Unsightly veins can affect anyone but if your mom has got 'em, you stand on your feet all day, or you're just a little overweight, chances are you may get them too ­- if you haven't already. Venous disease is usually hereditary, but you can sometimes acquire them through injury. And while even young children can get a blue vein or two, it's us women over 30 that are most at risk, says Lynn Moya, a registered nurse and manager of the Yorkville Vein Clinic in Toronto. That's because the problem is often precipitated by obesity, pregnancy or menopausal hormones, prolonged periods of standing and the natural aging process.

The venous system

Overview: Veins take blood to the heart through a series of small valves. We have three venous systems: the deep system, responsible for 85 to 90 per cent of blood return; the superficial system, responsible for the remaining 10 per cent; and the communicating system, which connects the deep and superficial systems. Varicose veins occur in the superficial system when the valves lose elasticity or break down, allowing the blood to flow back down the leg.

Symptoms: The legs often feel heavy or painful, and where the blood pools, veins can bulge and your ankles may swell.

Types of veins

Varicose veins: raised, blueish and sometimes painful veins, most common in legs

Spider veins: small, red, thread-like capillaries that cause itching, burning or aching, most common in legs

Reticular veins: medium-sized and blue-greenish, they don't bulge, common to legs

Prevention

To prevent veins, follow these tips from Lynn Moya

• Maintain an ideal weight for your height, body structure and age
• Avoid standing for long hours
• Wear comfortable shoes or support stockings
• Limit sun and heat exposure - warm temperatures will dilate blood vessels
• Exercise regularly
• Eat healthy meals
• Avoid tight clothing where your veins are prominent

Assessment

Every patient is unique, says Dr. A. Malik, a surgeon at the Peel Laser and Vein Clinic in Brampton, Ont. If you are going to a new doctor for your treatment, make sure that your practitioner asks for your complete history so that he or she can better understand you. An assessment may include a duplex ultrasound or a venogram - a procedure that uses an X-ray machine to look at your veins. Once the doctor has assessed your situation, he'll be able to make a recommendation for the most appropriate procedure to treat the veins.

Treatment options

Surgery

The most invasive of treatments, surgery is usually performed when the valve that connects the leg to the body doesn't work, says Malik. The surgery is performed in a hospital, and the doctor either removes the vein entirely or it is tied off surgically so that the blood flowing to the heart doesn't flow back down the vein, making the legs swell. In some cases, patients fall in a "grey area" between surgical and nonsurgical treatment, and since surgery is covered by provincial insurance (such as OHIP), it can be a more attractive option for some patients.

Treatable areas: Varicose veins requiring surgery are found in the legs.

Length of treatment: 30 to 60 minutes, depending on whether surgery is performed on one or both legs. Recovery time is 24 to 48 hours.

Cost: Surgery is covered by provincial insurance.

Possible side effects: Scarring, bruising, swelling and, though rare, infection can occur.

Sclerotherapy

This type of treatment has been around for nearly 100 years, and is a very common treatment used for varicose, reticular and spider veins, says Nancy Luther, registered nurse at the Sherlase Clinic in Markham, Ont. Registered nurses can perform sclerotherapy when working under the directive of a physician. An irritant, usually a mixture of dextrose and saline, is injected into the vein. The substance causes the inner walls of the vein to be irritated. As a result, "the vein swells inwardly, sticks together, dries out and fades," says Luther. A vein may need to be injected a second time or the solution may need to be strengthened. Larger-sized veins are treated first because they feed into the smaller veins, says Moya. Injections feel like pinpricks and, afterwards, compression stockings or bandages are used to aid in closing down the veins.

Treatable areas: Legs and face.

Length of treatment: Treatments can range from three to eight sessions, with 15 to 60 injections per visit. Sessions are generally two weeks apart.

Cost: Treatment is covered by provincial insurance if veins are over 5 mm in diameter and painful. Otherwise, costs range from $70 to $125 per session, depending on the clinic and the number of injections.

Possible side effects: Redness, bruising, hypo- or hyperpigmentation, and slight, temporary irritation can occur. Veins can return, often to the same area, says Luther. However, there is no limit to the number of treatments you can undergo without risk.

Laser

"Sometimes, veins are too small for sclerotherapy to be successful. In these cases, lasers are used," says Dr. Brown of the Yorkville Vein Clinic in Toronto. They are also ideal for needle-phobes. The laser coagulates the blood, which causes the vein to shut down, and slowly it disappears. Patients should notice a difference in two to three weeks.

Treatable areas: Lasers are usually used for cherry hemangiomas, reticular veins and spider veins on the face and legs.

Length of treatment: Two to three treatments, six to eight weeks apart.

Cost: Laser is not covered by provincial insurance and costs range from $100 to $350 per session, depending on the clinic and the duration of your treatment. Most treatments take one to two sessions.

Possible side effects: Burning, pigmentation or redness. After the treatment, a cold compress applied to the affected area can help constrict blood vessels. Heat and exercise should be avoided. You should avoid sun exposure for two to three weeks before, during and after the treatment, advises Dr. Brown.

What's New?

EVLT (Endovenous Laser Treatment)

A new, minimally invasive laser treatment called the Endovenous Laser is being used instead of surgery at some clinics. EVLT can be performed as an outpatient procedure in as little as 45 minutes, under a local anesthetic, with less chance of scarring.  Since it is a new treatment, however, it is not ideal for all candidates; it's not covered by provincial health coverage, and can cost anywhere from $2000 to $4000.

Be Prepared

What you should know about your doctor:

1. What are the doctor’s qualifications? Find out if the doctor is a family practitioner or specialist, if he/she is a member of the Royal College of Physicians and Surgeons of Canada or fellow of the American College, how long he/she's been performing the procedure (some clinics have been around for 20 years, some more recent) etc.
2. How many procedures has the doctor performed? In the case of surgery, the learning curve is around 50, says Dr. Malik. With sclerotherapy and laser, it's best to visit a variety of clinics before choosing one.
3. Will you get to see the doctor at each session? In surgery, always. Though sclerotherapy and laser are often performed by an RN, they should be under the directive of a physician.
4. What are the staff's qualifications? Are the RNs experienced in the procedure?

Is it possible to speak to previous patients?