Lower Extremity Venous Problems

What are Lower Extremity Venous Problems (spider veins, varicose veins, deep vein thrombosis)?

Venous problems may include spider veins, varicose veins, and deep vein thrombosis (DVT). 

Spider Veins 

Spider veins are small red or purplish dilated end vessels. Spider veins, or telangiectasia, are usually found on the legs and sometimes on the face. They generally cause no medical issue but are treated for cosmetic reasons. 

Varicose Veins

Varicose veins are bulging, twisted veins that are typically 3 mm or more in diameter. Although varicose veins primarily cause cosmetic concern, they may also cause pain, leg heaviness, fatigue, itching, night cramps, restless legs at night, and leg swelling. 

In severe cases, varicose veins can lead to eczema, inflammation of the skin, or even ulceration of the lower leg. In addition, varicose veins increase the risk for phlebitis, or inflammation of the vein.

Deep Vein Thrombosis

Deep vein thrombosis is a blood clot within a deep vein, usually occurring near a venous valve. If left untreated, deep vein thrombosis can cause permanent damage to the vein wall and the valve. Damage to the vein wall and valve can cause reflux, or the backward flow of blood, and congestion. 

At Yale Vascular Surgery, we offer the widest range of treatment and management options for a variety of lower extremity venous problems. In addition to being well-versed with the traditional or classic techniques and surgeries, many additional procedures offered by our innovative surgeons are at the leading edge of vascular surgery. Our multidisciplinary vascular team works collectively to create personalized treatment plans that provide the best options for each patient, reflecting his or her specific condition and individual needs.

Causes of Lower Extremity Venous Problems

Spider Veins

When a group of blood vessels near the skin’s surface dilate and create a red or purple group of veins, it is referred to as “spider” of veins. There are two basic patterns of spider veins. The first pattern forms the spidery looking vein formation as a group of veins radiate outward from a central point. In the second pattern, there may be a single vein or a few separate linear lines. There is an association between spider veins and the hormone estrogens and pregnancy. The condition also tends to run in the family. 

Varicose Veins

When the walls of a vein are weak and bulge and twist, the condition is called varicose veins. Varicose veins occur when the veins continually overexpand because the valves fail to close properly, causing blood to spill backwards, resulting in more pressure on the valves below. 

Deep Vein Thrombosis

When blood does not flow properly, a clot (thrombosis) may form. There are many reasons why blood may stop flowing properly, which include: 
  • Immobility: being immobile for long lengths of time causes the blood flow to slow. Therefore, situations that may heighten the chance for developing a blood clot include prolonged sitting, hospitalization, postsurgical recovery, trauma to the lower leg, pregnancy and postpartum healing time, and obesity. 
  • Hypercoagulability: if blood coagulates, or clumps, faster than usual, the risk for developing a blood clot increases. Some factors that may cause the blood to clump faster include certain medication (especially birth control pills and estrogen), smoking, genetic inheritance, polycythemia (an increased number of red blood cells), and cancer. 
  • Trauma to the vein
  • Leg fractures
  • Bruised leg
  • Complication of an invasive vein procedure

Symptoms of Lower Extremity Venous Problems

Varicose Veins
Symptoms of varicose veins include: 
  • Bulging, unsightly veins
  • Eczema (dermatitis) or other skin irritations
  • Pigmentation changes
  • Swelling (edema)
  • Tiredness or achiness in the legs, especially when standing for long periods
  • Heaviness
  • Skin irritation
  • Swelling symptoms 
Deep Vein Thrombosis
  • Blood clots in the superficial (not deep) venous structures
  • Redness
  • Warmth
  • Tenderness 
  • Swelling

Treatment of Lower Extremity Venous Problems

Treatment for venous issues depends on the specific condition. Whether you have spider veins, varicose veins, or deep vein thrombosis, our surgeons will take the time to discuss the treatments available and help determine the best for option for you. Before any treatment, our surgeons will review your plan with you, in detail, so that you know what to expect before, during, and after the procedure. 

Spider and Varicose Veins

All treatments for varicose and spider veins are minimally invasive and can be performed as an outpatient procedure.

Treatment options include cutaneous laser treatment, sclerotherapy, ambulatory phlebectomy, endovascular laser therapy, and minimally invasive vein surgery.

Cutaneous Laser Treatment
Cutaneous laser treatment eliminates spider veins with high-intensity laser beams targeted at the veins. This procedure may be combined with sclerotherapy for optimal results. 

Sclerotherapy
Sclerotherapy is used to treat spider and small varicose veins. During this procedure, the veins are injected with a solution that causes the affected veins to close. Blood flow is taken up by the healthier veins. This procedure may be combined with cutaneous laser treatment for optimal results. 

Ambulatory Phlebectomy
Ambulatory phlebectomy requires tiny incisions along the path of the enlarged varicose vein in order to remove it. A phlebectomy may be combined with endovascular laser management to remove the veins with minimal scarring. 

Endovascular Laser Treatment
Endovascular laser treatment is a minimally invasive technique used to treat varicose veins using a thin laser fiber, guided by ultrasound, into the vein. The vein is then heated with laser technology. This procedure has replaced the previous technique to remove veins, referred to as “vein stripping.” 

Minimally Invasive Vein Surgery (Stripping and Ligation)
Our surgeons offer minimally invasive stripping and ligation procedures for varicose veins. 

Vein ligation and stripping is used to remove a damaged vein and to prevent complications caused by varicose veins. When several valves in the vein are severely damaged, minimally invasive surgery can be used to remove (strip) the vein. A small incision is made below the vein and a flexible instrument is threaded up the vein so that it can be grasped and removed (stripped). When the vein does not need to be removed, the damaged valve(s) in a vein can be tied off (ligated) in a procedure called ligation. 

Deep Vein Thrombosis

In most cases, deep vein thrombosis is treated with blood thinners or anticoagulants (used to break up a clot). Surgery may be used for patients who cannot take blood thinners or for patients who have developed blood clots while taking an anticoagulant.