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Normal vein valves

In healthy veins, normal one-way vein valves direct the blood flow upward and prevent it from flowing back and pooling in the lower extremities.

Varicose vein valves

Faulty vein valves in varicose veins allow reverse blood flow and pooling in the lower extremities.


Veins - Varicose Veins - Spider Veins - Overview

Tired of Hiding Your Legs? Let Your Vein Doctor Help

Veins - Function and Categorization

Veins (from the Latin vena) are blood vessels that carry blood towards the heart. Arteries on the other hand, carry blood away from the heart, completing the circulatory system. A vein can range in size from 1 millimeter to 1.5 centimeters in diameter. With a few exceptions, like the veins carrying blood from the lungs to the heart, veins that return blood from the body carry oxygen poor (deoxygenated) blood. Veins can be categorized into superficial, and deep veins.

Leg Veins - Great and Small Saphenous Veins and Perforator Veins

The venous structure of the lower limb may be envisioned as similar to an upside-down tree, with blood originating in superficial venous capillaries and moving upward and inward through increasingly larger veins on its way towards the heart. This task is accomplished through two vein systems that run parallel to each other. One is the deep vein system that runs within the muscles of the legs, and the other is the superficial vein system that runs between the muscle compartments and the skin. The superficial veins communicate with and drain into the deep veins either directly at certain locations like the groin and the back of the knee, or throughout the legs via smaller and short bridging veins called perforator veins.


Saphenous and perforator veins of the leg

Superficial veins include innumerable venous tributaries known as collecting veins, as well the truncal veins and their tributaries. The truncal veins (similar to the trunk of the upside-down tree mentioned earlier) are made up of the Great Saphenous Veins (GSV), and the Small Saphenous Vein (SSV, also known as Lesser Saphenous Vein or LSV ). Deep veins are situated deep inside the muscle compartment of the legs. Perforator veins, on the other hand, are short communicating veins that transport the blood directly from the superficial veins to the deep veins. These are the veins that connect two parallel systems: the superficial venous system, and the deep venous system, somewhat like the rungs of a ladder connecting the two side rails.

The Great Saphenous Vein is the longest vein in the body; it runs from inside of the ankle, to the inside of the knee, and up to the groin where it joins the femoral vein (deep vein system). This vein derives its name from the word safina, meaning "hidden", because it is "hidden" under a layer of connective tissue. The Short Saphenous Vein, on the other hand, runs in the back of the calf from the level of the ankle to the back of the knee where it drains into the deep venous system. Large bulging leg veins are often tributaries of either saphenous veins.

What are Varicose Veins?

Varicose veins are swollen and twisted "rope-like", often unsightly veins. Any vein in the body may become varicose, but the veins most severely affected and most often visible are the ones in your legs and feet, due to the higher gravitational effect of the pooled blood at the lowest point of the body. Varicose veins do not occur suddenly. It usually takes years for signs and symptoms to develop. Although anyone can develop varicose veins, an inherited weakness of the vein wall (genetic) is by far the most important determinant. Secondary contributing factors include female hormones (progesterone), pregnancy, obesity, prolonged standing, sedentary lifestyle and localized trauma.

Cosmetic concern is the most common reason patients seek consultation. However, these veins are often associated with numerous health concerns because they are the visible surface manifestation of significant degree of venous congestion due to venous insufficiency syndrome or venous reflux. If left untreated, varicose veins can cause potentially irreversible skin changes and in severe cases, even venous leg ulcers.


Forms of varicose veins

Healthy veins have unidirectional flaps called venous valves that direct the blood flow upward and prevent blood from flowing back and pooling in the lower extremities due to the effects of gravity. The return of blood to the heart is assisted by the action of the skeletal-muscle pump, and also by the pumping action of breathing. When blood pools in veins, they enlarge under the pressure exerted by the blood. This happens, for example, during prolonged periods of standing. Over the years, increase in the diameter of a vein results in the malfunctioning of valves inside the veins and blood leaks back and pools, forcing veins to enlarge more and become varicose. The visual appearance and size of varicose veins are not reliable indicators of the underlying pressure or volume of venous reflux. Deeper veins may be subject to extreme pressure but not be visible; conversely, superficial veins may demonstrate extreme dilatation from just a small increase in venous pressure.

