Ask the Doctor
Q I have always had great legs, but recently I have noticed some broken threads and what looks like the beginning of a varicose vein. I am in my late 40s, so is this age related? Will I just have to manage it or perhaps have surgery at some point? Also, are there cosmetic procedures that you recommend?
A It sounds like you may have developed spider veins on the legs. Yes, you are right to assume they are commonly seen as we get older. Approximately three in every 10 adults are affected by venous disease, with women being twice as susceptible as men. Varicose veins are often seen in people with jobs that keep them on their feet for prolonged periods. Spider veins get their name from their spiderweb pattern seen on close inspection. They are small, red, purple, or blue blood vessels on the surface of the skin that occur on the legs or even on the face.
Varicose veins are larger blood vessels that have become lumpy, swollen, bulging and/or twisted in appearance.
You do not need treatment unless varicose veins become painful, infected or cause skin changes such as eczema or ulceration. Health insurance companies usually will not pay for treatment when it is simply for cosmetic reasons.
One of the more common techniques involves sclerotherapy. A doctor injects a solution directly into the abnormal vein. The blood vessel is destroyed, becomes fibrotic, and eventually disappears. After sclerotherapy treatment, spider veins generally disappear in three to six weeks, while varicose veins can take three to four months to respond. Potential side effects include skin discolouration, or the formation of new, superficial tiny blood vessels. Treated veins do not reappear, however, you will probably continue to develop new spider veins at the same rate as before.
Some people opt for a less invasive but often slower to see results treatment in the form of laser therapy and intense light pulse that destroys tiny spider veins and small varicose veins with heat. The heat causes scar tissue to form, which closes off the vein. Side effects may include minor discomfort in the treated area, skin discolouration, and the formation of blisters.
Endovascular (going into the vein) repair involves using energy either from high-frequency radio waves (radiofrequency ablation) or lasers (endovenous laser treatment) to seal the affected veins. Both procedures involve having a catheter inserted into your vein and using an ultrasound scan to guide it into the correct position. Once inside the vein, the laser or high-frequency radio waves delivers heats to the vein until its walls collapse, closing it and sealing it shut. Once the vein has been sealed shut, your blood will naturally be redirected to one of your healthy veins. Both procedures can be carried out under local or general anaesthetic. Afterwards, you may feel tightness in your legs, and the affected areas may be bruised and painful.
Lastly, a new technique called transilluminated powered phlebectomy involves making one or two small incisions in your leg. The doctor places a special light, called an endoscopic transilluminator, underneath your skin so that they are able to see which veins need to be removed. The affected veins are cut before being removed through the incisions using a suction device.
You are likely to experience some pain, bruising or bleeding after all treatments and the cosmetic result may not restore your legs to the fabulous young legs you once had.
Dr Jennifer Grant is a GP with Beacon HealthCheck