While spider veins – networks of fine reddish or bluish veins on the ankles, thighs or face – are mainly a cosmetic concern, varicose veins are often a serious medical issue. They are often the natural result of the aging of the blood vessels, but they can be caused just as often by the increased pressure in the veins from overweight and obesity, which themselves are at epidemic levels in the United States.
Varicose veins occur when the veins become weak, thin-walled and stretched-out, causing the vessels’ one-way valves to fail. When some blood improperly flows backward, it pools in the veins, swelling them. The result is veins that bulge out from the legs in a ropy, purplish pattern. The varicosity can make the legs painful, tired, swollen and heavy. Blood clots and skin ulcers can also form.
“The good news is, you have lots of veins, so it’s no problem to remove one or two or even several,” said Edward G. Mackay, a vein specialist who has offices in St. Petersburg and Palm Harbor, Fla. “You have a network of veins and lots of extra circulation.”
The treatments for both varicose and spider veins, which can take just 30 to 60 minutes in a doctor’s office, are comparatively simple – and have become even simpler in the past few years. The older method of vein stripping requires full anesthesia, the recovery time is longer, there is scarring, and there is far more recurrence of the condition than with the new methods.
The doctor first does an ultrasound scan of the affected leg or legs. This finds problems that there may be even in the deep veins, which might be causing the surface-vein difficulty.
For spider veins, Mackay said, “the gold standard for treatment” is sclerotherapy. Here, the physician injects a solution into the veins that collapses them. They generally fade from view after several treatments over a period of weeks or months. Sclerotherapy costs $200 to $300 a session, but most insurers view it as a cosmetic procedure and won’t cover it.
For varicose veins, a patient can choose endovenous laser therapy (EVLT). In this procedure, the doctor inserts into the vein a long filament tipped with a laser, guiding it with ultrasound to the affected spot. The laser then heats the inside of the vein, causing it to collapse. The destroyed vein shrivels, and is absorbed by the body.
Another option is radiofrequency ablation (RFA). Ablation is the removal of diseased tissue. RFA is just the same as EVLT, except that the filament is tipped with a radiofrequency device to heat the vein wall and collapse the vessel. Endovenous and radiofrequency treatments run about $1,500.
A third procedure is micro-incision phlebectomy. Here, the physician makes several tiny needle incisions and uses a small surgical hook to remove the vein. The incisions are so small that no stitches are needed – but patients must wear pressure stockings for two weeks afterward to ensure proper healing. Phlebectomies cost between $1,500 and $2,000. Ultrasound exams run about $300. Costs for all of these treatments can vary from one locale to another.