Symptoms of varicose veins may include aching, night cramps, heaviness, numbness, tiredness, burning sensation and itching. Varicose veins may also be an important contributing factor to the Restless Leg Syndrome. Interestingly, the size of varicose veins does not necessarily correlate with the severity of symptoms; massively dilated varicose veins may not result in any symptoms in some patients, whereas seemingly minor ones may be quite tender and painful in others.

Varicosities in the veins of deep venous system are uncommon because these veins are situated deep in the leg and are firmly supported by muscles. Superficial veins, on the other hand, are located in looser connective or fatty tissue, lack this muscular support, and therefore are prone to form varicose veins. In most patients saphenous (classified as superficial) and perforator vein varicosities are not seen on the leg surface. The twisted, swollen veins, which are often dark blue in color and are near, or raised above the surface of the skin are most often the tributaries of the saphenous or perforator veins.

At Nu Vela Vein center, Dr Dishakjian currently treats varicose veins with a combination of minimally invasive techniques, including treatment of the sources of reflux (like the saphenous and perforator veins) with endovenous, heat based techniques (from inside the vein)using special catheters and laser fibers. These include the two currently FDA approved varicose vein treatment techniques, Venefit Targeted Endovenous Therapy (formerly the VNUS Closure procedure) and Endovenous Laser Treatment (EVLT). Vein doctors often combine these endovenous techniques with either a microsurgical removal of vein called microphlebectomy or ambulatory phlebectomy, or with Foam Slerotherapy and regular liquid sclerotherapy for the smaller branches of the varicose veins. All of the above techniques are essentially considered minimally invasive, ambulatory, office-based procedures with minimum to no downtime. Patients are expected to walk out of the vein clinic and resume most normal activities the next day.

Spider Veins

Spider veins (Telangiectasias) are small, red, blue or purple superficial veins commonly appearing as thin wiggly lines on the thighs, legs and ankles. Spider veins occur in the general population much more commonly than varicose veins. In fact, most people who have spider veins do not have varicose veins. However, once venous reflux occurs and varicose (bulging) veins form, the pressure in these veins leads to accelerated and often uncontrolled growth of spider vein clusters.

In the absence of venous reflux , spider veins occur spontaneously and independently due to the inherent weakness of the one-way valve system of the smaller veins of the legs. These veins subsequently dilate, expand and recruit ever smaller network of thinner surface veins that are visible to the naked eye. This is why these dysfunctional smaller veins are also known as "feeder veins".

Spider veins usually take on one of three basic patterns: they may appear in a true spider shape with a group of veins radiating outward from a dark central point (A); they may be arbored and take branch-like shapes (B); or they appear as separate lines, each about the size of a large hair (C). Linear spider veins are commonly seen on the inner knee, whereas the arbored pattern often appears on the outer thigh in a sunburst or cartwheel distribution.


Forms of spider veins

Spider veins and their feeder vein counterparts are often perceived as a cosmetic problem, but in some patients they could be associated with disproportionately severe symptoms similar to those occurring with varicose veins.

Please go to spider vein removal to read about the treatment of these unsightly veins, or click vein treatment options to read about the many non-surgical vein treatment techniques currently offered by advanced vein centers and clinics.

Reticular Veins

Reticular veins are larger than spider veins but smaller than varicose veins, approximately 1-3 mm in diameter. They are usually flat and less tortuous than bulging varicose vein and appear as dilated blue and green veins beneath the skin surface. Reticular veins are most often noted in the outer thighs, backs of the thighs and knees, and occasionally on the face. These veins can exist independently but can also be the underlying problem that gives rise to surface spider veins. Because spider veins can result from refluxing reticular veins, they are also known as feeder veins. Removing reticular veins will help eliminate spider veins.


