilizar la sangre hacia el corazón. Cuando las válvulas venosas se encuentran dañadas, la sangre fluye hacia atrás (reflujo) en dirección a los pies. La sangre se acumula en la parte inferior de las piernas, causando venas protuberantes en la superficie. Los síntomas incluyen pesadez, fatiga y dolor en las piernas, hinchazón de los tobillos, flebitis (venas inflamadas y dolorosas), piernas inquietas por la noche y calambres nocturnos. La enfermedad por reflujo venoso es progresiva y empeora con el tiempo. La piel también puede presentar cambios, incluido el oscurecimiento de la piel alrededor de los tobillos. El oscurec- imiento de la piel a veces se conoce como cambios en la piel por estasis venosa. La piel puede volverse seca y producir picazón (eccema venoso). Eventualmente, la piel puede romperse provocando una herida, llamada úlcera venosa de la pierna.

leg heaviness

Link Between Leg Heaviness and Your Veins

One of the most common symptoms of venous reflux disease is a feeling of leg heaviness. Venous reflux disease refers to ‘leaky’ vein valves in the leg.  Healthy veins return blood flow from the legs to the heart. When the valves are weak and leaky, blood will backflow or ‘reflux’ and pool in the leg veins, instead of returning up toward the heart.  This increases the pressure in your legs, giving you that tired, heavy feeling. Leg heaviness tends to worsen throughout the day, especially after long periods of standing.  You may notice that elevating your legs or using compression stockings reduce the symptoms of leg heaviness. Leg tiredness, fatigue, ankle swelling are other common symptoms of venous reflux disease.

varicose veins

Varicose veins most frequently cause the legs to become heavy, achy and tired. But, these symptoms can be present even in the absence of varicose veins. Venous insufficiency, the underlying cause for varicose veins can cause leg heaviness, tiredness and swelling even before bulging veins are visible.


woman leg pain

Why Leg Pain Worsens with Menstruation

Leg pain from varicose veins tends to worsen just before menstruation.

Many women who suffer from varicose veins or venous reflux disease (without any visible signs of disease) commonly experience increased leg discomfort, leg fatigue and swelling prior to menstruation.  The reason for this is the hormone progesterone. Progesterone rises about a week before menstruation. Progesterone has a significant effect on the veins. Progesterone causes the vein walls to relax, allowing more blood to pool within them. The increased pressure caused by the excessive pooling of blood worsens symptoms.  Saphenous veins, the large superficial blood vessels found in legs, are particularly susceptible to varicosity due to extra progesterone. This is also a reason pregnancy contributes to the development of varicose veins. We have had several patients who have reported their first sign of pregnancy was leg and varicose vein pain (because of the hormone changes).

Symptoms prior and during menstruation can be treated conservatively, with leg elevation, exercise, compression therapy, ibuprofen, and ice packs.
corona phlebectasia

Spider Veins Along the Ankle Indicate Underlying Reflux Disease

Bluish and red-colored spider veins along the inner ankle and foot are referred to as corona phlebectasia in the vein world. This description refers to the ‘crown’ or cluster like distribution of these small blood vessels. Spider veins are often falsely considered as a cosmetic issue. But on the contrary, the presence of corona phlebectasia is a clinical sign that is often associated with underlying venous reflux, most commonly saphenous vein reflux, but the deep or perforator veins can also be incompetent. Underlying disease can be evaluated by a duplex ultrasound examination. Whenever corona phlebectasia is present, a duplex ultrsaound examination should be offered to evaluate the underlying cause for the development of spider veins around the ankle. This will help accurately determine the treatment plan.


Blood Vessel Diseases that can be Diagnosed with Duplex Ultrasound

Duplex ultrasound combines Doppler flow information and conventional imaging information, sometimes called B-mode, to allow physicians to see the structure of your blood vessels. Duplex ultrasound uses sound waves to get images of your blood vessels. It also helps determine how fast blood moves through the vessels. It can also be useful to estimate the diameter of a blood vessel as well as the amount of obstruction, if any, in the blood vessel. Using duplex ultrasound technology, the structure of your blood vessels, the valve function, the movement of your red blood cells and direction of blood flow through the vessels, and any blockages or blood clots can be seen.

Diseases of the blood vessels can affect both veins and arteries.

Vascular refers to the blood vessels in the body. There are two main types of blood vessels; the arteries and veins. Arteries bring oxygen-rich blood from the heart to every inch of the body; vein return the blood back to the heart and lungs for more oxygen. Vascular disease is when the blood vessels are no longer healthy.

Common types of vein disease include:

  • Varicose veins
  • Chronic venous insufficiency
  • Deep venous thrombosis

Common types of artery disease includes:

  • Carotid artery disease and stroke (TIA or Stroke)*
  • Lower extremity arterial disease (PAD)**
  • Upper extremity arterial disease
  • Abdominal aortic aneurysm (AAA)

Micro-Phlebectomy to Remove Varicose Veins

Micro-Phlebectomy involves using a scalpel to make tiny incisions (less than 3mm- about the size of a grain of rice) along the legs to remove the veins. This is performed with a local anesthesia that is used to numb the skin of the leg. This procedure may take 1 to 2 hours, depending on the extent of the individual’s varicose veins. Return to normal activities after the procedure is possible. There will be significant bruising with this procedure. The benefit is that the veins are removed immediately, although it may take several weeks for the bruising to resolve. This procedure may be performed in conjunction with other procedures or stand alone, depending on the individual’s specific vein issue. Alternatives to phlebectomy is foam sclerotherapy, which is an injection into varicose veins to cause them to shrink and eventually disappear. Discuss with your doctor which treatment is better for you.

