Treatment of varicose and spider veins

It was the aim of the annual scientific meeting of the Australasian College of Phlebology to discuss and disseminate the latest ideas on venous pathology and the treatments of varicose and spider veins. I would like to share with you some of the more salient points on what is currently known about venous disease.

We are a cosmetic practice and as such, most people come to see us because they do not like the look of their veins. Spider veins represent the most common type of pathological veins that we encounter. These are typically post-capillary venules (small veins) between 0.1-1mm that are situated in the dermal layer of the skin. Patients also complain about larger blue vessels, these are reticular veins 1-4mm in diameter that lie just beneath the dermis. Lastly we come across larger bulging varicose veins, which are dilated superficial veins that lie in the subcutaneous layer.

Irrespective of the type of veins that we are presented with, the underlying pathology is similar. The function of a vein is to allow blood to return to the heart. In the leg, blood has to flow upwards against gravity. In order for this to take place, there are valves in the veins to ensure that the flow is unidirectional (one way). In susceptible individuals, the vein wall dilates (becomes larger) and the valves no longer work properly. When this happens (we call this an incompetent valve or incompetent vein), the unidirectional flow is no longer possible and back flow occurs. This is called venous reflux. Back pressure then builds up below the refluxing segment, which in turn causes further dilatation of the vein wall and further incompetence. This back pressure will eventually cause changes in the skin and subcutaneous tissue, leading to thickening and discolouration of the skin, and ulceration.

There are many reasons that predispose an individual to the development of venous reflux, such as genetic factors, hormone, pregnancy etc. In any case, venous reflux is more common as people get older, the reason is that the structural components of the vein wall undergo ageing changes, resulting in greater tendency to develop venous reflux.

There are no current means to repair the damaged veins and valves completely. All treatments are therefore ablative in nature. In other words, the damaged refluxing segments have to be removed. One of the most useful and non-invasive ways to ablate an incompetent vein is sclerotherapy. This involves the careful injection of sclerosant into a vein. The way a sclerosant works is that it damages the endothelium (the lining) of the vein, and exposes the underlying collagen within the vein wall. A cascade of events then develop which will result in closure and scarring of the vein. Hypertonic saline (concentrated salt water) was commonly used in the past, however this has been superseded by more effective sclerosant that are less likely to cause complications. These modern sclerosants can either be injected in a liquid form or as foam, depending on the diameter of the veins to be treated.

When a patient comes in to see us at Facial Artistry for their unsightly veins, we take note their areas of concern. We then set about trying to identify any underlying venous reflux that might be leading to these visible veins. Based on the findings, a treatment plan can then be instituted. Due to the nature of venous disease, the visible veins may only be ‘the tip of the iceberg’ and therefore the treatment plan may well be more complicated that what the surface veins would indicate.

Read more about varicose and spider veins.

Request an appointment with Dr Bernard Leung.