Troublesome varicose veins and capillaries occurring on the legs

Veins are the blood vessels that return blood from the organs and limbs to the heart. If there is a prolonged and recurrent blockage in the blood flow from the lower limbs, symptoms and signs of CVD (chronic venous disease) occur. In addition to varicose veins, which are blue in colour, there are blue-red coloured spider-shaped varicose veins and red capillaries and other signs on the skin.

Varicose veins are dilated, tortuous veins that may bulge above the surface of the skin. They are blue to bluish-purple in colour, several millimetres in diameter. Capillaries are millimetre-wide veins of red colour. In most cases, both types of veins are seen at the same time, which is very disturbing for many people. Often, troublesome capillaries and small varicose veins can be an aesthetic nuisance that does not cause serious symptoms. The appearance of capillaries is also influenced by photo-radiation, hormonal influences and previous injuries.

Treatment can reduce the symptoms of venous disease such as pain, night cramps and heavy legs and prevent the progression of this chronic disease. Capillaries and veins cannot be removed by ‘soft measures’ or creams offered online, in drugstores or pharmacies. They can be removed by medical procedures, which involve a controlled injury to the walls of the varicose veins and capillaries, which are gradually broken down and removed from the venous circulation.

How to recognise chronic vein disease?

Chronic vein disease (CVD) is the most common cause of varicose veins and capillaries in the legs. It starts very inconspicuously and is often overlooked in its initial stages. It is influenced by many causes, from age, heredity, sedentary or standing work to body height. It is important to spot chronic vein disease in time and start treating it properly. Initially, it can be noticed as swelling in the ankle area, often accompanied by a feeling of heavy, tired, even restless legs. Swelling can also occur after exertion, prolonged sitting or standing, in warm weather at the end of the day, etc.

A very common first sign is the appearance of blue veins on the inside of the ankles. Dilated, tortuous veins – varicose veins – can also appear on other parts of the shins, feet and thighs. Some patients experience night-time cramps in the area of the varicose veins on the shins and thighs.

Risk factors for varicose veins include:

• Age, as the risk increases with age. Over the years, there is wear and tear on the venous valves, which affect the flow of venous blood.
• Genetic influences: one parent has an influence of 30 %, both around 60 %, on the likelihood of offspring developing chronic venous disease.
• Gender: women are more prone to varicose veins because hormonal conditions such as pregnancy , monthly cycle and menopause influence the occurrence.
• Pregnancy increases the volume of circulating blood; the hormone progesterone dilates the veins and the weight of the foetus puts pressure on the large veins that drain blood from the legs. The combination of all of these exacerbates or triggers chronic vein disease. The solution is to wear pregnancy compression stockings.
• Obesity has the effect of restricting movement, which reduces the backflow of venous blood and increases the pressure on the vein wall.
• Prolonged standing or sitting has a negative effect on venous blood circulation.

 

Capillaries occurring on the legs and elsewhere on the body can also appear as a result of excessive and repeated sun exposure, smoking, hormonal changes and trauma. Their appearance is not necessarily related to chronic vein disease, as they have many other causes besides those listed above.

Chronic vein disease (CVD) is a progressive disease that has a major impact on the quality of life. Treatment should consider the risk factors that may exacerbate the disease and the most appropriate way – for the patient – to reduce venous pressure in the legs. By adapting a lifestyle with more exercise, we can greatly alleviate the problem and influence the progression of the disease. Compression therapy with stockings or compression bandages, lifestyle and drugs that affect inflammation in the vein wall – venotonics – have a major influence on the progression of the disease.

In the advanced stage of CVD, a shin ulcer occurs, which significantly impacts the quality of life. Complications of ulceration include recurrent bacterial and allergic inflammation, systemic bacterial infection, bleeding from the ulcer.

ADVICE: If dilated veins are suspected to be the result of chronic venous disease, ultrasound of the superficial and deep venous system and treatment of the damaged veins by a vascular surgeon or dermatologist is necessary.

