Audrey Rosinberg, MD, spends a lot of her time debunking myths about varicose and spider veins. For example, many people still believe you can get them from crossing your legs. While she does counsel about prevention, Rosinberg is also an expert at getting rid of them for once and for all. More than just a cosmetic issue, these veins can greatly impair an individual’s quality of life and also cause pain and problems with mobility.
The good news is that treatments are far less invasive than ever before, explains Rosinberg, a vascular surgeon at Union Square Laser Dermatology in Manhattan. She is board certified in both general and vascular surgery. Rosinberg took some time to chat with Beauty in the Bag about this unique niche.
What causes varicose or spider veins?
There is a strong hereditary component to varicose veins. In addition to genetic predisposition, age, pregnancy, and obesity all contribute to the development of varicose veins. People in occupations that require standing or sitting for long periods of time such as a hairdresser or a surgeon may also be at increased risk from developing varicose veins and would likely benefit from wearing compression stockings on a regular basis. Contrary to popular belief, there is no scientific evidence that crossing one’s legs leads to varicose veins.
Do they occur in men or just women?
Both men and women are affected but there is a higher incidence in women. A large population based study reported the annual incidence of varicose veins to be 2.6% among women and 1.9% among men. Although not clearly defined, the incidence of spider veins is thought to be much higher.
Are vein disorders cosmetic, medical, or both?
Vein disorders can range from cosmetic to serious in nature. Spider veins are nearly always cosmetic in nature and do not pose any serious medical risks. For the vast majority of patients, varicose veins are cosmetic in nature as well. A small percentage of patients will have symptomatic varicose veins with symptoms ranging from pain, tenderness, itching, and bleeding to much more serious complications involving, darkening of the skin with stasis dermatitis and ulcers that are difficult to heal and infections. Phlebitis can also be seen in patients with varicose veins and these clots can then propagate to the deeper veins that can cause deep vein thrombosis and even fatal pulmonary emboli.
How do vein disorders affect quality of life?
Even cosmetic spider veins and varicose veins can affect a patient’s quality of life. Lower limb varicose vein disease is estimated to be the 7th most common reason for physician referrals in the US. Many women are self-conscious of their legs due to the presence of spider veins and may be embarrassed to wear shorts or skirts in the summer. They may be reluctant to enjoy outdoor summer activities like a day at the beach or the pool. Quality of life scales are used to measure disability due to varicose veins. Chronic venous disease has been shown to impact quality of life due to pain, decreased mobility, and limited activities of daily living. The impact increases with increased disease severity. In these patients, quality of life scores improve dramatically with treatment of the underlying venous reflux and varicose veins.
When is the best season to treat vein disorders?
Fall, winter, and spring are the best times to treat your veins. Whether you have large bulging varicose veins or just a few spider veins, we recommend that compression stockings be worn for two weeks following treatment to maximize the cosmetic outcome. In addition, tanning and sunlight should be avoided for six weeks following the procedure to minimize the chances of skin discoloration. Most people don’t want to wear compression stockings during the hot days of summer. Some bruising and discoloration can result from the treatments and these often take several weeks to fade, which is not ideal during shorts and swimsuit season. The maximal effect of fading of the veins is seen 6-12 weeks after sclerotherapy, so if you want to see the results in time for summer, you really need to start in winter as most people will require several sessions of sclerotherapy to cover all of their veins.
What is the greatest advance in treating varicose veins?
The greatest advance in the treatment of varicose veins is the development of endovascular technology. Varicose veins result from increased pressure in superficial veins due to incompetent valves in the underlying saphenous veins resulting in reverse flow or reflux. To treat the varicose veins effectively, the underlying saphenous veins need to be evaluated with ultrasound and if they are found to be the source of the varicose veins, traditionally, the veins were stripped. This required general anesthesia and caused significant discomfort, bruising, and swelling. If the underlying refluxing saphenous veins are not treated, the increased venous pressure will find other escape paths and new varicose veins will form. With the approval of endovenous thermal ablation techniques in 1999 and 2002, the treatment of varicose veins was revolutionized. Local tumescent anesthesia is administered around the vein and a fiber is then placed inside the vein using a small needle. Energy is used to generate heat and the vein is closed by heating it from the inside. The energy source can either be a laser or radiofrequency. Both work equally well in closing the veins. The entire procedure takes about 20-30 minutes and the patient is ambulating and ready to go home 20 minutes after the procedure is finished. In experienced hands, the procedure is very safe with a low incidence of complications.