There is very little evidence that any specific measures are helpful in preventing varicose veins. However limiting or modifying some of the contributing factors may be helpful in preventing progression of varicose veins. It is likely that exercise, avoiding be overweight and avoiding long periods of standing stationary might be helpful. You should also avoid wearing garments (socks or stockings) that restrict the blood flow from your legs. It may be helpful to avoid constipation and it may also be useful to avoid wearing high heel shoes for prolonged periods of time as these shoes mean the calf muscle is unable to provide an optimal pumping effect. There doesn’t seem to be much evidence that crossing your legs has any effect on varicose veins.

Spider veins are invariably treated with Sclerotherapy whereby a small amount of solution (the sclerosant) is injected into the abnormal veins to close them off. The body then dissolves these treated veins. Laser treatment of spider veins has produced inferior results to Sclerotherapy. As with all medical treatments the skill of the treating doctor is a critical component to achieving a successful result. The Australasian College of Phlebology has a register of doctors credentialed to perform certain procedures. Varicose veins are increasingly being treated less with surgery (“vein stripping”) and more with the “non-surgical” procedures of Ultrasound Guided Sclerotherapy (UGS) and Endovenous Laser Ablation (ELA). Some Phlebologists still perform adjunctive surgery (ambulatory phlebectomies) in association with one of the non-surgical techniques. Whether UGS or ELA is used depends on many factors with the most important being the size of the vein being treated. The larger the veins are more likely to be treated with ELA.

Compression stockings

These come in a variety of compression strengths ranging from support pantyhose to Class 3 medical compression stockings. In between are the compression stockings that are useful in the prevention of DVT’s when flying and the anti-embolism stockings that are often work in hospital. After Sclerotherapy it is usual for a Class 2 stocking to be worn from 3 days to 2 weeks depending on which vein was treated. As an adjunct to wearing stockings it is important to do as much walking as is possible.

Endovenous techniques (radiofrequency and laser)

In many countries Endovenous Laser Ablation (ELA) is replacing, or has replaced, the traditional surgical “stripping” of veins. The reasons for this are that ELA can be done as an office procedure (walk-in, walk-out) and has less risk than surgery. It also does not have the recovery time associated with surgery. The long term results of ELA are excellent. Importantly the recurrence rate of new varicose veins after surgery, which is often very concerning for patients, is avoided by performing ELA. The technique of ELA consists of placing a small laser fibre up the middle of the vein. This fibre is then very slowly withdrawn from and the laser energy from the tip of the fibre then heat seals as it is withdrawn. The laser is introduced via a 3-4 mm cut (done under local anaesthetic) and the procedure itself is also done under local anaesthetic. Normal walking is possible straight away as the local anaesthetic is not into the muscles but only placed around the vein being treated. The actual laser treatment is painless although some patients report a buzzing sensation.

  

Interestingly there is no dictionary definition of what constitutes a varicose vein but it is generally accepted that if a vein is “raised” above the surface then it is a varicose vein. What is critical in the management of varicose veins is the determination of the underlying anatomy. Almost all significant varicose veins are associated with an underlying vein that has valves that do not work and allow back pressure (with standing and gravity). This back pressure “forces” its way to the skin as varicose veins. The best and least invasive way to determine the state of the underlying anatomy is to have a Duplex Ultrasound examination. This examination gives a clear understanding of which veins are working (competent valves) and which veins have valves that are not working (incompetent valves / veins). It is only with this information that the treatment options be considered. There are many doctors who can look at veins but the special interest group called Phlebologists are playing an increasing role in assessment and management of all vein conditions.

  

Spider veins are NOT dangerous and present a cosmetic concern although they can occasionally be associated with some minor aching particularly after prolonged standing. Varicose veins on the other hand can be associated with Deep Vein Thrombosis, Pulmonary Embolism, ulceration of the skin (usually around the ankles), cellulitis (if the damaged skin gets infected) and significant bleeding episodes if the varicose vein is traumatised and bursts. For many people though varicose veins are small and not associated with much in the way of symptoms and the risk of the aforementioned problems is low.

Varicose veins can be associated with a range of symptoms including aching, throbbing, swelling around the ankles, dermatitis (and itching) and discoloration of the skin around the ankles. In severe cases the skin can ulcerate around the ankles. Interestingly varicose veins can also be associated with leg cramps and restless legs (at night) although the mechanism for these two symptoms is not clear. Importantly the presence or absence of aching is NOT a good guide as to the severity of veins. Sadly often the first problem that some people have is the appearance of an ulcer in a leg that had previously had no aching. This means that it is important to assess the severity of the situation by means other than the severity of the aching.

  

The main factor is gravity. Because both varicose veins and spider veins are associated with faulty one way valves that allow back pressure, and the legs have the biggest effect from gravity, this is where varicose veins and spider veins most frequently occur. It is common to get spider veins on face particularly around the cheeks and nose but this is predominantly due to sun damage.

The most important factor in whether or not you will develop varicose veins is your genetic background. This situation can be aggravated by relative inactivity, occupation (prolonged standing), pregnancy, constipation, wearing high heel shoes, being overweight and advancing age. There is also some evidence that dietary factors may have some influence but the specific foods have not been identified.

Varicose veins are the sausage like veins that appear “above” the surface of the skin. This distinguishes them from the very fine spider veins that appear on the surface of the skin. Spider veins appear as fine purple, blue or red veins in a network sometimes looking like a “spiders web”. Varicose veins, if severe, can look like a bunch of grapes, particularly around the inside of the knee. Varicose veins are invariably associated with a deeper vein that is not working. This “incompetent” deeper vein has either faulty or absent one-way valves that results in back pressure down the vein and the subsequent appearance of varicose veins on the surface. Thus, varicose veins can be thought of as “escape routes” for the underlying back pressure.

Spider veins on the other hand rarely have any underlying incompetent veins but invariably are associated with larger surface veins with faulty valves. These “reticular” veins which are blue or green in appearance also have back pressure which then leads to the formation of spider veins (“telangiectasia”). Because of the association of varicose veins and spider veins with these “high pressure” feeder veins it is critical that these associated veins are treated for a satisfactory result to be obtained.

  

This is a question that I am often asked to which I reply.... “If the quality of treatment is high the treatment frequency will be low”.

Specifically for surface veins, if the reticular veins (the blue / green veins that lead into spider veins) are treated prior to treating the spider veins then not only is the treatment more effective but it lasts a lot longer. For example, a 40 year old lady would usually get between 5 – 10 years between treatments if treated correctly. This time between treatments extends as people get older. The treated veins do not come back but there will be new veins grow over time for the same reason that the original veins grew – genetics!

If the reticular veins are not treated first then not only do patients often get a poor result but they require frequent treatment (every 6 -12 months) because the treated spider veins will just keep reappearing. There is also a higher incidence of the complication of “matting” if the reticular veins are not treated.

Why don’t all doctors treat veins this way? Sadly because the training of some doctors is less than optimal or their real interest lies elsewhere. For deeper veins treated with either Ultrasound Guided Sclerotherapy or Endovenous Laser Ablation, the results are invariably long term and often permanent with any recurrence usually minor in nature and easily treated. These successful results will only occur if the treating doctor is very well trained and experienced.

Until November 1, 2011 the cost of Endovenous Laser Ablation (ELA) has been totally out of pocket for patients but from this date onwards there is a Medicare Item number that will offset some of the cost of laser. Often ELA is combined with either Ultrasound Guided Sclerotherapy or Ambulatory Phlebectomies but these procedures have always been associated with Medicare Item numbers.