Measures to improve venous circulation and prevent the appearance of new varicose veins and capillaries 

Measures to improve venous circulation and prevent the appearance of new varicose veins and capillaries include regular daily exercise, raising the lower side of the bed by 20 cm, walking with at least 15 steps after 30 minutes of continuous sitting or standing, and keeping the legs at least in a horizontal position when sitting (properly, they should be elevated above the level of the heart, which is almost impossible in practice). Further advice includes avoiding prolonged and repetitive soaking in a hot bath or sauna, avoiding leg therapies based on vacuum action, avoiding repetitive lifting of loads and sports involving running or jumping on a hard surface. Moreover, the measures encompass applying compression therapy, which means wearing of compression stockings – medical classes 1, 2 or 3, or sports compression stockings while performing sport activities. Preventive stockings (outside Slovenia they are known as DEN stockings, with DEN being the weight in grammes of the 9000 m long thread from which the stockings are made) are not intended for the prevention and treatment of chronic venous disease. They can only be used occasionally in people who regularly wear compression stockings for chronic venous disease and would like to give up wearing them for a day.

A staged approach to the treatment of varicose veins and capillaries in the legs

When dilated veins are suspected to be due to CVD, it is necessary to have an ultrasound of the superficial and deep venous system and to treat the damaged veins with a vascular surgeon or a dermatologist who deals with the treatment of advanced chronic venous disease by sclerosant foam under ultrasound guidance, intravascular interventions with lasers, radiofrequency probes, special glue or microwaves. In these procedures, the damaged veins are removed from the circulation. Often, some aesthetically disturbing smaller veins and capillaries remain, which are then removed by sclerosant or vascular laser.

The progression of the disease is strongly influenced by compression therapy with stockings or compression bandages, lifestyle and the use of drugs that affect inflammation in the vein wall – so-called venotonics.

Compression therapy is the cornerstone of successful treatment of chronic venous disease (CVD). With correct and consistent compression therapy, all symptoms and signs of this disease can be successfully treated. Compression therapy can be performed with compression bandages and compression systems and compression stockings.

Compression stockings apply constant pressure to the leg. The pressure is highest in the area above the ankle, then gradually decreases towards the knee or groin. Compression therapy helps venous blood flow towards the heart, reduces swelling, inflammation and cramping and stops the progression of chronic venous disease. The dermatologist will prescribe the type of compression stockings (knee socks, thigh-high stockings, tights) and the level of compression (compression classes I, II, III or IV) based on an examination of the legs and, if necessary, a preliminary ultrasound examination of the veins.

Aesthetically disturbing varicose veins and minor varicose veins that are not related to advanced CVD are removed at the Derma Center Rogaška/Maribor by sclerotherapy or with vascular lasers. Procedures on varicose veins and capillaries cannot cure CVD, as they are only the end result of chronic inflammation of the vein wall, which weakens the vein wall over the years. The effect of sclerosants and vascular lasers on veins and capillaries is temporary, lasting from a few months to years, depending on a number of factors. Repeated treatments and lifestyle adjustments and other measures can reduce the number and/or remove most varicose veins and capillaries in the long term, thus improving the appearance of the legs.

Sclerotherapy of varicose veins

The procedure is used to remove small varicose veins and SPIDER veins. The procedure is most effective in cases where the CVD is not in an advanced stage.

The procedure is carried out as follows:

• The procedure is carried out in the supine position, the skin is previously disinfected with an antiseptic.
• A fine needle is used to inject a sclerosant solution into the vein, causing inflammation of the vein wall.
• The injection is made in several places and the puncture site is immediately covered with a patch.
• No anaesthesia is required as you only feel a slight prick from the needle during the procedure.
• Sclerotherapy causes the walls of the varicose veins to stick together so that blood can no longer flow through them. This improves the circulation of venous blood in the legs and reduces the swelling as well as the symptoms and improves the appearance of the legs.
• The capillaries fade in 3-6 weeks and the varicose veins break down gradually over 3-4 months.
• The best effect of the therapy is achieved after 2 to 3 repetitions of the procedure.
• No time off work is required.

