Everything You Need To Know About Varicose Veins, Spider Veins And Vein Treatments

What are varicose veins?

Healthy veins do one job: move blood back to the heart for reoxygenation. But when the one-way valves that carry out this task become faulty (what’s called chronic venous insufficiency), blood can flow backward and pool in veins—rendering them progressively more swollen, or varicosed. Varicose veins tend to develop in people over 50, after pregnancy, in the obese, if you have a genetic disposition or an occupation that requires long periods of standing.

Is it possible to prevent them?

Short answer: not if you’re predisposed. “If one parent has varicose veins, you have close to a 50 percent chance of getting them. If both parents have them, you have a 98 percent chance,” says Alexander Matz, a general surgeon and founder of Canada Vein Clinics, which has locations in three provinces. “I don’t believe you can completely prevent them—but you can delay them.” Steps you can take include exercising, keeping body weight in check and wearing compression socks.

What’s the difference between varicose and spider veins?

Varicose veins bulge from the skin, and are visibly enlarged, lumpy and twisted, while spider veins resemble a tangle of thin, flat lines. Despite distinct appearances, the two conditions sometimes share a common cause: chronic venous insufficiency. Superficial spider veins tend not to cause the same discomfort as full-on varicose veins. Liquid sclerotherapy is the most common treatment to make spider veins disappear.

What are the health risks of varicose veins?

Varicose veins will worsen if untreated—and the complications can be severe. They can rupture and bleed, and lead to skin ulcers and blood clots. Deep vein thrombosis, a clot that can break loose and cause a pulmonary embolism, can be fatal.

What are the treatment options for varicose veins?

Procedures for varicose veins have similarly high success rates (around 90 percent or greater), but the most suitable treatment will depend on the size of your problem veins and your pattern of blood flow. “There’s no ‘one size fits all,’” says John Chung, an interventional radiologist and medical director at EVA Vein Care in Vancouver. “Mid- to late-stage chronic venous disease may require multiple types of treatment.” Expect to undergo an assessment, typically involving an ultrasound exam and/or other imaging. Here are the five most common treatment options.

1. Vein ligation and stripping

This is an old-school treatment and not as popular as new, minimally invasive procedures. A vascular surgeon will make an incision in the leg, find the abnormal veins, tie off any branches and pull the abnormal veins out of the legs. Although very invasive, it’s considered minor surgery and done under anesthesia in hospital; most patients return home the same day.

Risks: bruising, scarring, pain, nerve injury, longer recovery time (usually two weeks). Typical cost: Usually covered by provincial insurance, if patients have two or more symptoms of serious varicose veins.

2. Sclerotherapy

Spider veins and small varicose veins can be injected with liquid sclerotherapy. A sclerosant, a detergent-type material, causes the inner lining of the veins to scar shut. For larger veins, sclerotherapy can be done with a foam agent, though many clinics won’t offer this approach because the foam can travel unexpectedly and increase the risk of heart attacks and strokes to patients. Depending on how many veins require treatment, the procedure can take five to 30 minutes. Risks: bruising, scarring, allergic reaction. Skin discolouration, or post-inflammatory hyperpigmentation is the most common side effect and can take up to a year to fade (in rare cases, it may be permanent). Typical cost: $300 per session; more than one may be needed.

3. Radiofrequency ablation

Radiofrequency energy, directed into the varicose vein via a thin catheter, is used to heat up and cause damage to the vein walls. This prompts scar tissue that closes off the diseased vein. The procedure usually takes under an hour. Risks: skin burns, nerve damage. Typical cost: $2,500-plus.

4. Endovenous laser treatment

This technique is similar to RFA, except that laser energy is used to heat up and prompt scarring in the vein. A tiny laser fiber is inserted directly into the vein through a thin catheter, and the procedure, typically done in clinics, is usually over in under an hour. Risks: skin burns from the laser, skin discolouration, nerve damage. Typical cost: $3,000-plus.

5. VenaSeal

A newer treatment option, it was only approved by Health Canada in 2014. After a numbing medicine is applied, a small catheter is inserted and guided along the varicose vein via ultrasound. A medical-grade adhesive is then very slowly injected into the vein while it’s pressed together at the same time, continuing until the length of the vein has been treated. The process, about 40 minutes long, shuts it immediately. Risks: The most common side effect is an allergic reaction to the adhesive, but this is treatable with over-the-counter allergy medications. Phlebitis (vein inflammation). Typical cost: $4,500-plus

Published May 2019. Updated May 2021.