Heide Katros did everything she could to hide the ropy, prominent blue veins in her legs. • "I'd wear capri pants and longish skirts, and I'd hold my purse low to cover part of my legs," said Katros, a writer of romance novels who lives in Winter Haven. She declines to give her age but does acknowledge she's a grandmother and "past 50."
In her youth she was a model, but more recently, "I hated to be in a swimsuit on the beach," she said. "I'd insist my husband walk on my left," very close to her, to hide the prominent vein that ran from her left thigh to her ankle. When she stood, "I'd cross my legs a certain way to hide as much as I can," including the bulging vein on her right leg that ran from below the knee to the calf.
"I was very aware when I was playing tennis" of how her legs looked — this from a woman who's on the courts a couple of times a week.
The final blow came when a friend (who needs friends like this?) pointed to her leg and said, "Hey, you've got a worm crawling up your leg!" Katros went off and wept.
More than 80 million people in the United States suffer from spider veins or varicose veins. Half of women over age 21 in the U.S. have spider veins, the American Society of Plastic Surgeons estimates. Varicose veins affect half the people age 50 and older in this country, the National Women's Health Information Center says.
It's not just a matter of vanity, doctors say. Varicose veins can make the legs feel achy, tired and heavy; can generate pain and cramping, swelling and itching; and make the sufferer more prone to blood clots and ulcers.
Men think varicose veins are "a woman's disease, but half our patients are men," says Dr. Daniel J. Mountcastle, who operates vein centers in St. Petersburg and Largo.
Veins to spare
First, a few definitions.
Spider veins are networks or clusters of thin, fine, bluish or reddish veins, typically in the ankles or thighs but also on the face, that look like the body of a spider or a spider web. These are mainly a cosmetic concern.
Varicose veins are larger veins, purple or dark blue in color, that look bulgy, twisted and swollen. Typically they lie close to the surface of the skin, but veins deeper inside the leg can become varicose too.
Varicose veins develop when the valves that push blood back toward your heart start to fail. This may happen as a result of aging or genetic predisposition. (If your mother had varicose veins, you likely will too.) Some women develop varicose veins while pregnant; these usually disappear on their own after the baby is born.
When those valves fail to close properly, pushing the blood along, the blood sinks back toward your feet, and the veins begin to swell and bulge. That can lead to swollen ankles; "stained" skin where iron deposits build up; and even ulceration in areas where circulation is greatly limited. Meanwhile, when the affected vein ceases to function properly, other veins will take up the slack and keep pumping blood back in the direction of your heart.
"The good news is, you have lots of veins, so it's no problem to remove one or two or even several. You have a network of veins and lots of extra circulation," says Dr. Edward G. Mackay, who has offices in St. Petersburg and Palm Harbor and who treated Heide Katros.
Variety of treatments
Treatments include injecting the vein with a chemical or heating it with a laser, causing it to collapse and dissolve, to be reabsorbed by the body; or removing the vein.
All these treatments can be done in a doctor's office in 30 to 60 minutes. You're up and on your way with no down time and minimal discomfort, doctors say.
Doctors will begin vein treatment by looking at your legs and performing an ultrasound to find out why your veins are failing. Sometimes there is an underlying circulatory problem that has to be addressed.
For spider veins, "the gold standard for treatment," Mackay says, is sclerotherapy, in which a solution injected into the veins scars and closes them, and they fade from view. Several treatments over a period of weeks or months may be necessary.
For varicose veins, options include endovenous laser therapy. A very fine catheter is inserted into the vein, and a tiny laser inside the catheter cauterizes the vein, closing it down and stopping the backward blood flow. The damaged vein shrivels up and is absorbed by the body. A variation is the use of a radiofrequency device rather than a laser.
Another alternative is micro-incision phlebectomy. A series of tiny needle incisions is made and a tiny surgical hook removes the vein. No stitches are required. The multiple needle sticks feel like the bites of mosquitoes or fire ants or like sand spurs, practitioners say. This is considered a great improvement over the surgical vein-stripping procedures, common years ago, that required local or general anesthesia, were more painful and required larger incisions and weeks of recovery time.
What it will cost
Sclerotherapy, which most insurers consider a cosmetic procedure and will not cover, runs $200 to $300 a session. Endovenous ablations cost about $1,500, and phlebectomies between $1,500 and $2,000. Ultrasound exams cost around $300. (All these prices are estimates and may vary from clinic to clinic.) "When the treatments are medically indicated, insurance covers it," Mackay said.
The Florida Department of Health says the removal of varicose veins is within the scope of practice of a medical doctor, osteopathic M.D., physician's assistant under the indirect supervision of either of those doctors, or an advanced registered nurse practitioner.
Still some recovery time
If you're thinking of stopping at a vein clinic en route to the beach, think again. Yes, you'll be able to walk out the door, but there may be slight soreness, treatable with ibuprofen. There may be lumps or bruising that take a while to fade. Your legs won't look fabulous overnight. Significant improvement may take six months or so.
It's also important to remember that you've got lots of other veins, and "there's always a chance another one will go bad," Mackay said. "I can't tell someone, 'I'm curing you.' I can say, 'I'm fixing this one.' "
A good candidate for vein procedures will be in general good health and mobile, since walking is part of the recovery process.
Heide Katros says her tennis pals marvel at the difference in her legs, which were treated with laser and radiofrequency procedures. Now she wears shorts and short skirts without a second thought. "I have grandchildren, so who cares what I look like, but I do," she says. "I'm like a little kid with my legs."
Information from the Mayo Clinic, the Cleveland Clinic and the National Women's Health Information Center was used in this report. Judy Stark, a former Times editor, is a freelance writer in St. Petersburg.