If you suffer from problems related to varicose and spider veins, you are not alone. It is estimated that more than 8 million Canadians and 80 million Americans suffer from some form of venous disorder.

While some people seek treatment for cosmetic improvement, many seek relief from pain. Help is available.

To understand venous problems, you need to know about the anatomy and physiology of the venous system. You will learn about deep veins, superficial veins, connecting or perforating veins, the venous pump, and the importance of venous valves. If you read the next short section and take a look at the vein diagram (below), you will know more about venous disease than most physicians.

What is the difference between an artery and a vein?
Arteries are thick walled vessels which carry blood from the heart to the periphery.
Veins are thin walled vessels which carry blood from the periphery back to the heart.
There is a third kind of vessel, called lymphatic vessels which are tiny, extremely delicate vessels that carry proteins and lymphatic fluid from the periphery back to the heart.

What are the important veins of the legs?
There are three different kinds of veins in the legs.
The deep veins run down the center of the leg ( dark blue in the picture ).  In the calf there are three pairs of deep veins.
The superficial veins are closer to the skin.  Two have names: the great saphenous vein, and the small saphenous vein. There are short connecting veins between the superficial and deep veins.  These are called perforators because they penetrate the fascia of the leg.

The heart.
The heart pumps oxygenated blood returning from the lung out to the periphery of the body.

How does blood get back from the periphery to the heart?
The muscles of the foot and the calf constitute the "venous pump."  When you walk using your calf muscles and compressing the veins in your feet, the blood is propelled upward toward the heart.  If you sit motionless for a long period of time, such as riding in a car or plane, blood accumulates in your feet, ankles and lower legs causing swelling.

A one way street
As you walk blood is pumped up the veins by the calf muscles.  As you prepare to take the next step, gravity intervenes and tries to pull the blood back down. 
Venous valves are located throughout the veins of your legs to prevent the backward or downward flow of blood (reflux ).  If these valves are damaged or defective, reflux occurs; that means that the blood flows the wrong way down the vein. This is the cause of venous hypertension (high blood pressure in the veins) and the fundamental cause of all the problems associated with varicose veins or chronic venous insufficiency.

The dark blue are the deep veins. The light blue are the superficial veins.

See if you can find a connecting (or perforating) vein*  between the superficial and deep veins.  (Although the artist did not show all of them, normally there are several in the thigh and more in the calf.)

Hint:  Look half-way between the words femoral and popliteal on the right side of the diagram.  The perforating vein is at right angles to the great saphenous vein and is dark blue

Normal Blood Flow After the blood has been replenished with oxygen in the lungs, it is pumped to the body by the heart. Blood that is pumped to the lower extremities is pumped back to the heart partially by the action of the calf muscle pump. The blood returning from the lower extremities in the deep and superficial veins goes past a series of one-way valves. These valves stop the blood from flowing backwards in the veins.

Reflux The valves in the veins close just as blood begins to flow backwards. If the valves do not close properly, the blood falls backwards through the poorly closing or leaking valves. The veins downstream that are now unprotected by valves further upstream are exposed to the weight of an increasingly high column of blood. These downstream veins cannot endure the pressure of the column of blood and expand becoming snake-like in appearance. This causes the veins to bulge through the skin surface and become varicose veins.

Veins, which have one-way valves, channel the deoxygenated blood back to the heart. The one-way valves prevent blood from flowing backward (reflux). If they fail to close properly, blood will leak through the valves and result in pooling. Over time, this pooling will force the vein wall outward resulting in enlargement and bulging of the vein. These enlarged veins are varicose veins. Varicose veins can protrude from the skin surface resulting in a rope-like appearance.

Varicose veins are usually enlarged and unsightly and are often associated with symptoms of discomfort. We take a careful history designed to elicit any of a number of symptoms commonly associated with varicose veins and perform a careful examination to identify any signs of advanced venous pathology.

Common symptoms associated with varicose veins include:

• Aching
• Heaviness
• Tiredness
• Cramping
• Swelling
• Burning
• Itching

Less common signs or symptoms include:

• Restless legs at night
• Leg cramps at night
• Superficial blood clotting (thrombophlebitis)
• Bleeding from a superficial vein after minor trauma
• Unusual rashes or areas of dermatitis

If the condition progresses , you may notice:

• Discoloration of the skin above your ankle (hyperpigmentation)
• Hardening of the tissues above your ankle (dermatofibrosclerosis)
• Skin ulceration

Heredity is the number one contributing factor causing varicose and spider veins. Women are more likely to suffer from abnormal leg veins. Up to 50% of Canadian women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury.

 

Spider veins are small red, purple or blue veins located just below the surface of the skin. They can have a web-like appearance, hence, the term spider vein. Most spider veins have an unattractive cosmetic appearance and, in some cases, may give rise to symptoms of itching, burning, or throbbing of your legs. Another type of vein is the reticular vein, which is bluish, deeper than spider veins, and often "feed" the spider vein. A commonly seen reticular vein is the (lateral) Vein of Albanese. These veins need to be treated or else the spider veins cannot be reliably eliminated.

Heredity is the number one contributing factor causing spider veins. Women are more likely to suffer from abnormal leg veins. Up to 50% of Canadian women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease. It is very common for pregnant women to develop spider veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury.

The most common symptom of spider veins is stinging or itching.  Spider veins result from reticular veins, often called feeder veins, or from improper function of the major leg veins.  If the patient is also experiencing pain and swelling in the leg, a physician may use ultrasound to make a complete diagnosis.

Branch-Like

Linear

Spider-Shaped

The Vein Institute of Toronto also offers safe and effective treatment of facial veins. All patients will start with a personal consultation with our physician. The doctor will then outline the best treatment option for your particular problem. Our physician will then work closely with you as well as the technologist to ensure optimal results are achieved.