Dr. Kathylee Santangelo, M.D.

Simply, no. Being overweight exacerbates your varicosities; however, the underlying reason you have them is the excessive pressure and backward flow in them. I see many patients who are in their ideal weight range for their height and whose BMIs are in the normal (or even low) range, who have symptomatic varicose veins. See a vein specialist to get informed about your varicose veins.

Varicose vein procedures are mostly minimally invasive, performed in an outpatient or office setting, and take about 1 hour to perform. Pain is an experience that is difficult to gauge; however, most of the patients treated with the newer technologies of thermal ablations or microfoam ablations have very limited periods of pain during the procedure (most of the time limited to the 3-5 minutes it takes to get the numbing medicine in the skin to surround the treated vein). Once this part of the procedure is through, you should not feel any pain whatsoever so if you do, you need to alert your physician. If you are having your varicose veins surgically removed, you may want to investigate the lesser invasive options available today. If you are scheduled for an ambulatory microphlebectomy, you should receive enough anesthetic that there should be minimal pain. Best of luck to you! Remember, communicate with your physician about your concerns. For the most part, it should be a gratifying procedure with little real pain!!

Varicose veins are superficial veins that are larger than usual. Compression socks are designed to exert an external force on the leg and depending on the strength of the compression can reduce the size of and the pressure in the varicose veins while the socks are being worn. Gradient compression socks are manufactured to squeeze tighter at the foot and ankle and to squeeze less tightly as they go up the leg. This "helps" the blood flow out of the leg back to the heart. Properly fitted and proper gradient compression socks can alleviate some of the swelling, aching pain, heaviness, and fatigue in patients who have varicose veins of the legs. They will not cure the varicosities and as soon as the socks are removed and you stand up, the varicosities will bulge again and can cause symptoms. That's why it is important to wear the compression socks from the time you get out of bed to the time you get back in bed (that way your veins don't have a chance to bulge and cause problems). The short answer to your question is YES, compression socks help the symptoms of varicose veins AND they do not cure or resolve your varicose veins.

KathyLee Santangelo, MD

The most common methods for treating spider veins are laser and injection sclerotherapy. With laser treatment, the laser specifically targets the hemoglobin in these small, superficial blood vessels. The light of the laser needs to be focused on each millimeter of the "red" line on the skin where the spider appears. This light energy can feel like a rubber band "zapping" your skin multiple times. Laser treatment of spider veins can be performed with numbing medicine on the skin to make it less uncomfortable. It almost always takes multiple sessions of the same spider veins before they are completely gone so it can be rather expensive. There are few side effects when performed by an expert. Injection sclerotherapy uses a tiny needle (similar to that used to administer Botox) to deliver a medicine that "shuts down" the red vein. The medicine can fill an entire length of the spider vein so there may be fewer needles with sclerotherapy than laser "zaps." The medicine works to close the tiny vein down and it thus becomes a thread that is no longer filled with blood and no longer appears red or blue. Injection sclerotherapy usually takes multiple treatments of the same veins and causes some inflammation immediately afterwards that makes the veins look worse rather than better for a week or so. Injection sclerotherapy usually is less expensive than laser treatment. Contact your nearest vein specialist to review your options for treatment and their risks.

KathyLee Santangelo, MD

About 20% of patients who see spider veins on their legs have an underlying venous disease as their cause. Compression socks may be helpful for such patients as gradient compression can alleviate the swelling, heaviness, achiness, and fatigue of underlying superficial venous reflux disease. If you haven't seen a vein specialist to have an ultrasound, you may want to book an appointment with one. For patients without underlying venous disease, compression socks are not "helpful". There are treatments for spider veins including injection sclerotherapy and laser. Again your local vein specialist will advise you on the best treatment for yours.

Not at all. Spider veins are unsightly but not dangerous.