Similarly to vascular laser sclerosant, effectively removed veins disappear permanently, but new veins may appear over time due to the causes listed above under risk factors for CVD.

The vascular laser is used to remove capillaries on the face, neck, chest, trunk, legs and varicose veins up to 5 millimetres in diameter on the legs and feet.

The light from vascular lasers has the ability to be selectively absorbed by the blood pigment, haemoglobin. The vascular laser causes the walls of capillaries and small veins to overheat, leaving the surrounding skin unharmed. The light from the lasers is concentrated in the targeted capillary, and the modified capillary is then broken down and removed from the skin through the blood vessels. Longer wavelength lasers (900-1200 nm) are used for deeper and larger varicose veins and shorter wavelength lasers (532 , 595 nm) are used for thin, superficial red capillaries.

Vascular lasers can be used to remove troublesome veins of all dimensions: the thinnest red capillaries measuring less than 0,5 mm and the common ones measuring 0,5 to 1 mm, as well as broom-shaped varicose veins measuring 1 to 3 mm in diameter.

Before the first procedure on a large area of the legs, a test is carried out 15 minutes before the procedure (or two days before the procedure for darker phototypes), preferably on a less visible area, to determine the individual sensitivity to pain, the skin’s reaction to the vascular laser procedure and to determine the effective energy of the laser beam.

The procedure is carried out as follows:

• Before the procedure, the skin must be cleansed of creams, make-up, perfumes, sprinkles, oil shower gels. Hair must be trimmed, or even better, shaved.
• Before the procedure, the skin should be cleansed with antiseptic fluid and the eyes should be protected with protective goggles.
• The laser head is positioned exactly over the vein to be removed.
• The skin is cooled with cooling gel, cooling gas or a cooled handpiece. However, a stinging sensation is felt, which is more pronounced for larger varicose veins and less pronounced for capillaries.
• During the procedure, the vessel walls shrink and the varicose veins and capillaries treated with the vascular laser are eliminated from the venous circulation in the legs. This eliminates occasional pain in the veins and improves the appearance of the legs.
• The capillaries may disappear immediately after the procedure or become cloudy and not fade on pressure. They break down within a few weeks.
• Varicose veins, which are blue or blue-red in colour, up to 5 millimetres wide, either shrink, turn pale red or darken after the procedure and lose their sharp edge (a sign of the vein wall breaking down). Furthermore, swelling of the vein area occurs, rarely bruising. Over several months, the vein walls gradually break down by the body’s own mechanisms.
• Capillary and varicose vein laser removal is only possible on skin that has not been suntanned.
• Wearing compression stockings after the laser procedure is mostly not necessary. Also, a regular skin moisturiser for skin care can be applied.
• Sun protection is advised after the procedure until the redness of the skin has disappeared. Sunscreen helps to prevent the appearance of excessive pigmentation of the skin at the site of the procedure.
• Year-round sun protection prevents the development of telangiectasias and skin cancer.

The degree of improvement depends on the number of repetitions of the procedure and the individual difference in the expression of varicose veins and capillaries between different individuals. It is necessary to repeat the treatment from time to time to refresh the effect.

The pain experienced during the procedure is similar to that of snapping caused by a rubber band and is more pronounced in larger veins. The removal of thin red capillaries is felt much less. Pain is only present when the laser pulse is applied, it is absent after the treatment. If you have a low pain threshold, please confide this to your doctor, as it is possible to make the therapy bearable by adjusting the delivery of the treatment and certain medications.

Possible side effects and contraindications to vascular laser treatment

You will discuss your suitability for vascular laser treatment with a dermatologist at the Derma Center Maribor/ Rogaška before your first treatment.

Appointments and further information

To book an appointment, contact us Monday to Friday from 8:00 to 16:00 on the following telephone number: 064 12 80 15 or send an e-mail: info@derma-rogaska.si