Varicose veins and telangiectasias in Quebec

Varicose veins and telangiectasias affect a significant proportion of Quebec's adult population - it's estimated that between 25 and 33 % of women and 10 to 20 % of men have some form of visible chronic venous insufficiency. Yet these conditions often remain poorly understood: many are unaware of the difference between a varicose vein and a telangiectasia, the treatment options available in Quebec, and what is and isn't covered by RAMQ. This article presents the mechanisms involved, the clinical criteria that distinguish the different presentations, and the treatments available in medical clinics - from the most common to the most recent.

Varicose veins and telangiectasias - two distinct vascular conditions

The term «varicose veins» is often misused to refer to any vein visible under the skin. In reality, varicose veins and telangiectasias are two different clinical entities, involving distinct vascular structures and pathophysiological mechanisms.

Telangiectasias - small-calibre superficial veins

Telangiectasias are permanent dilations of very small blood vessels in the superficial dermis. They generally measure less than a millimeter in diameter and appear as red, purple or bluish spider-web-like or fan-shaped networks, mainly on the legs, ankles, face or décolleté. They are essentially cosmetic in nature, and generally do not cause functional symptoms. They carry no direct cardiovascular risk.

Varicose veins - larger veins with valvular dysfunction

Varicose veins are pathological dilatations of larger veins in the subcutaneous tissue. They result from a failure of the venous valves - small folds that normally prevent blood from flowing backwards. When these valves no longer function properly, blood accumulates in the superficial veins, which gradually dilate and become visible and palpable. They usually measure over 3 millimeters in diameter, and can be serpentine, protruding and painful. They are sometimes accompanied by heaviness, cramps, itching or edema in the legs - especially at the end of the day or in hot weather.

Reticular veins - between the two

Reticular veins constitute an intermediate presentation: dilated (between 1 and 3 mm), bluish, located just under the skin, they do not protrude like classic varicose veins, but are visible through the skin. They can feed surrounding telangiectasias and often need to be treated at the same time to avoid recurrence.

Clinical classification - CEAP stages

In vascular medicine, the severity of chronic venous insufficiency is assessed according to the CEAP (Clinical, Etiological, Anatomical, Physiopathological) classification, which ranges from stage C0 (absence of visible signs) to stage C6 (active venous ulcer). Telangiectasias correspond to stage C1, and uncomplicated varicose veins to stages C2 to C3. This classification guides the choice of treatment and partly determines RAMQ coverage.

Causes and risk factors - why varicose veins appear

The appearance of varicose veins and spider veins is the result of a combination of genetic predisposition and environmental or hormonal factors. Understanding these factors enables us to identify those at risk and the appropriate preventive measures.

Heredity - the most important risk factor

Genetic predisposition to venous insufficiency is well established. When both parents suffer from varicose veins, the risk for their children is estimated at around 90 %. With a single affected parent, the risk varies between 25 and 62 %, depending on gender. This heredity concerns both the quality of the venous wall and the competence of the valves.

Pregnancy and hormonal fluctuations

Pregnancy is a major trigger. Increased blood volume, compression of pelvic veins by the uterus and the effects of estrogen and progesterone on venous tone favor the appearance or aggravation of varicose veins, often as early as the first trimester. Prolonged use of estrogen-progestin oral contraceptives and hormone replacement therapy during menopause are also recognized contributing factors.

Prolonged standing, a sedentary lifestyle and obesity

Occupations involving prolonged standing or sitting - healthcare workers, teachers, catering or commercial workers - exert increased hydrostatic pressure on the veins of the lower limbs. Obesity aggravates this phenomenon by increasing abdominal pressure. Conversely, regular physical activity (walking, swimming, cycling) stimulates the calf muscle pump and promotes venous return.

Age and gender

The prevalence of varicose veins increases with age, in line with the progressive loss of tone in the vein wall. Women are more frequently affected than men, partly due to hormonal variations associated with the menstrual cycle, pregnancy and menopause. However, men often consult us later, at a more advanced stage, due to less attention being paid to early signs.

Varicose vein and telangiectasia treatments - clinic options

The treatment of varicose veins and telangiectasias has evolved considerably over the last two decades. Heavy surgical approaches have largely given way to minimally invasive techniques that can be performed in medical clinics, without the need for general anesthesia or hospitalization.

Sclerotherapy - the reference treatment for telangiectasia and reticular veins

In sclerotherapy, a very fine needle is used to inject a sclerosing agent directly into the targeted vein. This substance causes irritation of the internal venous wall (endothelium), leading to progressive fibrosis and closure of the vein. Blood flow is then redirected to adjacent healthy veins. The treated vein is gradually reabsorbed by the body over a period of weeks to months. Sclerotherapy is the first-line technique for telangiectasias and reticular veins. For larger varicose veins, foam sclerotherapy (a sclerosing agent mixed with air or CO2) can be used to treat larger diameter veins with greater efficacy. It is performed in consultation, without anesthesia, and generally requires several sessions spaced four to six weeks apart.

Laser and pulsed light photocoagulation - for fine telangiectasias

Laser treatment uses a targeted wavelength of light, selectively absorbed by the hemoglobin in the vein. The heat generated destroys the vein wall without damaging the surrounding tissue - this is the principle of selective photothermolysis. This approach is particularly effective for very fine telangiectasias inaccessible to the sclerotherapy needle, as well as for facial telangiectasias. It can be used alone or in conjunction with sclerotherapy. Several sessions are generally required. After-effects may include temporary erythema or slight ecchymosis.

