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Thread veins
Many names are often used to refer to similar conditions; Thread
veins, spider veins, reticular veins and venous flares. They may
vary in appearance and size but their development and treatment
may be identical.
The skin has a huge network of small blood vessels. These may become
more prominent either due to enlargement of the blood vessels themselves
or due to the changes of the supporting tissues within the skin
that makes these veins more prominent. The larger thread veins may
be a reflection of higher pressure within the superficial veins
and this should be excluded prior to successful local treatment.
Cosmesis is the commonest concern often restricting the choice of
clothing/exposure with which the patient feels comfortable.
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Varicose
veins
Superficial venous hypertension/reflux exposes a constant pressure
on the small tributaries (branches) of the superficial leg veins.
These then enlarge. As they enlarge under the skin they also lengthen
and become tortuous and result in their typical appearance. Abnormalities
can be demonstrated within the veins in adolescence and certainly
conditions such as pregnancy can make things worse but are not necessarily
the cause. Many factors play a role (multifactorial) in their development.
The
symptoms can result from either the underlying reflux within the
superficial veins or from the varicose veins themselves. These include
aching (particularly at the end of the day), discomfort, heaviness,
nocturnal cramps and swelling. The leg may feel tense and hard and
shoes may appear to be too small. It remains difficult to predict
which patients may develop more advanced problems with their legs
and also therefore which patients would benefit from early treatment
of their superficial venous reflux. The more advanced changes are
discussed below.
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Phlebitis
‘Inflamed veins’ (superficial thrombophlebitis) are a common presentation
in patients with advancing varicose veins. An acute onset of severe
pain, tenderness and redness overlying a varicose vein may occur
without provocation. The effected vein often clots and can be felt
as a hard lump. The phlebitis will settle on its own in about 6
weeks. Treatment should include a combination of pain-killers (anti-inflammatory
drugs) and many patients benefit from support hosiery. Extensive
phlebitis particularly effecting different areas should be investigated
further.
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Skin
change/Ulceration
The skin around the ankle is usually involved first. Mild ‘flakey’
eczema occurs that can be itchy. Scratching can cause a rapid advance
in development of further changes and should be avoided. Further
changes include white or brown discolouration and thickening of
the skin, a loss in fatty tissues around the ankle (lipodermatosclerosis)
and eventually a breakdown of the skin causing an ulcer.
With advanced changes the skin is very vulnerable to damage and
healing can be very prolonged in those patients with established
ulceration. Many patients require lifelong dressings once the ulcers
have developed. It is important to understand that ulcers may be
caused by other medical conditions (arterial disease, arthritis,
inflammation, trauma, infection). Ulcers caused by vein disorders
are called venous ulcers.
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