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Types of Vein Conditions

There are two primary types of vein conditions—both of which are indicative of some level of underlying venous insufficiency. Spider veins are tangled groups of tiny blood vessels just under the skin’s surface that resemble spider webs, hence their name. Typically, they are red, blue or purple and are clearly visible on the thighs, lower legs and face. Varicose veins tend to be larger in diameter and are visibly bumpy or rope-like. Both types of vein conditions can produce physical symptoms—from leg pain and fatigue to itching, burning and nighttime restlessness. Only a comprehensive ultrasound scan can reveal what truly lies beneath your skin.

Varicose Veins

What Are Varicose Veins?

Often painful and unsightly, varicose veins are visibly bumpy or rope-like and may occur in almost any part of the leg—most often in the back of the calf or on the inside of the leg between the groin and the ankle. Common symptoms include leg pain, aching, or cramping, fatigued or heavy-feeling legs, itching/burning, swollen ankles, restless legs, and, in severe cases, ulcers. Varicose veins can be sometimes be debilitating, limit a person’s mobility, and affect their quality of life.

What Causes Varicose Veins?

According to the National Institutes of Health (NIH), many factors can raise your risk for venous insufficiency, which causes varicose veins. These include family history, age, gender, pregnancy, weight/obesity, and lack of movement. Peoples’ jobs may also contribute to their risk—especially those who sit or stand for long periods of time.

Who Gets Varicose Veins?

More than 30 million Americans suffer from venous insufficiency, the cause of both varicose and spider veins. Contributing factors include heredity, gender, age, weight, pregnancy, history of deep vein thrombosis (blood clots), and standing or sitting for long periods of time.

How Are They treated?

There are several methods for treating varicose veins, ranging from radiofrequency and laser ablation to ultrasound-guided foam sclerotherapy. Visit our Treatments page for more detailed information.

Spider Veins

What Are Spider Veins?

Spider veins are tangled groups of tiny blood vessels just under the skin’s surface that resemble spider webs or tree branches. Typically, they are red, blue or purple and are clearly visible on the thighs, lower legs and face. Spider veins can sometimes cover large areas of skin. Occasionally, they may cause itching, burning or even pain, but oftentimes they cause no physical symptoms at all.

What Causes Spider Veins?

Like varicose veins, spider veins are caused by a common medical condition called venous insufficiency. Normally, your veins carry blood from body tissues back to your heart to be replenished with oxygen and then re-circulated throughout your body. To help the blood from your legs flow upward, against gravity, each vein is equipped with tiny, one-way valves. With each pump of the heart, blood travels further through this series of valves. When these valves fail or leak, blood collects or pools, causing the veins to exhibit their characteristic “spider web” appearance.

Who Gets Spider Veins?

More than 30 million Americans suffer from venous insufficiency, the cause of both varicose and spider veins. Contributing factors include heredity, gender, age, weight, pregnancy, history of deep vein thrombosis (blood clots), and standing or sitting for long periods of time. Additional factors seen to cause spider veins include smoking, exposure to heat (hot tubs, baths, saunas), and tight clothing.

How Are They Treated?

Spider veins are treated with a safe and quick procedure called visual sclerotherapy (conducted “visually” by a nurse or doctor without the need for imaging equipment like an ultrasound which is often used to treat deeper veins). A chemical called a sclerosant is injected into the veins, causing them to close and prompting the body to reroute the blood to other, healthier veins. The treated veins are eventually reabsorbed into the body.

Restless Leg Syndrome

What is Restless Leg Syndrome (RLS)?

Restless legs syndrome (RLS) is a common disorder with a known association with venous insufficiency.

Restless legs syndrome—also called Willis Ekborn Disease—was first described by Chinese physicians in 1529, and 1763 by French physicians. The condition was first suggested to be associated with venous insufficiency by Dr. Karl A. Ekbom in 1944. RLS is characterized by unpleasant or painful sensations (dysesthesias or paresthesias) in the legs and an urge to move the legs. Symptoms occur when the patient is relaxing, inactive or at rest, and can increase in severity during the night or latter part of the patient’s wake period. Moving the legs reduces and may relieve the discomfort. The discomfort and constant need to move the legs disturbs sleep and can lead to impairment of function in daily life.

What Causes RLS?

Restless leg syndrome may have genetic causes, and has been associated with low iron storage in the brain as well as diminished dopamine in the basal ganglia (the brain area also associated with Parkinson’s disease). RLS is associated with Parkinson’s disease, diabetes, renal insufficiency, iron deficiency anemia, peripheral neuropathy, and multiple sclerosis.

RLS occurring secondarily from a chronic disease can often be improved or cured by adequately treating the associated condition. For instance, restless legs syndrome caused by iron deficiency anemia can be treated by normalizing iron levels. The relationship between RLS and venous insufficiency has been established so strongly that some medical insurers require that a ferritin level be drawn on any patient before initiating another treatment for RLS.

Who Does RLS Affect?

Restless leg syndrome affects approximately 10 percent of adults in the United States. RLS may begin at any age, including childhood, and affects approximately twice as many women as men. Eighty percent of those affected by RLS also experience Periodic Limb Movement Disorder during sleep, in which the patient has brief “jerks” of the legs or arms while sleeping.

How is it Treated?

Restless leg syndrome is commonly treated with dopaminergic drugs, but these drugs have numerous short and long-term side effects. When RLS co-exists with venous insufficiency, treating the venous insufficiency can provide substantial improvement in the patient’s symptoms and subsequently the patient’s quality of life.

How is RLS related to veins?

Those who treat varicose veins have long heard from their patients’ descriptions of throbbing, buzzing, creepy-crawly pains in the lower extremities—symptoms that sound very similar to those of RLS. Restless leg syndrome has long been accepted as a symptom of venous insufficiency by phlebologists. It was McDonagh, et al., in 2007 who published the paper, “Restless legs syndrome in patients with chronic venous disorders: an untold story.” This case-control study found a significant difference (at p < 0.05) between the cases (36% prevalence of RLS) and controls (19% prevalence). The clinical difference found between the two groups was a higher prevalence of cramping symptoms in the group with both RLS and venous insufficiency when compared to the control group that had RLS without venous insufficiency.

In 2008, Clint Hayes and John Kingsley, et al. published their ground-breaking paper “The effect of endovenous laser ablation on restless legs syndrome,” in the journal Phlebology. This cohort study took patients with ultrasound-proven venous insufficiency and RLS (by NIH criteria) and separated them into operative and non-operative cohorts. The operative cohort received endovenous laser ablation and sclerotherapy. The results: correcting the SVI decreased the mean IRLS score 80%. Also, 89% of patients had a decrease in their score of > or =15 points. Fifty-three percent indicated their symptoms “had been largely alleviated” and 31% reported complete relief of their RLS symptoms. Hayes et al. concluded that patients with diagnosed RLS should be sent for ultrasound evaluation for venous insufficiency prior to drug therapy being initiated or continued.