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Spider and Varicose Veins Info
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Naturale Clinic II -Limeira
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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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HTML Text Part 1 - What is varicose and spider veins

HTML Text Part 2 - Complications, preventions and FAQ

HTML Text Part 3 -Treatments

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Part 1

What are Varicose Veins? 

Varicose veins and Telangiectasia (spider veins) are usually normal veins that progressively stretch, bulge and become visible. Varicose veins may be caused by a hereditary factor; the father or the mother may have varicose veins, or in some cases, even one of the grandparents or an uncle / aunt. Besides the hereditary tendency, some other factors can aggravate the varicose veins. One of the main factors that may cause this aggravation is the pregnancy. Another one that is also very important is the use of contraceptives. Standing or sitting for very long periods of time also causes varicose veins. Therefore, people who stand or sit for long periods of time, who use contraceptive or who have several pregnancies and present the hereditary tendency, have a strong possibility of developing the problem. The hereditary factor reaches men and women equally, but a very larger proportion of women will have varicose veins because of the effect of the feminine hormone that aggravates the problem. 

Varicose veins: a problem since the antiquity 

The varicose veins of lower extremities have been studied and treated since the antiquity. There are references to treatments that raise from more than 2000 years ago. In Doctor Amynos's sanctuary, close to the Acropolis of Athens, a sculpture was discovered in an excavation. This sculpture probably represented the gratitude of a Greek person and it showed a leg with thick and visible varicose veins. The concern of the medicine about the varicose veins began in the origins of the civilization history. That happens because the varicose veins are visible. Then, for the practioners of the old medicine, who did not have adequate instruments to examine the human body, the cause and effect relationship of the symptoms with the presence of the veins, that are easily visible, was soon made. Due to the fact that it is a visible disease, it concerns the women in the XXI century. 

The varicose veins and the changes of the sixties 

The change of habits in the last decades, mainly the use of mini-skirts in the sixties, caused a great development in the treatment of the varicose veins of the lower extremities, especially in Brazil. Our country is known all over the world as a pioneer and an innovator when it comes to techniques for the treatment of varicose veins of lower extremities. The development of the sclerotherapy and of new equipment for cryosclerotherapy to treat the telangiectasies ("spider veins"), the use of the crochet hook, surgeries of varicose veins and microvarices using the microincisions, and even the wide range of techniques that can be used in each particular case, were developed here, by doctors who were good observers, who had very good sense and privileged creativity. All that allowed them, with few resources, to develop innovative techniques used all over the world. We can say, and of course, with certain pride, that in the area of Phlebology (the study of the veins) the place that has the best technology in the world is Brazil. I can mention the Brazilian phlebologist and vascular surgeon's creative characteristics, but of course , other factors should be taken into account: Brazilian women's concern with the body. Not only because of the climate that demands light clothes, but also because the pursue for beauty by Brazilian women, which is unique in the world.

The types of Varicose veins 

There are two types of varicose veins: the primary, that are caused by the hereditary factors, and the secondary, that appear because of diseases during the life.

The primary varicose veins are the responsible for the unaesthetic red and blue lines of several sizes in the woman's legs and also for the varicose veins of larger sizes. The primary varicose veins are the most frequent ones.

The secondary ones are the most difficult ones to be treated. They are erroneously called "internal varicose veins". "Internal varicose veins" do not exist. But, what do exist are serious problems of diseases in the internal veins, that are the secondary varicose veins. 

We can also consider the varicose veins, in a simplistic way, as "less severe" or "more severe". The "less severe" are the ones that, although they are a disease, do not cause an immediate health problem but aesthetic concerns. The "more severe" are the ones that result in serious problems, as bleeding, ulcers (wounds), eczema, infections, redness, stains, thickness of the skin, pain, phlebitis and even the lung clot, that although rare in primary varicose veins, may put in risk the patient's life. 

The Types of Varicose veins according to the Naturale Clinic 

A scientific classification of the varicose veins, called CEAP, is used all over the world for the scientific researches. But this classification is very complex, and it is not used in practice to treat the patient. In scientific researches, led by doctors of the Naturale Clinic, a new Clinical Classification was developed, known as Functional - Aesthetic Classification or " Francischelli' s Classification". It divides the patients with varicose veins in 4 Types or Groups. Each one of the groups has common characteristics that allow us to choose the best treatments. 

