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Spider and Varicose Veins Info
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Av. Moema , 87 cj 51-52
Moema – São Paulo
Parking : Al. dos Jurupis 452
phone: 55 11 50511075
Naturale Clinic II -Limeira
Avenida Antonio Ometto, 525
Limeira – São Paulo
Phone 55 19 34538490
clinical director
Informations about varicose and spider veins for patients and health professionals
Informações sobre varizes para pacientes e profissionais de saúde
Information à propos des varices et des télangiectasies pour patients et profissionnelles de la santé
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Why the varicose veins appear 

The defect in the varicose veins is in the valves and in the walls of the veins. There are two types of veins in the lower extremities: the superficial veins that are in the fat layer under the skin and that can be visible, and the deep veins that are in the middle of the musculature of the leg and they are not visible. There are communicating veins that link the superficial and deep veins. The valves guide the blood in the veins of the members, always from the superficial veins to the deeper ones, through the communicating veins. They impede the blood to go the wrong way when the person is standing or sitting. 

The arteries take the blood from the heart to the whole body. The blood then, after oxygenating and feeding the cells, returns to the heart through the veins. When the person stands or sits, the blood goes to the feet easily, because the heart impels it. But how does the blood return if there is no in the leg? When we stand or sit, there is a certain difficulty for the blood to return to the heart. In the people whose veins have normal valves and walls, the blood waits for the opportunity to return, without causing any alteration. In the people whose valves are faulty, an inversion in the flow road of the blood happens. The blood then starts going from top to the bottom and from the deep to the superficial veins. This fact causes an increase of the blood volume inside the superficial veins, resulting in the dilation process and the emergence of the varicose veins. The blood goes back to the heart through the peripheral heart, that actually, exists. It is the musculature of the calf. But this heart only works when we move, contracting and relaxing the muscles of the leg. When the muscles contract, they impel the blood upward accomplishing the circulation. 

The Role of the Saphenous Veins 

We have 4 Saphenous Veins: 2 in each member. There are the Long Saphenous Vein and the Short Saphenous Vein. The Long Saphenous Vein is a vein that goes from the internal part of the ankle to the groin, in the internal surface of the leg and thigh. The Short Saphenous Vein goes from the lateral part of the ankle to the knee, in the posterior part of the leg. The Saphenous Veins are little important for the normal circulation of the leg and because of that, they can be removed without problems. But as they are superficial veins, of easy access, extensive, and of good caliber with thick walls, they are removed to substitute other occluded vases, as the coronary arteries, the main arteries of the heart. The Saphenous Veins are then a type of "substitute " of vases for the body. 

However, the Saphenous Veins have connection with all of the veins of the surface of the leg, and they are frequently involved in the varicose veins disease. When this happens, they are very extensive, and they need to be removed. The doctor never removes all the four. He only removes the sicker ones, leaving the ones that are perfect or little sick, because then can eventually be necessary in heart surgeries, or even to substitute other important vases of the body that are altered or that suffered a cut as in an accident, for instance. 

All of the veins of the members are interlinked. It is as if it was a tree, where the Saphenous Veins are the roots, their branches are the trunks, the microvarices are the branches, and the vases are the leaves. 

In the treatment it is important to identify where the problem is and to treat all of the areas that are involved to obtain a good result. If the vases (the "leaves") are involved , then only they will be treated. If the microvarices ("the branches") are also involved , then they should also be treated. Otherwise they will produce new "leaves". If the "roots" (the Saphenous Veins) or the "trunks" (their branches) are sick, then all of them should be treated. 

For this reason, a detailed clinical exam should be made by the doctor in the initial consultation, that will determine the flow of the blood. Knowing the type of the varicose veins, the doctor can decide on the best treatment. If necessary, the doctor will request ultrasound, pletismography or even x-rays or angioressonance for better evaluating the alterations and planning the treatment. But the most experienced doctors, with a simple clinical exam, can already diagnose and know exactly what to do to correct both, the aesthetic problems and the venous disease. 

Standing or sitting may increase the problem of varicose veins. 

The positions that increase the probability of varicose veins is standing or seating. As I've already mentioned, when people are in these positions there is a difficulty for the returning of the blood in the circulation and it is exactly when the varicose veins appear. Being in movement makes the calf heart work, what will impel the blood upward, avoiding varicose veins. When we lay down , the heart is in the same level of the leg, what facilitates the return of the blood. If we put our feet up, the heart is down and the feet higher. Then, the blood returns much more easily.

Why veins of several sizes, from the "spider veins" of the skin to the large varicose veins appear

When the larger veins of the surface expand, the large varicose veins may appear. When it is the branches of these veins that expand, or in the initial phase of the disease, we have the microvarices that are bluish itineraries seen under the skin. When the veins of the skin are the ones that expand, we have the spider veins , whose technical name is telangiectasia: tele means far, angio means vase and ectasia means dilatation. Therefore, dilatation of the far vase. 