Anything that contracts the calf muscle (which activates the calf muscle pump) will be helpful to patients with swelling in their legs from varicose veins. There aren't any natural remedies for varicose veins; however, as your body resumes its normal pre-baby state, you may find that many of your varicosities resolve. This is due to the blood volume, hormone, and pelvic content changes that occur during your pregnancy and as these conditions normalize again, some, if not most, varicose veins may disappear. Elevating your legs routinely every 4 hours or so during the day will relieve the pressure in the varicosities as well and wearing gradient compression socks will help with the swelling and can prevent skin problems. If they persist and cause symptoms, you will enjoy your next pregnancy more if you have them treated before that occurs as they will likely become even worse with the next one.

I suspect there are creams "available" for varicose veins; however, I cannot say that there are any that are clinically effective. If you think you have varicose veins, search your area for a vein specialist who performs either free screening exams or free consultations and find out. You will be better informed and get some ideas about the treatments offered in your area.

Untreated varicose veins usually progressively worsen, either by getting bigger or by extending down the leg. The underlying problem is usually malfunctioning venous valves and if this occurs in your great or small saphenous vein, this problem can lead to bigger problems like discoloration of the skin, eczema, or even venous ulcers or open wounds most commonly on the inner ankle. A venous ultrasound is a simple, noninvasive test that will determine whether or not your varicose veins are related to a valve problem in your saphenous veins and your local vein specialist will have a variety of treatment methods for you to consider if they are.

There are many excellent solutions for varicose vein treatments currently and more on the horizon. The more commonly used minimally invasive techniques include catheter ablations using heat, chemical ablations using sclerosants (medicines), technologies that use combinations of these, and a medical glue. These procedures all work to close the varicose veins in your legs without removing the veins so there are no scars or surgery. The veins go from hoses that carry blood in the them (very ineffectively) to threads eventually that are not detected on the surface of your skin. The blood flow out of your legs is maintained in perfect condition by your deep veins as the varicosities are in your superficial system. Check with an accredited vein center or a board certified vein specialist for the option that is best for you.

KathyLee Santangelo, MD

Varicose and spider veins often occur during pregnancy due to your body's increased blood volume, hormone changes, and your growing baby sitting in your pelvis. Many women report that their varicosities resolve after delivery. For others, the changes in their legs don't. During pregnancy, wear at least 20-30 mmHg gradient compression socks to prevent the varicose veins from worsening, elevate your legs routinely during the day, and walk at least 30 minutes daily. Most vein specialists would advise against any treatments during pregnancy and until at least 6 weeks post-partum because during theses times and immediately after you give birth you will have a higher risk of developing blood clots with any treatments.

KathyLee Santangelo, MD

Unlike varicose veins or vulvar veins that occur during pregnancy and often resolve following delivery, the spider veins that appear during pregnancy often do not resolve. The options for treatment include injection sclerotherapy and laser treatments. Both treatments are effective yet both types will likely require multiple sessions. Both are mildly uncomfortable and could lead to some discoloration of the skin afterwards. The number of treatment sessions with laser therapy is usually higher than with injection sclerotherapy. To have the best results with either, you may choose a vein specialist who is experienced with these procedures. Check out the AVLS (American Venous & Lymphatic Society) website or a provider who has certification with the ABVLM (American Board of Venous & Lymphatic Medicine). AND, you should know, if you made spider veins with this pregnancy you will almost certainly make more with your next!!

KathyLee Santangelo, MD

Varicose veins can sometimes seem to resolve after delivery. With pregnancy, the extra circulating blood volume in your veins, the changes in your hormones, and the usual weight gain, varicose veins may be more evident on your legs or in your vulvar area. These veins may "decompress" after delivery yielding a much less engorged look to your veins although if you intend to become pregnant again, they will likely reappear and seem worse. Sometimes the veins do not improve so much after delivery and this signals that there may be other reasons for them. If yours persist after delivery and they are present on your legs, consider seeing a vein specialist for a comprehensive examination and an ultrasound examination. These will help determine your best options for treatment which could include laser treatment, injection sclerotherapy, radiofrequency ablation, or foam/chemical ablation. Finding a vein specialist who is either board certified (ABVLM- American Board of Venous & Lymphatic Medicine) or a member of the AVLS (American Vein and Lymphatic Society) should improve your chances of having an expert opinion about all the options and an excellent recommendation for your best option. If your varicosities persist in your vulvar area after delivery, injection sclerotherapy may be your best (and only nonsurgical) option. Again, a vein expert is likely to be very helpful to you.

