Vein Disorders and Diagnosis
What are spider veins?
Spider veins, also known, as telangiectasias are dilated tiny blood vessels near the surface
of the skin. They can have a variety of appearances and are mostly commonly found on your
legs. They can look like threads, stars or webs and can have a variety of colors ranging from
red, pink, bluish and purple. Spider veins can range in sizes from very small to larger network
of veins.
What are varicose veins?
Varicose veins are larger blood vessels than spider veins. They often appear to bulge and
may have a tortuous, ropy appearance. They are typically bluish in color and are deeper than
spider veins. Varicose veins develop gradually and are usually painless unless complicated.
In many cases, they may be unsightly and can cause symptoms. Amongst a variety of
symptoms, common ones include: Fatigue, tenderness or aching of the legs, night cramps,
swelling around the ankles, skin changes and ulcers. Symptoms may vary from day to day.
Varicose veins may progress with worsening symptoms and go on to cause complications
such as, inflammation and clot in the veins, or ulcers.
Causes of varicose veins
There are many factors that contribute to varicose veins. A strong family history may predispose
us to having varicose veins. Being female increases our likelihood of having varicose veins
when compared to males. That ratio can be as high as 4:1. Along with being a female,
pregnancy may cause varicose veins to appear due to a variety of reasons including hormonal
changes and pressure of the growing womb. Most varicose veins after delivery disappear.
OOther factors may include advancing age, having a standing occupation and being overweight.
Progression of varicose veins
Varicose veins and spider veins will not disappear spontaneously once formed. They usually
progress to worsen. Veins keep their integrity by having one-way valves that help the blood
to be pumped back to the heart. Once varicose veins form, the valves are no longer
functioning and blood tends to pool and veins get larger as they accumulate more blood and
are unable to effectively return back the blood. This causes the veins to stretch and their
valves become ineffective. In the majority of cases, varicose veins do not progress rapidly
but in some they worsen and may cause painful ulcers and skin discoloration with swelling
around the ankles.
How are varicose veins diagnosed?
In the majority of cases, a comprehensive history and clinical examination will be more than
sufficient to establish the diagnosis of spider and varicose veins. An office duplex ultrasound
may help guide our clinical judgment in documenting valves that are not functioning or 'reflux'.
A duplex study, which is performed in the office, helps us map the varicose veins and any
underlying refluxing veins we are not able to tell by the naked eye and exam. Ultrasound is
an adjunct used in the office which takes anywhere between 20 and 30 minutes to perform.
