Believe it or not, but it won’t be long before you start thinking about wearing shorts. But many people hesitate at baring those calves because of varicose veins, or unsightly and swollen veins in the legs. Varicose, or spider veins, are more than just a cosmetic problem though. They can lead to swelling, discomfort and fatigue, especially for folks who spend a lot of time on their feet.
Science Life recently spoke to vascular surgeon Robert Steppacher, MD, about what causes varicose veins, who is most at risk and why treating them isn’t all that different from wearing yoga pants.
Are varicose veins and spider veins the same thing?
Varicose and spider veins are the same disease process, it’s just a matter of severity and size. Spider veins are small blue or red veins under the skin. They’re called spider veins because they look like a spider web, and a lot of patients will find those unsightly. Varicose veins are larger, more dilated veins. We have a grading system, and we make the cutoff based on size. So spider veins would be smaller, like 1 to 3 millimeters, where varicose veins are larger, and they typically bulge out above the skin level.
What causes varicose veins?
They’re both caused by the same thing, which is called venous hypertension, chronic venous insufficiency or venous reflux disease. Those three terms are used interchangeably, but they all basically mean the same thing. It’s increased pressure within the vein because of a failure of what’s called the venous valvular system. So normally you have to have a way of getting blood, against gravity, out of your legs and back to your heart. The way that works is every time you take a step, the calf muscles contract, and that squeezes on the veins in your leg and pumps the blood out of your leg back to your heart. When you relax, gravity wants to pull the blood back into your leg. To prevent that from happening, in normal veins you have a valve that looks like a little triangle. Every time you take a step, the valve pops open, the blood exits the leg, and then when gravity wants to pull the blood back in the leg, the valve snaps shut. For various reasons like family history, weight, having jobs where you sit or stand for long periods of time, these valves stop working, and that allows gravity to continuously pull the blood back into the leg. This causes pressure on all the superficial veins, which causes them to dilate over time and grow larger.
Does it cause other symptoms, besides the cosmetic issues?
If left untreated, some patients can progress to more serious forms of venous disease, such as lypodermatosclerosis, which is a thickening of the skin. In very severe cases it can cause ulcerations, so you can actually get a wound because of the pressure on the skin. Most patients don’t experience that. What they experience are things like aching, burning, or swelling of the legs, and their legs feel tired at the end of the day.
Are certain people at risk for developing varicose veins?
The number one predisposing factor to this is a family history of varicose veins, plus lifestyle, or having a job where you stand for long period of time. A lot of my patients are nurses, other physicians, police officers, schoolteachers, hairdressers—basically anyone who’s standing up for a long period of time. Smoking doesn’t help, and believe it or not, wearing high heeled shoes for long periods of time actually also contributes.
Really? How does that happen?
Remember, you pump blood out of your legs with the calf muscles every time you take a step. When you wear a high-heeled shoe, your calf is always elevated, so when you take a step, you’re not moving your calf muscle, you’re not stretching your Achilles tendon, and it deactivates that pump.
So how do you treat varicose and spider veins?
The cornerstone of treatment is wearing external compression stockings. Basically, they it’s a sock that comes up to the knee that has elastic in it—just like the same elastic they put in yoga pants or athletic shirts. That provides external pressure on the leg, which counteracts the force of the venous pressure and also augments the calf muscle pump.
Typically, a lot of patients have tried compression in the past and say they were uncomfortable or they didn’t like it, and I always tell them to try again. One of the nice spillovers from the athletic industry is we’ve had a lot of transfer of technology. The same stuff that Nike or Lululemon is using in their materials has now been adopted by compression industry. So I always tell my patients, these are not your grandmother’s compression socks. They wick, they breathe, and they’re very comfortable to wear. In fact, most patients who I have given the compression stockings to they tell me their legs feel better and they’d rather wear these at work versus the standard sock.
Have you seen better adherence to treatment because they’re a little more fashionable?
Absolutely. Traditionally you get compression stockings from a physician. They have to be medical-grade, and you have to get a prescription for them. What we’re finding is that we’re getting just as good an effect from manufacturers who are making these products as performance-enhancing garments for high endurance athletes, triathletes and marathon runners. So for a lot of the patients who were having trouble with compression, we’re putting them into the same socks designed for high-performance skiers, hikers, marathon runners and triathletes, and they’re finding that their symptoms are better and they don’t have a problem wearing them.
What are the treatment options if the compression doesn’t work, or the condition is more serious?
The modern treatment is percutaneous, which means we do it right through the skin with a needle in an outpatient setting. We put a very fine needle under local anesthetic into the vein that we intend to treat. Then we put a tube which has a heating element—and for lack of a better description—we weld the inside of the vein shut. We’re able to treat it in an outpatient setting. It’s painless and doesn’t require general anesthesia, and the patient can resume their normal activities in two to three days after the procedure.
Why come to a big medical center to treat varicose veins? Don’t a lot of spas offer the same services?
The advantage of coming to the University of Chicago for venous treatment is you’re having treatment delivered by board certified vascular surgeons. You’re right, there are a lot of options in the marketplace. This is offered at medi-spas, at specialized vein centers … you can literally get a Groupon to have your veins treated. When you come here you’re going to get a thorough medical evaluation, and we’re not selling you something. We’re going to take care of you, the patient, and make sure that you have the best treatment options available, not just because we’re a vein center. There’s an old saying, “Go to Midas, get a muffler,” and a lot of times if you go to a medical spa or an outpatient vein treatment center, that’s what they do.
We offer a more objective, unbiased assessment, and frankly, not everyone who comes in with tired or swollen legs has chronic venous insufficiency. Sometimes they can have arterial disease or lymphedema, spinal problems or back problems that are contributing to their symptoms. By getting an evaluation by a board certified vascular surgeon, you are also ensuring that these other conditions that may mimic venous disease are being investigated and evaluated. If you have something that requires more advanced treatment from another specialty, say orthopedics for spine surgery, or plastic surgery for lymphadema, then we’ll get you plugged in for the appropriate treatment.