Vanish Those Veins!

Varicose veins and spider veins not only look unsightly, they can also be a source of pain and cosmetic concern. Here, DR TANG TJUN YIP and DR JULIAN WONG CHI LEUNG answer questions about how they form – and how to get rid of them.

What are varicose and spider veins and what causes them?

Varicose veins are enlarged, swollen and twisted veins that usually appear on the legs and feet. They occur when the valves in the veins become weak or damaged, causing blood to pool and the veins to stretch, leading to higher pressure in the veins in the legs, or chronic venous insufficiency (CVI). Varicose veins can be blue, red or flesh-coloured and may be accompanied by symptoms such as pain, heaviness, swelling and leg cramps. While they are generally harmless, they can sometimes lead to more serious conditions, such as ulcers or blood clots.

Spider veins, also known as telangiectasias, are similar to varicose veins but are smaller and less severe. They are a cosmetic concern and appear as thin, web-like networks of red, blue or purple veins on the surface of the skin, usually on the legs or face. Unlike varicose veins, spider veins are not typically swollen or raised and do not cause significant pain or discomfort. They can both be influenced by factors such as genetics, hormonal changes, pregnancy, obesity and prolonged periods of standing or sitting.

What is the first step to removing these unsightly veins?

Spider vein treatment is focused on improving cosmetic appearance, often with sclerotherapy (injections to close off the veins) or laser (Candela) therapy. But first we check whether the underlying truncal veins are faulty by performing a Duplex ultrasound scan. This is a non-invasive 20 minute scan that shows the extent and severity of valvular reflux (or malfunction of the valves) in the vein walls.

If present, truncal reflux in the main surface veins needs to be sorted out first. Otherwise any treatment of the spider veins will need to be repeated when the inflow problem causes them to recur. This can be done using a keyhole procedure such as laser, radiofrequency or microwave ablation, and

can be performed as a day procedure under local anaesthetic with minimal downtime and pain. This is usually covered by medical insurance as it’s a medical problem. Patients walk out of the hospital the same day and are back to their normal daily routine within 24 to 48 hours.

What’s the next stage to improve the cosmetic appearance of spider veins?

The Candela laser is a popular and particularly effective treatment. It can selectively target the damaged blood vessels without damaging the surrounding skin. The laser is beamed over the affected area, and it emits a specific wavelength of light that is absorbed by the pigment in the blood, allowing for precise and controlled treatment. The heat generated by the laser causes the blood vessels to collapse and eventually be absorbed by the body.

What should a patient expect when having Candela laser?

The procedure is relatively quick with minimal discomfort and downtime and can be done in the clinic setting without any anaesthetic. At The Vascular & Endovascular Clinic (VEC) we normally give Candela treatment complimentary to our patients after their truncal reflux is dealt with as we appreciate that this part of the treatment is cosmetic and not covered under insurance.

What is the downtime like?

After Candela treatment, the patient will have mild redness over the area treated due to inflammation. This is a natural response and it will take about ten days to subside. In the meantime, the patient applies a repair cream three times a day for two weeks to help all the discolouration disappear. The treatment can be repeated again every four weeks if there are any residual spider veins. It normally takes one or two treatments for near complete eradication.

How are compression stockings used to help recovery?

They are routinely used after varicose vein surgery as evidence-based medical practice. Post-op there’s some swelling inside the leg and stockings help these issues settle down faster. Also, there’s a condition called thrombophlebitis (inflammation of the veins), which happens to the normal veins near the treated veins. Wearing stockings for the first week helps to prevent this from happening. We recommend to continue wearing stockings for a second week to help recovery.

In what other situations do you recommend compression stockings?

For air travel because the blood in the veins stagnates due to lack of gravity. Compression stockings help the blood to move from the legs back to the heart.

We also recommend daily use for patients with mild vein disease experiencing cramps and leg swelling, to ease symptoms while considering surgery. And they’re great for people with jobs that require prolonged standing like teachers, chefs, sales-assistants, nurses and policemen. Stockings help prevent the development of varicose veins.

The Vascular & Endovascular Clinic is at #08-08 Gleneagles Medical Centre, 6 Napier Road.

6252 7138 | WhatsApp 9173 0272 enquiries@vascularclinic.sg | vascularclinic.sg