TYPE 1 - PAVD: The varicose veins that are more an aesthetic problem. 

We call Type 1 or PAVD -Predominantly Aesthetic Venous Disease - the presence of small varicose veins that are the telangiectasies (spider veins) and reticular veins (microvarices). The telangiectasies (spider veins) are the small red or blue veins of the skin, with the thickness of a hair. They may be very small or a little larger and they are inside the skin. They present several formats, from small lines to large webs. They can be present in all the lower extremities: the thigh, the leg, the buttocks and, in some cases, in the back. The reticular veins (microvarices) are larger, longer, bluish, and located under the skin, but linked to it. These veins are frequently linked to the telangiectasies. The association of telangiectasies of the thigh's lateral area with these reticular veins that extend on the lateral area of the knee and reach the leg is very common. In spite of being a health problem, these small veins they do not cause immediate risks, but they affect the patient's self-esteem. Therefore, the patient usually seeks the doctor for the aesthetic subject. That is the reason why we called this type PAVD - Predominantly Aesthetic Venous Disease. They are the small varicose veins of the skin, such as the telangiectasies (spider veins), and under the skin, such as the reticular veins (microvarices). Although it is not a health problem in a short term, it is still a long term disease because some problems may appear, as bleeding, for example. 

Type 2 - FAVD: The varicose veins that are a health problem (functional) as well as an aesthetic problem. 

We call Type 2 or FAVD - Functional and Aesthetic Venous Disease - the presence of veins of medium and larger caliber. It is a disease already and it involves some risks and problems for the patient. For that, it should be treated. Besides, it can cause some cosmetic concerns for the patient. In this case the two problems should be considered: the disease (functional) and the aesthetics. FAVD - Functional and Aesthetic Venous Disease - happens when the patient presents both, the varicose veins that needs treatment to avoid complications, and concerns about the appearance. 

It is important to recognize these two conditions: the disease (functional) and the appearance (the aesthetics), because during the treatment the doctor should not only correct the disease, but also use aesthetic techniques to fulfill the desire of a better appearance of the patient's lower extremities.

A perfect balance between the two factors is desirable in the treatment. This type of varicose veins is very frequent, and aesthetic and functional techniques are used for this treatment, so that the disease is corrected and, at the same time, an aesthetic result is also obtained. For this double characteristic, this condition type needs specific attention from the doctor, and it is classified in one separated group. 

Type 3 - FVD : The Varicose veins that are a health problem (functional) without an aesthetic concern by the patient and that still haven't presented complications. 

We call Type 3 or FVD - Functional Venous Disease, all of the situations of varicose veins where the aesthetic subject is not involved. In this case, the disease (functional) is present, without the patient's concerns with the appearance (aesthetics). In some cases the varicose veins can reach great dimensions before presenting complications. The treatment, in this case is directed more to the functional subjects of the venous disease, although the concern with the appearance is present for the most careful doctors. 

Type 4 - CVD: The varicose veins that are a health problem (functional) and that already present complications. 

We call Type 4 or CVD - Complicated Venous Disease, all of the situations when varicose veins have shown complications . The most frequent complications are Trombophlebites , Leg Ulcers, Hyper-pigmentation , the Venous Eczema, Bleeding , Fibrosis, the Dermatitis Ocre, Infections , Pain, and Pulmonary Embolism. In this case, the disease (functional) is present, without the patient's concern with the appearance (aesthetics). They are usually patients who have had this problem for a very long time without treatment, and that already present complications. In this case, the doctor concentrates more on the disease, that is very serious, and that could cause serious restrictions for the patient. 

All these types follow an evolution, but it does not mean that one type will necessarily evolute to the other. The varicose veins always get worse, but each patient will have a different history. The disease is chronic and it should always be accompanied by a competent vascular surgeon that will know how to choose the best treatment alternatives. 

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. 

HTML Text Part 1 - What is varicose and spider veins

HTML Text Part 2 - Complications, preventions and FAQ

HTML Text Part 3 -Treatments

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