Preparing for your Procedure:

There are no medication restrictions before the procedure. If you have asthma, please bring your inhaler with you to your appointment or your doctor may have recommended to take an antihistamine such as claritin prior to the procedure. You should take this the morning of your treatment.
Please notify our office if you are scheduled to have any type of medical procedure or surgery 2 weeks prior or after your treatment.

If you choose to take the light sedative offered, be sure to make arrangement for transportation to and from the procedure, as you will not be able to drive yourself home. The morning of your procedure, please shower and thoroughly wash your leg with soap from your groin to your ankle and wear loose fitting pants to your appointment. It is also advised for you to bring an extra pair of underwear with you to your appointment. It would be best if you have a light meal before you arrive. You may bring a book or an iPod to listen to during the procedure. We also offer a movie to watch during the procedure. If you already have 30-40 thigh high compression stockings, please bring them with you to your appointment. If not, we will fit you for stockings the day of your procedure.


leg pain

How to Manage Varicose Vein Pain at Home

While venous interventions are the best way to alleviate long term pain related to varicose veins, symptoms can be managed conservatively at home. Especially under the stay-at-home safe harbor orders.  Conservative management can be helpful to relieve symptoms and also prevent complications (such as thrombophlebitis). These include:

  • Avoid standing or sitting for long periods of time:  To keep blood moving when you have to sit or stand for long periods, try these tips: at work, take walking breaks and try walking during your lunch hour. While sitting, try flexing your feet up and down 10 times an hour. When standing, raise yourself up and down on your toes or rock back and forth on your heels.
  • Exercise: Exercising is good for your veins because it improves blood flow. Walking, cycling, or swimming are great exercises for vein health. But be sure to check with your doctor before starting any exercise program.
  • Weight loss or maintaining a healthy weight: Being overweight puts extra pressure on your veins.
  • Leg elevation: Use leg elevation three or four times a day for about 15 minutes at a time. Even elevating your legs on a step stool or ottoman is beneficial. If you need to sit or stand for a long period of time, flexing (bending) your legs occasionally can help keep blood circulating. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms.
  • Compression stockings: These elastic stockings squeeze or compress the veins and prevent blood from flowing backward. Compression stockings must be graduated, medical grade compression to be beneficial. TED hose are not adequate to reduce symptoms in venous disease for active patients. Although we typically recommend being fit for compression stockings, compression stockings can be purchased at home, from online resources. Email us if you would like suggestions.
  • Supplements such as horse chestnut and grape seed extract can help reduce symptoms of venous disease. Vasculera is a prescription medication that may be helpful for some. Always check with your PCP before starting supplements or new medications as there may be side effects.
  • Flavinoid rich diet including berries, green teas can reduce inflammation and pain.
  • Anti-inflammatory medications such as ibuprofen
  • ice packs are my favorite way of reducing painful veins. Put ice cubes in a ziplock bag and apply to tender veins.
  • Anti-inflammatory creams can be prescribed to apply directly on painful veins.
Nutritional Tips for Varicose Veins

Nutritional tips for varicose veins

Varicose veins are bulging, purplish-colored veins that occur when the one-way valves, which are responsible for regulating the constant flow of blood, become weak, especially in the lower limbs. Although many consider them a simple aesthetic problem, they can be a sign of circulation disorders, fluid retention, and inflammatory diseases. Fortunately, this condition can be significantly improved by making better nutritional choices before it becomes chronic.

In a diet to prevent varicose veins, it is suggested to increase the intake of some foods that promote blood flow. Similarly, the aim is to control total calorie consumption, since lowering the body mass index is a determining factor both in avoiding varicose veins and in reducing them.

Another objective is to help control the body’s inflammatory processes, whose alteration may trigger this condition. Additionally, this allows decreasing the pressure on the legs, which controls symptoms, such as heaviness and pain. So, what you need to do nutritionally speaking?

Increase Omega-3 consumption. Due to their ability to cleanse the arteries, these fatty acids are ideal for reactivating circulation, lowering cholesterol, and preventing possible blockages. These healthy fats control excess inflammation and help maintain good cardiovascular health. Choose oily fish, nuts, and seeds.

Eat more fiber. Fiber-rich foods are allies in lowering cholesterol levels and optimizing circulation. They also reduce constipation so that there are no difficulties due to the pressure produced by the difficulties in defecating. Choose fruits, vegetables, whole grains, legumes, nuts, and seeds.

Consume more folic acid. Foods containing folic acid help reduce homocysteine, an element that causes injury to the artery walls. They also prevent the appearance of thrombi, a chronic disorder that affects varicose veins and cardiovascular disease. Choose spinach, asparagus, cabbage, beef liver, whole grains, and nuts.

Increase the dose of vitamin E. This well-known antioxidant is essential in preventing varicose veins because it promotes the breakdown of lipids in the blood and optimizes circulation. Choose fruits, avocado, and olive oil.

Include diuretic ingredients. These can stimulate the elimination of retained fluids to decrease the overload of the legs. Therefore, their inclusion in the diet promotes the relief of varicose veins and prevents other diseases associated with poor circulation. Choose pineapple, artichoke, lemon, cucumber, blueberries, and parsley.

Limit salt consumption. Maintaining a sodium-rich diet is one of the factors that increase the risk of varicose veins, producing edema and high blood pressure. Because of this, it is essential to limit its intake and seek healthy alternatives. Choose healthy spices like oregano, thyme, garlic, and turmeric.

Consume healthier drinks. Healthy drinks complement the effects of the diet to prevent varicose veins. Adequate fluid assimilation helps balance inflammatory processes and promotes proper blood flow by regulating fluids in the tissues. Choose plain water and healthy smoothies or juices.