Let’s look at four typical patients that we routinely treat— those with varicose veins, spider veins, recurrent varicose vein disease, or restless leg syndrome:
Patient #1: Varicose veins
Patient #1 is about 40 years of age, and had a mother and grandfather who had vein stripping surgery in the past for varicose vein disease. At the age of 20 they noticed that some small varicose veins had appeared on their inner, lower legs. Over the course of the next twenty years, the veins slowly increased in size and extent.When patient #1 got up in the morning, their legs would feel fine and there would not be any swelling. After several hours on their feet, the legs would start aching and feel heavy. They would notice that walking—as opposed to just standing—would help relieve the discomfort. Indeed, they would be able to walk for blocks and their legs would feel better; but as soon as they either had to stand in one location without walking, or sit down for prolonged periods, the legs would start aching again.
Whenever they would be able to either sit down or lie down and elevate their legs, the discomfort would immediately improve. Over the course of the day, as they kept on their feet, their ankles and lower legs would start swelling; and any varicose veins they had would become distended and perhaps slightly tender. They would probably notice some bluish discoloration or “venous congestion” in their lower legs.
While laying down and elevating the legs would relieve the aching and heaviness, and improve the swelling, they would discover that their standing discomfort was replaced with a different type of pain—cramping in their legs that at times could become severe. In addition, they could be wakened from a sound sleep by their legs suddenly jerking (restless leg syndrome). Finally, they would also wonder why they now needed to get up several times a night to urinate—when previously they never had to get up more than once.
Not all vein patients will have all of these symptoms, and some patients may have symptoms such as these that are caused by other conditions. Some vein patients may have other types of pain.
One thing common to all vein patients, however, is the response to wearing compression stockings. As a rule, the venous insufficiency symptoms will improve if surgical compression support stockings are worn. The stockings themselves may be hot and uncomfortable, and difficult to put on and wear—but they will decrease the severity of the symptoms caused by venous insufficiency. While the symptoms will improve, it is unlikely that wearing the stockings will eliminate the symptoms completely.
Patient #2: Spider veins
Patient #2 is a female, also about forty years of age. In contrast to patient #1, she does not have ropey veins in her lower legs, but does have spider veins located on both legs. She may have first noticed the spider veins just a few years ago—or may have first noticed them, much to her dismay, when she was a young teenager. Every few years she noticed a new patch would develop—perhaps on the lateral thighs or calf, or posterior calf. Probably the spider veins she disliked the most were the ones located around her ankles that were obvious when she wore anything other than full length dresses or pants.These would not be particularly painful, although on occasion she would notice burning pain in the areas where the spider veins were located. Unlike patients who have disease of the larger veins, she would not experience unusual aching, heaviness, or tiredness of the leg.
Spider veins are known to be associated with several conditions, but their exact cause is subject to debate. This condition almost never occurs in men.
Patient #3: Recurrent varicose vein disease
Patient #3 is a lot like patient #1—only ten to twenty years older, and several vein procedures later.
Vein stripping scars in red
At some time in the past they may have had the archaic and somewhat brutal procedure known as a vein stripping. They may have had other venous treatments, such as a ligation of the great saphenous vein, sclerotherapy, or surface laser treatment. They may have even had venous ablation treatment with either a laser or radiofrequency catheter. Whatever type of treatment they have had in the past, the present result is the same. The veins and symptoms they once had have returned, and returned with a vengeance.
One particular type of surgical intervention—the high saphenous vein ligation-–by itself can actually make the venous problems become worse after several months of temporary improvement. Recurrent vein disease is not at all uncommon—studies have shown that five years following a vein stripping, about 20% of patients will have developed recurrent veins. This percentage jumps to 60% twenty years after the procedure. More modern procedures, such as thermal ablation and sclerotherapy, also can be associated with recurrence rates if the patient does not receive appropriate follow-up. Fortunately, with appropriate follow-up care, the recurrence rate at five years can be reduced to nearly zero.
Patient #4: Restless leg syndrome
Patient number four may have disease of the larger superficial veins such as patient number one, they may have scattered spider veins such as patient number two, they may have both large diseased veins and spider veins, or they may have no obvious vein disease at all.
However, they do have the symptoms of restless leg syndrome (RLS), which typically occur at night; and include the sensations of creeping, crawling, pulling, tingling, or bubbling along the skin. They also have an almost uncontrollable urge to move their legs or get up and walk. Walking tends to relieve the symptoms. These symptoms frequently cause sleep disturbances. As a result of sleep deprivation, they are also prone to problems with anxiety, depression, confusion, and slowed thought processes.
The cause of restless leg syndrome is not known; and until recently, at least, there was no known cure for the condition. It is known to be associated with certain diseases, such as Parkinson’s disease, peripheral neuropathy, diabetes, iron deficiency, and the use of certain medications.
There are a number of psychoactive drugs that can be used to minimize RLS, such as Pramipexole (Mirapex), Ropinirole (Requip), Sinemet, Gabapentin, Pregabalin, and various tranquilizers. Unfortunately, these drugs frequently cause undesirable side effects.