By Robin Roberts
You can tell awards season is in full swing by the red carpets, the glamourous gowns, the ropy arms . . . wait, the what? It’s hard to miss the rail-thin arms of celebs such as Madonna, Angelina Jolie and Julie Bowen sticking out of those sleeveless dresses and not wonder, what’s with those big, bulging veins?
Vancouver-based registered dietician Jessica Pirnak says it’s all about body mass. “I think the root cause would be lean bodies with minimal fat and too much exercise,” she says. “Once healthy weight is put on, these bulging veins would probably go away.”
As unsightly as they might be, these voluminous vessels are not a sign of poor health. Quite the opposite, in fact. “Prominent upper extremity veins are, for the most part, simply representative of relatively low body fat,” says Dr. David Szalay, head of vascular surgery at Hamilton General Hospital. “[They’re] healthy, well-functioning veins that do not require any invasive treatment. This is in contrast to lower extremity varicose veins, which are very common and are indicative of incompetent, or leaky, valves. Those veins can be addressed with various surgical and endovenous strategies.”
So let’s take a closer look, then, at those abnormal twisty tubes of blood conveyance, along with their cousins, the spider vein.
What Causes Varicose Veins?
Roxanne Hallgren, RN, BScN, who treats vein abnormalities at her Vancouver clinic, Arbutus Laser Centre, says there are a variety of causes, the most common being genetics. “If one parent had varicose veins then there’s a 33 per cent chance you will,” she says. “If both parents had them, it’s a 90 per cent chance.”
Exacerbating that genetic predisposition — particularly for women, who are most prone to the pesky protuberances — are such natural conditions as ovulation, which Hallgren says dilates and stretches the veins. Pregnancy is also a factor, since it results in 40 per cent more blood volume, stretching the veins beyond their normal capacity. And, according to the Canadian Society of Phlebology (phlebology being the study of veins), varicose veins tend to worsen with every pregnancy.
Standing or sitting for long periods can cause blood to pool in the legs, putting pressure on the valves. As we age, the valves and vein walls weaken, leaving us vulnerable to vein disease. Obesity also puts pressure on leg veins. As for which ethnicity is most at risk, according to the American College of Phlebology, Caucasians have a higher incidence of varicose veins than those of African, Hispanic or Asian descent.
What Causes Spider Veins?
Most often visible on the face or legs, spider veins are the smaller relatives of varicose veins. They’re enlarged red, purple or blue blood vessels at the surface of the skin that branch out in a web-like pattern, hence the name. Contrary to popular belief, bolstered by comedian WC Fields’ famously bulbous red beak, that over-imbibing causes spider veins, the condition is more the result of genetics and lifestyle: sun exposure, smoking, obesity and hormonal birth control all can restrict circulation, causing the vessels to swell or weaken. And, just like varicose veins, your genetic tendency is further exacerbated by pregnancy, weight gain and long periods of inactivity.
How Are They Treated?
Unfortunately, there are no topical creams or medications you can take to zap your oversized arteries. Medical intervention is the only option. Before you undergo any treatment, however, you should first be assessed by a phlebologist. “Make sure the clinic has an ultrasound machine to map out your veins,” advises Hallgren. Mapping allows the practitioners to see the condition of the valves in your veins in order to prescribe the appropriate treatment.
Sclerotherapy is commonly used for spider and medium-sized veins. A tiny needle injects a solution of salt, glycerin and fatty acids directly into the vein to collapse and close it off. This redirects the blood through healthier veins and the old varicose is eventually reabsorbed into the surrounding tissue and fades away so it’s no longer visible. The procedure takes only a few minutes at the clinic, is usually painless, and requires four to six sessions on average. Bigger veins require only one or two, says Hallgren, who estimates she’s performed some 12 million such injections over her 26-year career. Other methods include cryo-sclerotherapy, which uses cool air to numb the skin and is completely painless, and foam sclerotherapy for larger veins, which pumps in foamed drugs that cling to the vein, causing them to scar, harden and close up.
Endovenous laser is a minimally invasive, in-office treatment using heat to zap the offending vein. Hallgren says her colleague at the clinic, interventional radiologist Dr. Michael Martin, “Makes a little puncture just above the knee and feeds the laser fiber right up to the groin [to the damaged vein]. He then freezes the tissue and activates the heat in the laser, which destroys that upper segment. The actual lasering takes about one minute.”
Patients are able to walk right away and can usually return to work the following day.
Endovenous radio frequency ablation is also a minimally invasive alternative to surgical stripping of the great saphenous vein, the longest one in the body, extending from the foot to the groin. Instead of complete removal of the vein, a radio frequency catheter is inserted through a needle to deliver radiofrequency energy, generating heat, which causes the vein to cave in and close off.
Traditional ligation and stripping surgery in a hospital is usually recommended for large varicose veins. An incision is made in the groin to tie off the saphenous vein, followed by more incisions in the leg to insert a wire into the veins, which are then stripped out. Complications can include numbness, swelling and scarring.
Another procedure, ambulatory phlebectomy, floods the area around the vein with anesthetic fluid before making a puncture next to the vein. A small hook is inserted to grab and remove the vein, leaving a barely noticeable scar.
Prevention of Varicose Veins
If varicose veins run in the family, there’s not much you can do to prevent the eventual appearance of these protruding pipes. You can, however, delay their onslaught through:
regular exercise, particularly walking or any activity that uses the calf muscle;
maintaining normal weight to ease the pressure;
wearing compression stockings when standing or sitting for long periods, including on airplanes;
stretching your legs by pointing and flexing your feet, says Hallgren. “The calf muscle pumps the venous blood out of the leg so the more you move the blood out of the leg the less chance you’ll get a clot.”
drinking enough water (two liters a day), as dehydration can cause tissue to retain fluid.
Prevention of Spider Veins
Avoid prolonged sun exposure, and slather yourself with sunscreen when you can’t. Avoid sitting or standing for long periods, crossing your legs or wearing high heels for too long, which can impede blood flow. Tight clothing can also constrict your waist, groin or legs, so loosen up.
Although both varicose and spider veins are relatively common, they can lead to more serious medical conditions, such as blood clots or cancer. “If I see varicose veins in the abdominal area we’re going to question whether the person has a cancerous tumour,” says Hallgren.
Whether unsightly or unhealthy, abnormal veins can be a pain, physically and literally. Forestall genetics and prevent self-infliction by caring for your body, the most important vessel of all.