The Saphenous Veins are the main superficial veins, and they are involved in the process of appearance of varicose veins. As I mentioned before, there are two in each leg: the Long Saphenous Vein and the Short Saphenous Vein. 

There are links among the varicose veins, microvarices and "spider veins". Everything happens as if it was a net, that transmits the pressure of the blood volume. The ones that dilate first are the ones that receive larger volume of blood in the wrong direction (from the top to the bottom and from inside to outside, the inverse of the normal - which is from the bottom to the top and from outside to inside), or where the blood gets more blocked. The veins of the skin generate the "spider veins". When they expand, the micro veins appear. The expanding of these microvarices result in varicose veins. If the inverted flow or the accumulation of blood reaches only a part of the veins, only these ones will expand; if they reach all the veins, then all of them will dilate. 

If the flow in the inverted direction happens only in the skin, the spider veins will appear. For its treatment, it is enough to take care of these small vases. But if a vein forces the flow in the inverted direction to the skin, this creates the vases to accommodate the blood. The treatment then is not only to remove the vases, but also the vein that in causing the inverted flow and the accumulation. This situation is called "combined telangiectasies"; the vases are linked to a vein and both have alterations. This process is very wide in the lower extremities and it may reach several types of vases at the same time or separately. The same way, a saphenous vein can cause an inverted flow to the veins of the skin or to peripheral ones. Depending on the veins that dilate, we will have a different type of varicose veins. 

A careful initial exam carried out by a doctor is very important before any treatment takes place, because with a clinical exam or an ultrasound, he will identify these flow patterns and understand if there are problems in the Saphenous Veins (roots), in the peripheral ones (trunks), in the reticular or microvarices (branches) or in the telangiectasies or spider veins (leaves). Once identified, he will suggest the best treatment options, considering the disease and the aesthetics. 

The varicose veins may affect the health in different levels, but there also are aesthetic issues involved.

The varicose veins of TYPE 1 are mild varicose veins that do not expose the patient to immediate complications, although they can cause stains and bleeding in the future. They are the ones of greatest aesthetic concerns.

The ones of types 2 (aesthetics and functional) and 3 ( functional) can be mild or severe, depending on the stage. But even if they are considered mild ones, the disease already exists, predicting problems for the future, and they should be treated, whenever possible. 

The one of the type 4 are the severe varicose veins; the ones that can provoke serious complications as trombophlebitis, clots, edemas, eczema, ulcers (wounds) and bleeding . They are a serious disease that may not show symptoms for years. The complications takes the patient to incapacities and even to risk of life, when trombophebitis and clots happen. However, even these more severe varicose veins can be easily treated with modern techniques that accomplish correction with low scars and marks. 

The mild varicose veins can be treated in agreement with the own patient's desire and with the doctor's orientation. On the other hand, the severe varicose veins should be treated whenever possible. The treatment of the mild varicose veins, although it is not immediately necessary from medical point of view, is not useless, because these varicose veins that now configure a problem that affects specially the patient's self-esteem, will be a severe disease in the future. Furthermore, although rarely, they can present complications. Then the aesthetic treatment of varicose veins is not only a good for appearance but it's also a treatment for a disease. To treat the aesthetic varicose veins is to "unite the useful to the pleasant". Pleasant is to improve the appearance and the self-esteem; useful is to control a disease that can cause complications in the future. 

How Spider Veins Appear

Os vasos na pele se distribuem em várias camadas e pertencem a microcirculação  (79kb) Os vasos da pele em desenho esquemático, mostrando a arteríola, os capilares e as vênulas - são as vênulas que se dilatam e formam as telangiectasias - vasinhos  (80kb) A microcirculação  (54kb) A microcirculação , as arteríolas, os capilares e as vênulas. São as vênulas que se dilatam e provocam o aparecimento das telangiectasias - vasinhos. Não sõa os capilares e nem a arteríola.  (35kb) As telangiectasias  - vasinhos se formam por vários motivos. Neste caso, uma veia doente , cahamada perfurante direta, vem da veia profunda da perna e reflui sangue para a pele, formamando uma telangiectasia (80kb)
As telangiectasias - vasinhos se formam por diversos motivos: neste caso o refluxo de sangie se deu através de uma microvarizes  (82kb) As telangiectasias - vasinhos se formam por diversos motivos: neste caso o refluxo de sangie se deu através de uma veia colateral de uma safena doente (78kb) As telangiectasias - vasinhos se formam por diversos motivos: neste caso os vasinhos se formaram por causa de uma fístula, uma comunicação entre a artéria e a veia, que aumentou muito o fluxo sanguíneo. isto pode ocorrer em qualquer parte do corpo, mas é mais frequente na face (83kb) As telangiectasias - vasinhos se formam por diversos motivos: neste caso o refluxo de sangue se deu através de uma veia perfurante comunicante, de dentro da perna para uma microvarizes e daí para a pele  (77kb)


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