It started with vanity, as so many health sagas do. I’ve never had supermodel legs, but in my 30s and 40s, I started noticing thin, squiggly blue and purple veins mostly below my knees and around my calves. I had one slightly bulging blue vein on the back of my right calf that looked like a branch pressing against a window in a storm. I soon learned these were spider veins and varicose veins.
I shrugged it off at the time, but the veins got worse, more appeared and they sort of hurt too. I thought of my father’s legs. No offense, Dad, but they’re as thick as tree trunks rooting in your shoes, with networks of blue and purple veins so visible, they might as well have been drawn with a Sharpie.
Fast-forward to my visit to the Metro Vein Centers in Manhattan, where I was expecting to hear about the newfangled treatments where they zip-zap-zap the offending veins and then I’d be Barbie-smooth and good to go. Not so fast.
[READ: Tips for Swollen Ankles and Feet.]
The Spider Vein Consultation
At the initial consultation, I changed into a size XXL paper culottes (one-size-fits-no-one), before the technician conducted a full-leg ultrasound — gliding a handheld scanner from the top of my inner thighs to the bottom of my ankles. At some point, she turned the monitor toward me and remarked gleefully, “That’s your vein! That’s blood moving through your vein!”
I was less delighted, mostly because … blood.
But also because, as I learned later, she showed me a BAD VEIN. It had a floppy valve, sloshing blood around lazily instead of whooshing it back up to my heart.
The diagnosis: “chronic venous insufficiency.”
[READ: What to Know About Varicose Veins.]
What Is Chronic Venous Insufficiency?
Plainly speaking, chronic venous insufficiency is a fancy term for busted veins.
This condition develops “when the veins are insufficient, meaning they’re incapable of doing their job well, and their job is to bring blood out of the legs,” explains Dr. Justin Ha, the board-certified physician and vein specialist who treated me at Metro Vein Centers. “If they can’t do that well, the blood moves in the wrong direction — downward toward the feet and toes. And over time, the accumulation of blood causes pressure to build in those veins, which causes them to stretch and grow.”
The problem is estimated to affect over 40% of women and around 17% of men, according to a study in the Journal of Vascular Surgery.
Chronic venous insufficiency is known to cause a range of symptoms, including pain, swelling, numbness, a feeling of leg heaviness, cramping, itchiness, burning and restlessness.
Personally, I check the boxes for pain when pressed, swelling (around my “ankles”), cramping — especially at night, and numbness after standing too long, or once after trying out a hybrid elliptical bicycle.
[READ: Does Medicare Cover Varicose Vein Treatment?]
Spider Veins vs. Varicose Veins
Both spider veins and varicose veins are caused by damaged valves in the veins. A spider vein is a smaller, more superficial vein that appears close to the skin’s surface, often looking like a spider web, while a varicose vein is a larger, more visible vein that bulges under the skin, usually appearing as a twisted, dark blue cord.
Spider veins don’t typically cause pain, while varicose veins can be painful.
Why Spider Veins Are Not Just a Cosmetic Problem
If you have visible spider veins, you have some degree of venous insufficiency.
However, the condition can progress over time, eventually leading to varicose veins, skin thickening and darkening. Venous stasis ulcers, which are open sores on the legs, can also develop. You don’t have to be super vain (pun intended), to want to avoid that scenario.
Medically speaking, there are six stages of progression, and Ha tells me I was around stage two or three, which means my veins were at least 3 millimeters wide (actually four in that bulgy spot on my back right calf) and swollen, and I had discomfort.
To be diagnosed with chronic venous insufficiency, you must have physical discomfort coupled with ultrasound findings of stretched-out veins — typically above 2 to 3 millimeters in diameter — and a minimum amount of blood moving in the wrong direction, called reflux.
“The blood is measured in time,” Ha says, “so if there’s over 500 milliseconds of blood moving in the wrong direction, then it’s considered insufficient.”
[READ The Most Common Signs of Poor Circulation and How to Improve Them]
Risk Factors for Chronic Venous Insufficiency
You may be wondering how to avoid this fate, and I don’t blame you.
The bad news is that some risk factors are out of your control — remember my dad? Yes, genetics are a significant factor. So is being female, getting pregnant, having an injury or surgery and aging.
“By the time you get older, around your mid-50s, gravity has had 50 years to stretch out your veins,” Ha says.
The good news is that there are some factors you can control, including not standing or sitting all day, avoiding obesity and overweight, quitting smoking and trying to prevent conditions such as diabetes and hypertension, all of which contribute to vein dysfunction.
[READ: What Are the Best Foods That Increase Blood Flow?]
Treatments for Chronic Venous Insufficiency
There are two main treatments — radiofrequency or thermal ablation (heat), or sclerotherapy (chemicals).
“The underlying principle, whether you use heat or chemical, is to cause the veins to kind of spasm and close,” Ha says. “And once they close, blood is rerouted to healthier veins.”
Over time, the body reabsorbs the diseased veins.
I chose radiofrequency ablation, and we did it in two appointments: First, my greater saphenous veins — one on each inner thigh — and then the smaller saphenous veins in the backs of my lower legs two weeks later.
Here’s how it went:
First, Ha gave me shots of Lidocaine, a numbing agent. Then he inserted a needle into my vein and guided it to the lumen, the center, where blood flows.
“If you imagine a pipe or a straw, I put a little guide wire in there, and once I’m inside the right vein and I see it on the ultrasound, I thread the laser catheter over that wire and put it in the correct position,” Ha explains.
From there, there’s some extra numbing agent to buffer against the heat, and then the laser action fries the inner walls of the vein, collapsing them. Each side took about 10 minutes.
Then I had to wear compression stockings– which might have been my least favorite part — and avoid exercise for three days.
Preventing Spider Veins
So, the radiofrequency ablation successfully closed my lazy-river veins, but I still have visible evidence of their sloth in the form of blue and purple spider veins. Soon, I will get those treated with a dermal laser, which is “like laser hair removal, but instead of hair follicles, we target the small spider veins on the surface of the skin,” Ha explains.
Although venous insufficiency and spider veins can’t be cured — I could be visiting Ha again in 10 or 20 years — there are measures I can take to lower the odds.
Those include exercising regularly (I probably need to do more than walk the dog), staying hydrated, keeping a healthy weight and wearing compression stockings, especially for extended sitting, like on a road trip or an international flight.
I may have inherited my love for travel from my dad — but hopefully I won’t also inherit his legs.
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Spider Veins: Treatments, Risks and What You Need to Know originally appeared on usnews.com
