"I’M TOO EMBARRASSED TO WEAR SHORTS NOW!"
Colleen lives for springtime and golf season! Recently however, her excitement has been dampened by the appearance of many blue blood vessels growing high in the surface of her thighs and calves. She has had to give up her shorts in the summer because people invariably point to the blue discolorations on her legs and ask how she hurt herself! Every time she must tell them that they are not bruises, rather they are clusters of abnormal leg veins. She is a healthy 50-year old with a large blue discoloration on the inside of her right knee, conspicuous enough. There are others that are smaller, but the cumulative total of the blue on her legs turns heads. Colleen has varicose and spider veins, just like her mother did. She used to suffer nighttime aching and heaviness of her legs, until she proceeded to do some sclerotherapy, This needle injection procedure helped her leg aching, but to her surprise and dismay, she developed a "fan" of small purple blood vessels high in the skin over the same zone. She proceeded to laser vein treatments of the tiny blue vessels because the vessels were generally too small to cannulate with a needle. She has seen immediate improvement, but she knows that the odds are strong that she will acquire a few new veins each year. Colleen is aware that genetics is another factor that will almost guarantee that she will have to maintain her leg vein treatments, perhaps once per year in order to preserve the beauty of her legs.
It is no surprise that Allie has noticed a horseshoe of similar small purple blood vessels over her thigh. She noticed these in the early springtime. She also gets a matte of the same kind of small purple vessels over the right ankle, site of a severe sprain in the past. She is a hair stylist who must stand most of her workdays, and she has noticed that the swelling is proportional to the length of time standing every day. By the end of the day her legs feel heavy, and ankles are swollen.
Karen was pregnant when her doctor advised her to spend more time resting with her feet up. She was in her third trimester when the symptoms developed. The enlarged uterus rested on the big veins in the abdomen, blocking the flow from the legs to the heart. Hormones of pregnancy were also contributors to the pooling of blue blood in the lower extremities. Fortunately, after delivery, her vein problems disappeared again for quite some time until in her early 40’s she experienced ankle swelling, and itchiness over the inside right ankle. A good look at the problem area revealed a couple of layers of blue abnormal vessels. The underlying, larger vessels were managed safely and effectively with ultrasound guided sclerotherapy while the overlying small, superficial blue veins were contracted by a near-infrared laser. It was a great relief for her to observe the diminished discoloration after three treatments.
Varicose is derived from a Latin word meaning "twisted". The distended, elongated, and tortuous blood vessels grow aberrantly for a variety of reasons, but most likely they occur secondary to the influence of gravity on the column of blood in our legs. Hence leg veins are the most often affected. Women experience more than men because they are exposed to a lifetime of female hormones, especially during lifetime events such as pregnancy. Youth is a time of high blood vessel elasticity, while aging comes with loss of elasticity. As the aging blood vessel loses its elasticity, there is weaker propulsion of blood back to the heart. And for the same reason, the valves weaken and become dysfunctional, leaky. Now, the propulsion forward is followed by regurgitation back to the bottom of the column, the feet.
Not only is the problem of varicose and spider veins an issue cosmetically, but it is also a risk factor for further vein complications. There may be symptoms of discomfort, heaviness, aching, bulging, restless legs, and edema. There might develop a case of phlebitis, (inflamed vein), or worse still, a blood clot.
Fortunately, the options for treatment are improving. The field of phlebology is growing with expanding technology. One advance is ultrasonic guided sclerotherapy, a method that localizes the sclerotherapy injections to "stop the leak" efficiently and early. And, newer sclerosing agents are more effective in managing the larger affected vessels, challenging the role of surgical ligation as a treatment option. Additionally, there are lasers that are threaded into the affected vein like an IV, running up the affected vessel to the apex and withdrawn again as the laser zaps the inside lining of the varicose vessel on its way out. This new technology may be done in an outpatient setting without general anesthesia, and the downtime is only on the order of a few hours in the vast majority, vs weeks after surgery! Debate ensues as to the role for traditional surgical ligation of veins in this era. At least there may be fewer surgical candidates as other techniques become more efficient. And last, but not least, the matte of blue spider veins that is such a pervasive cosmetic concern will be managed mostly with modern lasers that pass through the skin, focusing the energy on the target purple blood vessel, causing it to contract and self ablate, without downtime.
Such advances in treatment of leg veins will soon alter the patterns of care for those struggling with varicose or spider veins.