KathyLee Santangelo, MD

Spider veins on the face may be treated with Intense Pulse Light (IPL) or injection sclerotherapy depending on their size and the preference of the patient. IPL treatment is similar to laser light (although it has multiple wavelengths) and involves having a gel applied to the site and then the light energy. Typically, these spider veins require multiple treatments and it is not expected that one treatment will resolve the problem area. Injection sclerotherapy can be performed and is usually very effective for larger caliber spider veins of the face. Check with your local vein specialist about facial spider vein treatments in your area.

KathyLee Santangelo, MD

Spider telangiectasias (commonly known as spider veins) can be treated in nonsurgical ways including injection sclerotherapy or laser therapy. Both procedures are nonsurgical. Injection sclerotherapy uses a medicine directly administered into the culprit tiny veins with a very small needle. The medicine causes the vein to collapse and become a thread through which blood can no longer flow. Laser used light energy to "zap" the blood cells in the veins and cause a similar process to occur. Both types of treatment will almost certainly require multiple sessions. Look for a vein specialist who is certified by the American Board of Venous and Lymphatic Medicine to perform your treatments or an IAC accredited Vein Center for the most expertise.

Atrial fibrillation does not have to hold you back from having sclerotherapy by a trained vein specialist. Spider veins are not general "removed," but are treated with either laser energy or radio frequency energy or an injectable medicine called a sclerosant that seals them shut. Be sure to inform your specialist about your atrial fibrillation and the medicines you are taking for it (and all medications you are taking).

KathyLee Santangelo, MD

Yes, spider veins on the face can be treated in several ways including laser energy, injection sclerotherapy, and radiofrequency energy (VeinGogh or VeinWave). Locate a vein specialist or dermatologist in your area and contact the office to ask which types of treatment are offered. Consider an office where all 3 are available as that will provide you with the best options. Your face doesn't need them so go get rid of them!

KathyLee Santangelo, MD

Varicose veins vary in size and degree of symptoms. For smaller veins that cause little, medications called sclerosants can be injected into the veins. This usually can improve their appearance. For larger veins, getting an ultrasound and identifying the source of the problem is the best course of action. With a normal ultrasound, injections of sclerosants can clear almost all varicose veins. If your sister has an ultrasound that identifies any reflux disease as the source of her varicosities, a vein specialist can discuss with her the options of injection of Varithena which does not require any surgery at all or performing an endovenous laser or radiofrequency ablation of her refluxing superficial vein. Go to the American Board of Venous & Lymphatic Medicine's website (abvlm.org) and find a board certified vein specialist to evaluate your sister.

KathyLee Santangelo, MD

Blood clots in the deep veins (most commonly the legs) can be diagnosed clinically with a good history and an ultrasound test, which is about 99% accurate and sensitive. The ultrasound is a noninvasive test that involves jelly on your leg (just like the jelly on the belly test pregnant women have) and allows us to see the superficial and deep veins of your leg and see if there is any obstruction (clot) in them. Your doctor may perform a blood test (called a d-dimer). If the d-dimer is negative (or normal), you do not have a deep vein blood clot.

KathyLee Santangelo, MD

Raynaud's disease is a vasospastic disorder of the small blood vessels of the fingers or toes. Generally speaking, it is not treated with any surgery. It can respond to treatment with some medications including calcium channel blockers or migraine medications. Reducing stress, nicotine, and exposure to cold all can help with the discoloration and spasm of the small blood vessels in the extremities.

KathyLee Santangelo, MD