Varicose veins can be a source of discomfort and embarrassment for many. Although they can appear anywhere on the body, these enlarged, swollen or vividly coloured veins typically occur on the lower legs. This is because the body needs to work harder to pump blood to the heart from these extremities, often working against gravity. Which is why those who spend most of their days standing or sitting still are particularly at risk of getting varicose veins.
Over time, the valves in the veins that pump blood to the heart can become worn, and blood starts to pool within the vein instead of travelling back to the heart. This is the primary cause of varicose veins.
But how many types of varicose veins are there? And do they have different underlying causes? Here, we’ll take a look at the different types of varicose veins in the legs and elsewhere on the body to help those affected to better understand the condition.
Why it’s important to understand the different types of varicose veins
Varicose veins affect the blood vessels closest to the skin. This is known as the superficial system of veins. Although they look unsightly, they are typically not a threat to one’s overall health and wellbeing. Nonetheless, there are some instances in which varicose veins can cause cramps in the surrounding muscles, pain, and discomfort. This can impinge on a person’s quality of life and interfere with their sleep and relaxation. As such, it’s important to understand which type of varicose vein affects you in order to better understand the potential causes and the treatment options available to you.
With that in mind, let’s take a closer look at the different types of varicose veins.
Telangiectasia varicose veins
Telangiectasia varicose veins are better known as ‘spider veins’. Are among the most common types of varicose veins. They occur when the blood vessels close to the skin (venules) widen, resulting in a spider-web like network of lines appearing on the skin. These are usually red, blue or purple in appearance. They are thinner in appearance and tend to spread outwards on a webbed pattern. As well as appearing on the legs and ankles, they are also commonly found on the face.
Some people may also experience pain and discomfort due to the pressure placed on the venules, and itching of the skin above the vein.
Causes of telangiectasia varicose veins
While unsightly, telangiectasia varicose veins are generally not a threat to a person’s health. However, in some rare cases, they can be caused by serious conditions like hereditary hemorrhagic telangiectasia (HHT). This is where telangiectasia occurs on the vital organs rather than beneath the skin.
Other symptoms of HHT include:
- Frequent nosebleeds
- Shortness of breath
- Blood in stools
- Seizures
- Port-wine stain birthmarks
- Minor strokes
Beyond this, there is no definitive cause, although a combination of genetic, environmental or lifestyle factors can increase a person’s risk of developing spider veins. Chronic exposure to sunlight or extremes of temperature are known to cause telangiectasia varicose veins to appear on the face.
Other potential risk factors include:
- Ageing— As we get older, our blood vessels get weaker, becoming less able to pump blood effectively
- Alcohol consumption— Excessive drinking can affect the flow of blood through the small vessels close to the skin
- Use of corticosteroids— These anti-inflammatory compounds can weaken and thin the skin over time
- Pregnancy— The hormone changes and demands on the body during pregnancy place increased pressure on venules
- Skin conditions— Conditions like rosacea, scleroderma and dermatomyositis can cause spider veins by enlarging venules in the face, or inflaming and contracting the skin.
- Lupus— Lupus erythematosus can make the skin more sensitive to extreme temperatures and sunlight
Treatments for telangiectasia varicose veins
Although they are generally not harmful, many choose to treat telangiectasia varicose veins in order to reduce the severity of their appearance. Fortunately, there is a range of varicose vein treatment options available, including:
- Microsclerotherapy— A chemical agent is introduced to the affected venules to seal them shut
- Laser therapy— Pulses of laser light are used to seal the affected venules shut
- Surgery— In some cases, the affected venules may be surgically removed
Once the affected blood vessels are removed or sealed, the body automatically redirects blood flow through nearby vessels.
Reticular varicose veins
Reticular veins are prominent varicose veins that are vivid in colour, although they are not rope-like or raised. However, they are typically thicker than spider veins, and are often blue or purple in colour. They spread out in a mesh and cover a wider surface area than telangiectasia varicose veins.
They usually occur near the ankles, on the inner thighs or on the backs of knees. While usually merely cosmetic, they can also cause pain and cramps in the lower legs.
Causes of reticular varicose veins
These varicose veins are caused by vascular insufficiency, where the valves are unable to pump blood to the heart and blood begins to pool within them. While virtually anyone can get varicose veins of this kind, you are more at risk if:
- You sit or stand still for long periods of time
- You have a family history of varicose veins
- You are pregnant
- You are overweight or obese
Treatments for reticular varicose veins
Reticular varicose veins can often be mitigated through lifestyle changes. Regular exercise, keeping the legs raised to encourage blood flow and wearing compression stockings can help to improve the blood flow to the lower legs.
However, if these are insufficient to reduce the appearance or discomfort from your reticular varicose veins, there are multiple treatment options available.
These include:
- Microsclerotherapy
- Endovenous laser ablation— An ultrasound-guided laser is pulled through the vein, sealing it shut as it goes
- Radiofrequency ablation— A tiny probe is introduced into the affected vein which emits radiofrequency energy to seal the vein shut (also known as thermocoagulation)
- Surgery— The affected vein is tied off and removed from the body. The procedure is known as a ligation & strip
Saphenous varicose veins
Finally, saphenous varicose veins (also known as ‘trunk’ varicose veins) affect the saphenous veins of the legs. This is the main superficial vein that is associated with varicose veins, and the longest in the body, pumping blood from the feet, legs and thighs to the deeper vein at the femoral triangle. It begins at the ankle and extends all the way up to the groin.
When the valves of this vein fail, blood pools or flows backwards towards the ankle. When this happens, the veins can become distorted and the vein becomes very bulgy in appearance, pushing upwards through the skin. While these veins are not usually discoloured they can become very prominent, and a cause of embarrassment for those affected. In some cases, red or brown patches may appear on the skin above the vein.
In some cases, saphenous varicose veins can lead to pain, discomfort, aching, itching or cramping. Untreated complications from saphenous varicose veins can lead to changes in the skin (including varicose eczema), ulceration or bleeding.
Causes of saphenous varicose veins
Saphenous varicose veins are usually driven by the same factors as reticular and telangiectasia varicose veins. While anyone can get them, your risk is increased if you:
- Have a sedentary lifestyle and spend most of your day sitting or standing still
- Are a smoker
- Are overweight or obese
- Have a family history of varicose veins
- Are pregnant
- Women are also at greater risk, especially during the hormone changes associated with periods
Treatments for saphenous varicose veins
Most of the treatments for saphenous varicose veins involve sealing or closing the vein. After which, the vein is broken down and reabsorbed by the body. In some cases, surgery may be required, although this generally requires greater recovery time and can involve some pain and discomfort after treatment.
Common treatments for saphenous veins include:
- Microsclerotherapy
- Endothermal ablation (endovenous laser ablation or radiofrequency ablation)
- Ultrasound guided foam sclerotherapy— A foam is introduced to the affected vein to seal it shut with scar tissue
- Cyanoacrylate glue occlusion— A specially formulated glue seals the vein shut
- In some cases, a ligation & stripping procedure can be employed to remove the affected vein.
Diagnosing varicose veins and seeking treatment
Unless they experience severe pain or discomfort, many people do not seek treatment for varicose veins. In most cases, the treatment of varicose veins is considered a cosmetic procedure, and therefore not covered by the NHS.
However, a private vein clinic will be able to diagnose the type of varicose veins that you are experiencing and help you decide on the best course of treatment for your needs and budget.
Diagnosis will usually include:
- A detailed examination of your legs (and / or other affected areas)
- Investigation into your family history to see if anyone in your immediate family is affected by similar problems
- Carry out an ultrasound scan to determine the nature and extent of your varicose veins