Thermal endovenous ablation - for large-caliber saphenous varicose veins

For major varicose veins involving the saphenous veins (greater or lesser saphenous vein), thermal endovenous ablation techniques - using radiofrequency (RFA) or endovenous laser (EVLA) - have become the current standard. An optical fiber or radiofrequency probe is introduced into the vein under ultrasound guidance, and thermal energy causes the vein to close. These procedures are performed under tumescent local anaesthesia, without hospitalization, with resumption of activities within a few days. In Quebec, some of these procedures may be covered by RAMQ when medically indicated and documented.

Compression stockings - conservative and adjuvant treatment

Medical compression stockings (MCS) are the basic conservative treatment for chronic venous insufficiency. They exert graduated pressure on the lower limbs, promoting venous return and reducing symptoms. They are recommended for prevention, between treatment sessions, and during pregnancy. Pressure is expressed in mmHg and prescribed according to the stage of the disease and the patient's profile. A medical prescription is required for higher therapeutic classes (class 2 and above).

RAMQ and venous treatments - what's covered and what's not

The question of reimbursement is one of the first questions patients ask when consulting a specialist for varicose veins or telangiectasias. The distinction between medical and aesthetic treatment is central to RAMQ decisions.

What RAMQ covers - documented medical treatment

RAMQ may cover the initial medical assessment (consultation), certain investigations (venous Doppler ultrasound), and treatment of saphenous varicose veins associated with documented complications - venous insufficiency with chronic edema, ochre dermatitis, lipodermatosclerosis or venous ulcer (CEAP stages C4 to C6). In these cases, sclerotherapy or thermal ablation may be covered when performed by a physician as part of a documented and clinically justified medical management program.

What RAMQ does not cover - cosmetic treatment

Telangiectasias - being essentially cosmetic in nature - are not covered by RAMQ, whether by sclerotherapy, laser or photocoagulation. Similarly, varicose veins with few symptoms that are treated for aesthetic purposes are covered by the private sector. The cost of sclerotherapy sessions for spider veins varies according to the surface area treated and the number of sessions. Some private insurances may partially reimburse these treatments - it is advisable to check the policy conditions before starting.

Assessment and treatment of varicose veins in a medical clinic - what the service includes

The management of varicose veins and telangiectasias begins with a rigorous medical evaluation to classify the condition, identify underlying causes and determine the treatment best suited to the patient's profile. Clinique Omicron's professionals, available at several points of service, offer a complete evaluation including a vascular history, clinical examination of the lower limbs and, if indicated, a referral for venous Doppler ultrasound.

Sclerotherapy available in medical consultation

Sclerotherapy for telangiectasias and reticular veins can be carried out directly in consultation with the attending physician, without surgery or hospitalization. Treatment is planned according to the surface area to be treated, the type of vessels targeted and the patient's tolerance. A session-by-session treatment plan is drawn up during the initial consultation, with clinical follow-up between sessions to assess response to treatment.

Referral to specialists for complex cases

When the clinical presentation calls for endovenous ablation or specialized vascular assessment - bulky saphenous varicose veins, signs of deep venous insufficiency, history of thrombosis - a referral to a vascular surgeon or specialized phlebologist is promptly made. The medical team available at the clinic's points of service ensures case coordination and post-treatment follow-up.

Access without a family doctor - no referral required

People wishing to be evaluated for varicose veins or spider veins do not need a family doctor's referral to obtain a consultation at Clinique Omicron. Appointments can be made directly online or by telephone via the clinic's various points of service.

FAQ - Varicose veins and spider veins in Quebec

Q: What is the difference between a varicose vein and a telangiectasia?

A: Telangiectasias are very small superficial vessels (less than 1 mm), essentially cosmetic in nature, forming red or purplish networks visible under the skin. Varicose veins are larger veins (usually over 3 mm), often protruding, caused by failure of the venous valves. They may be accompanied by functional symptoms such as heaviness, pain and edema. Reticular veins (1 to 3 mm) represent an intermediate presentation, often associated with telangiectasias.

Q : Is sclerotherapy painful?

A: Sclerotherapy is generally well tolerated. Injections are carried out with very fine needles and cause a slight burning or pressure sensation at the time of injection, which quickly disappears. Temporary bruising, slight inflammation or transient pigmentation may appear after treatment, but these disappear within a few weeks to a few months. A prior medical consultation is required to assess whether this approach is appropriate for each profile.

Q: How many sclerotherapy sessions are usually required?

A: The number of sessions varies according to the surface area and type of vessels treated. For moderate telangiectasias, two to four sessions spaced four to six weeks apart are generally required. For reticular veins or medium-caliber varicose veins treated with foam sclerotherapy, the number of sessions may be greater. The treatment plan is established individually during the initial assessment.

Q : Can varicose veins come back after treatment?

A: Yes. Treatments for varicose veins and telangiectasias eliminate the treated veins, but do not correct the genetic predisposition to venous insufficiency. New varicose veins or telangiectasias may appear over time. Wearing compression stockings, regular physical activity and avoiding prolonged standing help to slow recurrence. Maintenance sessions can be scheduled according to progress.

Q : Is varicose vein treatment reimbursed by the RAMQ?

A: Partially, depending on clinical indication. Treatment of saphenous varicose veins associated with documented complications (severe venous insufficiency, venous ulcer, chronic dermatitis) may be covered by RAMQ after medical evaluation. Telangiectasia treatment is considered cosmetic and is not covered by RAMQ. Some private insurances offer partial coverage - check the conditions of your contract before starting treatment.

Phlebology (varicose veins) - Venous treatment | Clinique Omicron