Forms of reticular veins

Superficial Facial Veins

Superficial facial veins range in size from very fine, red and purple veins to larger blue-green veins. Despite the fact that these are carrying oxygen poor blood to the heart, dilation of these veins is thought to happen due to the breakdown and weakening of the collagen structure of the vein wall, rather than due to defective venous valves. Typically, facial veins do not cause any pain and are usually treated for cosmetic reasons.

The smaller veins that appear as fine irregular red lines on the nose, chin, cheeks and the side of the face, are called facial spider veins because they are often reminiscent of a spider's web in shape. The larger facial veins are the reticular veins. These appear greenish blue in color and can be 2-3 mm in diameter. Reticular veins are usually found along the cheekbones, under the eyes, and around the temples.

Facial veins are often related to fair skin complexion, sun exposure, heredity, oral contraceptives, hormone therapy, and the aging process. The smaller veins are occasionally related to Rosacea, an inflammatory condition characterized by episodic flushing of the facial skin, often lasting for several hours. Rosacea gives the skin a reddened appearance which tends to worsen over time. As the condition progresses, the redness becomes more persistent, and may result in bumps, pimples and visible broken capillaries.


Facial reticular vein laser treatment

Why to Treat Your Varicose and Spider Veins?

Besides the fact that varicose and spider veins are cosmetically unappealing, these veins are problematic because they indicate poor venous circulation. Although some of these veins may appear to be stable over many years, generally speaking, without treatment and professional help, varicose and spider veins tend to enlarge and multiply. When therapy is provided for advanced cases, many more treatment sessions are typically required, healing time tends to be longer, and some serious complications, like ulceration or irreversible tissue changes (like discoloration and loss of fat) in the legs may occur. Varicose veins may also signal a higher than normal risk of other disorders of the circulatory system, like deep vein thrombosis. Even very small varicose veins may be of more than cosmetic concern because the outward signs of venous disease often do not match the significance of the underlying venous disease and the complications associated with venous reflux.

How to Treat Your Varicose and Spider Veins?

As in most areas of medicine, the treatment of varicose veins has evolved toward increasingly less invasive interventions. Currently Sclerotherapy is considered the gold standard for leg spider vein removal, foam Sclerotherapy is ideally suited for large bulging varicose veins, the Venefit Targeted Endovenous Therapy (formerly VNUS Closure) or EVLT for the closure of saphenous and perforator veins, and laser therapy for facial vein treatment. These treatment modalities are associated with a number of benefits, including reduced treatment time, lower costs, fewer serious side effects, and improved treatment efficiency. Click vein treatment to read about the various options offered by Nu Vela, a leading vein treatment center servicing the Los Angeles area.

It should be pointed out that if venous reflux is present, simple treatment of superficial varicose veins and their branches is always ineffective, short lived and futile, both in terms of improvement in symptoms and cosmetic appearance, unless the sahphenous or perforator veins involved are also treated. Also, note that once venous reflux disease is treated and eliminated, you will probably need periodic maintenance treatment of spider and blue veins in your legs, since treating these finer veins will not prevent your body from forming new ones in the future, as the condition is treatable but not curable. It is, therfore, best to treat these veins periodically to maintain optimal results.


Foam Sclerotherapy of Bulging Leg Varicose

Click spider and varicose vein treatment Los Angeles to read about vein treatment options available at the Center.



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Nu Vela Esthetica
Cosmetic Laser Surgery and Vein Treatment Center

Postal Address:
11200 Corbin Ave
Porter Ranch
United States

Phone: 818-832-4500

Office Hours: Tuesdays 10:00 AM - 3:00 PM; Wednesdays to Fridays 9:00 AM - 6:00 PM