Over 80 million Americans are affected by leg vein disease. Leg vein disease comes in many varieties. Small dilated or broken blood vessels on the legs, face, and nose are often referred to as telangiectasias. Telangiectasias on the legs are often referred to as spider veins. Although often occurring without other symptoms, telangiectasias can cause leg heaviness, restless leg syndrome, itchiness, eczema like skin rashes, pigmentary changes to the skin such as brown discoloration around the ankles, and even pain. Larger veins are also affected by vein disease. When the largest blue veins are diseased, they become tortuous, bulging and may often ache. These abnormal leg veins are referred to as varicose veins. They occur because the one-way valves in our veins that help push blood back from our legs to our heart become dilated, flimsy, and no longer function properly. As a result, the veins become more engorged cylinders of blood, eventually dilating to the point that they become varicose veins. Varicose veins are common and typically occur when a strong family history of abnormal leg veins. An individual has a 90 percent chance of developing venous disease such as telangiectasias or varicose veins if both parents were affected by venous leg disease. If one parent has venous disease, a son has a 25 percent change of having vein problems, and a daughter has a 62 percent change of vein problems. Even if there is no parental history of leg vein disease, an individual still has a 20 percent lifetime risk of developing abnormal leg veins. Venous disease becomes more common with older age. In young adults before age 30, the prevalence of leg vein disease in women is around 10 percent and in men less than 2 percent. By the age of 40, over 40 percent of women and approximately 25 percent of men suffer from telangiectasias and varicose veins. By age 60, 70 percent of women suffer from leg veins such as varicosities and spider veins while over 40 percent of men have venous disease. As demonstrated by the disproportionate percentages between the genders, it is clear that woman are affected by leg vein disease much more often then men. Estrogen can dilate the veins, and this may provoke the worsening of poor leg circulation. The risk of leg vein disease such as varicosities increases with each pregnancy. With a first pregnancy, only about 13 percent of women developed leg vein disease. With a second pregnancy, 30 percent of women suffered from spider veins or varicose veins. By a third pregnancy, 57 percent of women had varicosities or telangiectasias indicative of venous disease of the lower extremities. Activity level also plays a role in the development of leg vein disease. A study of factory workers looked at employees, their activity level, and the presence of venous disease. Individuals whose work allowed frequent walking had a prevalence of leg vein disease of only 6 percent. When someone's job required long periods of sedentary activity or sitting long periods of time, the risk of developing spider veins and varicose veins increased to 29 percent. When a job involved long periods of standing, there was a 65 percent chance that leg vein disease was present. There is a stepwise approach to treatment of leg vein disease. Large vein disease much be dealt with first, and then the smaller veins approached once the varicose veins are improved. The standard of therapy two decades ago for varicose veins was vein stripping. This required hospitalization, was painful, and left very unappealing results with significant cosmetic concerns in terms of scars on the legs. Today, bulging veins called varicose veins are treated with endovenous laser ablation (EVLA). EVLA is completed in an outpatient center using just local numbing called tumescent anesthesia. Endovenous laser ablation allows a small laser fiber to be inserted into the varicose veins, heat it, and seal it so that it is permanently closed off. If no varicose veins are present and spider veins or telangiectasias are the main issue, sclerotherapy can be used to eliminate unsightly leg veins. Blue visible veins that are not swollen are called reticular veins. These veins feed the smaller spider veins, and they should be treated with injection sclerotherapy just as the small spider veins are treated. The goal is to treat the entire superficial venous system, including all spider veins and reticular veins. Sclerotherapy is nearly painless and is completed in a dermatology office during a short procedure. A series of treatments with sclerotherapy is necessary for a meaningful result. Dr. Melanie Palm of Art of Skin MD is a vein specialist in San Diego that has written medical journal articles on sclerotherapy and presented research regarding advancements in endovenous laser ablation.