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Closeup of a person's legs with varicose veins standing on a dock over a body of water

Clearing up the Confusion Around Spider and Varicose Vein Treatments

This time of year, we’re swapping warmer weather for warmer clothes. If you have spider veins or varicose veins on your legs that make you self-conscious, it may feel like a welcome change – out of sight, out of mind.

Maybe you’re telling yourself next summer you’ll finally do something about those purple, knotty pests. Well there’s no shortage of commercial vein treatment centers, offering a dizzying array of therapies, treatment plans and spa-like experiences. Health systems and hospitals offer spider vein and varicose vein treatments, too, so which should you choose? And are these unsightly veins simply a nuisance, or a sign of a larger problem?

We talked with Raghu Kolluri, MD, the medical director of vascular medicine at OhioHealth, to better understand what causes vein issues and what they mean for your health, as well as what you should look for in a vein treatment center, and what you should look out for.

First, a quick recap on the types of vein problems we’re talking about, because sometimes the terms for these words are used interchangeably.

  • Spider veins are small veins near the surface of the skin, often on the legs, that become red, blue or purple when the veins no longer function properly.
  • Varicose veins are larger, raised, twisting veins that appear on the surface of the skin, also often seen on the legs.

Why do varicose veins and spider veins form?

“Veins are like pipes in your legs that are supposed to carry deoxygenated blood back up north, where the blood is refreshed in your lungs with the oxygen your body needs and pumped by your heart back down through your body through a separate set of pipes called arteries,” says Kolluri. “What happens with venous disease is that the valves in your veins that ensure your blood makes a one-way trip to your heart and lungs become damaged, which can be caused by a variety of factors like age, genetics, a job that requires standing for long periods of time, or being overweight. These damaged valves in your veins allow blood to pool, initially causing spider veins. The added pressure can also weaken the walls of your veins, causing them to bulge and twist into varicose veins.

Are spider veins and varicose veins dangerous?

Kolluri says varicose veins and spider veins are often not an issue beyond being visually displeasing to the people who have them. But, he stresses, if you are experiencing other symptoms, these veins could be a signal of a larger problem.

“We call these symptoms HASTI symptoms:

  • Heaviness
  • Ache
  • Swelling
  • Throbbing
  • Itching

Spider veins and varicose veins are easy to spot and easy to treat, but if you’re also experiencing these symptoms in your legs, it could be a sign of a larger, hidden vascular issue,” says Kolluri. “Over time, this can lead to a more serious symptom of edema or swelling in the legs, discoloration of the skin from iron leaching out of the blood and, eventually, chronic inflammation and wounds on the skin. So, it’s not always simply a cosmetic concern; ignoring a larger problem can ultimately lead to dramatic lifestyle limitations.”

How do you determine whether my vein issue is cosmetic or more serious?

Kolluri says each patient begins with a 30-minute consultation, “where we discuss their symptoms and expectations, and explain what we can achieve, because their treatment needs to be individualized to their specific needs. What you choose is personal, but we give you all the information you need to make an informed choice.”

“If a patient comes in and says they want their spider veins removed and they have no other symptoms, we would do a clinical examination to see if the veins are arising by themselves and not connected to the larger veins called the saphenous veins, and then treat them accordingly,” Kolluri continues. “But if someone comes in with spider veins and HASTI symptoms, then we would investigate with a special ultrasound to see if they have issues with larger veins that require more significant treatment.”

What happens to my body when these veins are removed?

“Spider veins and varicose veins that are visible on the legs are what we call accessory veins. If you bypass or remove these veins with a procedure, the body does just fine,” says Kolluri. “We have lots of veins in our legs, so even if you take these dysfunctional veins out, once they’re gone, the body simply reroutes blood through healthy veins.”

What are the treatment options for spider veins?

For spider veins, he says the routine treatment is called sclerotherapy. “It involves injecting the spider veins with a liquid or foam that scars the lining of the veins and closes them. Then your body absorbs the veins and they begin to disappear over time.” He says sclerotherapy sessions last about 30 minutes, and treatment usually takes one to three sessions, depending on the number of veins. No anesthesia is required.

What are the treatment options for varicose veins?

For varicose veins, the options are more varied, but there are two main types: Catheter-based procedures and noncatheter-based procedures.

Catheter-based: A catheter is a thin flexible tube inserted into the vein through a tiny incision and guided along the vein using ultrasound. “With catheter-based procedures, we have thermal and nonthermal techniques. Thermal techniques use laser or radiofrequency to heat the veins and seal them shut. With nonthermal techniques, we inject a medical-grade foam or adhesive into the vein through the catheter to close it,” says Kolluri.

Both of these catheter-based procedures are performed under local anesthesia in an outpatient setting, which means you don’t need to be sedated, or bring someone to the clinic with you.

Noncatheter-based: For some of the large, twisting varicose veins close to the surface of the skin, using catheter-based procedures could potentially damage the skin with heat, or leave an undesirable visual result from hardening foam or adhesives. In these cases, Kolluri says he can remove the problematic portions of the vein entirely using a procedure called a phlebectomy. “We inject numbing medicine around the varicose vein, make tiny incisions with a scalpel along the vein and use a medical device that’s shaped like a crochet hook to pull the vein out. This is also an outpatient procedure.”

Why should I choose OhioHealth for vein treatment?

Kolluri says what’s even more important than the treatment you choose is the person you choose to deliver it. “At OhioHealth, we have physicians board-certified in vascular disease with years of combined experience on our team. We teach these treatments to physicians around the world. We’re widely published in the field. We approach patient care very scientifically. Very academically.”

He adds that because health systems like OhioHealth are not-for-profit, the providers aren’t compensated on the number of procedures they perform, so they’re not incentivized to perform unnecessary procedures. “I have seen patients who’ve had multiple procedures recommended on both legs when they’ve gone in with one bulbous vein as the main complaint and no other symptoms. The procedures are set up to unnecessarily treat segments of the same vein, rather than the whole vein at once. If someone tells you that you need four or five procedures on your legs at different times, that’s a red flag. Seek a second opinion.”

When should I choose to come in for treatment?

Kolluri says any time is a good time to talk to a vein specialist, “especially if something is bothering you. If it’s the appearance or other symptoms, call a doctor. Everything starts with a simple consultation. You’ll get a clearer understanding of your vein health, and the options you have to achieve the outcomes you want. We’re not here to push a procedure, we’re here to help you make the best decision for your health and happiness.”

Schedule your consultation today for healthier legs by calling the OhioHealth Vein Clinic at (614) 788.3939.


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