Varicose veins are twisted, enlarged and sometimes bulging veins that are often visible under or through the skin. They are usually dark blue or purple in color.
For many people, varicose veins and smaller spider veins — a mild type of varicose veins — are a cosmetic concern. However, varicose veins can cause heaviness, discomfort, burning, aching and significant pain. Left untreated, varicose veins can lead to more serious problems.
Varicose veins are caused by weak or damaged one-way valves, which return blood from your extremities to your heart to be recirculated, in the leg veins. Muscle contractions in your lower legs serve as pumps to make this happen, and the tiny valves in your veins open as the blood flows toward your heart and close to stop blood from flowing backward. When the walls of a vein become stretched and less flexible, the valves get weaker.
If the valves in the legs don’t work properly, blood flows backward and pools in the veins, causing them to twist and stretch, becoming varicose veins.
Though experts aren’t completely sure why some people develop varicose veins and others don’t, there are risk factors that you should be aware of if you don’t yet have varicose veins:
- Age – The risk increases with age, due to wear and tear on your valves.
- Gender – More women are affected than men.
- Genetics – Varicose veins run in families.
- Obesity – Being overweight or obese increases your risk.
- Menopause - The rise and subsequent drop of estrogen and progesterone during pre-menopause, perimenopause and menopause can create thickened and less flexible vein walls.
- Pregnancy – Women are more likely to develop varicose veins while pregnant than at any other time of life. This is due to having extra blood in their bodies that places additional pressure on the circulatory system, as well as changes in hormone levels that relax blood vessel walls.
- Work – Some jobs — especially those that require standing for long periods of time — increase your risk.
The most common symptoms of varicose veins include:
- Bulging, twisted, swollen blue/purple veins
- Spider veins in the affected leg(s)
- Heaviness, burning, throbbing or cramping in the lower legs, especially after exercise or at night
- Swelling in the lower legs
- Ulcers/sores or rashes on the lower legs
- Skin discoloration around one or more varicose veins
- Irregular whitish patches at the ankles
A varicose vein specialist will look at your health history and do a physical exam of your lower legs to determine if you have varicose veins and the severity of them. The examination will typically include a venous duplex (or duplex ultrasound) of your legs, which provides the specialist with images of the structures of your veins and an evaluation of the blood flow within them.
Varicose Veins: Is Surgical Treatment Right for You? - Jon Stanford, MD
According to Dr. Stanford, a general surgeon with Carollton Surgical Group, surgical treatment usually involves minimally-invasive in-office procedures such as radio frequency ablation, phlebectomy and sclerotherapy that can be completed in one day.
Varicose vein treatments
The treatment for varicose veins will depend on your age, overall health, symptoms and the severity of your varicose veins. Treatments will typically include one or more of the following:
Self-care — such as elevating the legs, losing weight, exercising and avoiding prolonged sitting or standing — can ease pain and prevent varicose veins from progressing. There are also over-the-counter creams and emollients to improve appearance and comfort. However, none of these will heal or remove varicose veins that have developed.
Compression stockings can squeeze the legs and improve circulation. They are tight around the ankles and looser further up the leg, encouraging proper blood flow toward the heart. The amount of compression varies by stocking type and brand. Your vascular physician may provide a prescription so that compression stockings for varicose veins can be covered by insurance.
Sclerotherapy destroys varicose veins by injecting them with a solution called a sclerosant. When injected into a vein, the sclerosant scars the vein and causes it to collapse, forcing blood into healthier veins. The collapsed veins disappear within several weeks or months. For larger varicose veins, the sclerosant may be turned into a foam before being injected, covering a larger surface area than a liquid. Sclerotherapy can be done in your surgeon’s office and does not require anesthesia.
For this procedure, a vascular or general surgeon uses a wire catheter to apply radio waves or radiofrequency energy to the vein wall. This causes the vein wall to heat up, thicken and contract. Over time, the varicose vein will be reabsorbed by the body and disappear. Your vascular physician will do this procedure in the office and will numb each vein prior to inserting the wire catheter.
Endovenous laser ablation
Similar to radiofrequency ablation, laser ablation uses laser energy rather than radiofrequency energy. A laser fiber is inserted into the catheter and — once positioned — laser energy is used, causing the varicose vein to collapse.
Used for smaller varicose veins, this procedure involves removing smaller varicose veins through a series of tiny skin punctures. Only the parts of the leg being punctured is numbed for this outpatient, in-office procedure. Scarring in minimal to none.
High ligation and vein stripping
This procedure involves tying off a vein before it joins a deep vein, then removing the vein through a small incision. This will not affect circulation because veins deeper in the leg will take care of circulating blood. This is generally an outpatient procedure.
Endoscopic vein surgery
This procedure is generally only used for an advanced case of varicose veins when leg ulcers are also involved. A surgeon will use a thin video camera inserted into the leg to visualize, close and remove varicose veins through small incisions. This is generally an outpatient procedure.
When to see a specialist
Varicose veins usually get worse over time, so the sooner you act and a physician intervenes, the better. This is true, even if you follow all of the self-care options listed above. In many cases, while unsightly and undesirable, varicose veins don’t debilitate – but they certainly can hinder an active lifestyle and cause embarrassment. In extreme cases, varicose veins not only hinder activity and cause pain, they also can cause ulcers, blood clots and chronic inflammation. In very severe cases, varicose veins can even rupture.
Varicose vein treatment is generally covered by insurance.
Get a referral
Call 770-214-CARE now for a referral to a varicose vein specialist on Tanner’s medical staff.