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What are varicose veins?

Varicose veins are twisted, enlarged veins. Any superficial vein may become varicosed, but the veins most commonly affected are those in your legs. That’s because standing and walking upright increases the pressure in the veins of your lower body.

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern. For other people, varicose veins can cause aching pain and discomfort. Sometimes varicose veins can lead to more-serious problems.

Treatment may involve self-care measures or procedures by an interventional radiologist to close the veins or a vascular surgeon to remove veins. 

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What causes varicose veins?

Weak or damaged valves can lead to varicose veins. Arteries carry blood from your heart to the rest of your tissues, and veins return blood from the rest of your body to your heart, so the blood can be recirculated. To return blood to your heart, the veins in your legs must work against gravity.

Muscle contractions in your lower legs act as pumps, and elastic vein walls help blood return to your heart. Tiny valves in your veins open as blood flow toward your heart then close to stop blood from flowing backward. If these valves are weak or damaged, blood can flow backward and pool in the vein, causing the veins to stretch or twist.

 

Risk factors leading to varicose veins include heredity, gender, pregnancy, age, obesity, and sedentary lifestyle. Some factors may speed up the development of this disease and make the veins worse, including prolonged standing, obesity, hormone levels, and physical trauma.

Women are more likely to suffer from abnormal leg veins. Up to 50% of American women may be affected. Hormonal factors including puberty, pregnancy, menopause, the use of birth control pills, estrogen, and progesterone affect the disease.

What are the symptoms?

Varicose veins may not cause any pain. Signs you may have varicose veins include:

  • Veins that are dark purple or blue in color

  • Veins that appear twisted and bulging; they are often like cords on your legs

When painful signs and symptoms occur, they may include:

  • An achy or heavy feeling in your legs

  • Burning, throbbing, muscle cramping, and swelling in your lower legs

  • Worsened pain after sitting or standing for a long time

  • Itching around one or more of your veins

  • Skin discoloration around a varicose vein

Spider veins are similar to varicose veins, but they’re smaller and are usually more a cosmetic concern than a symptomatic one. They are found closer to the skin’s surface and are often red or blue.  Spider veins typically occur on the legs, but can also be found on the face. They vary in size and often look like a spider’s web.

Are there complications of having varicose veins?

Complications of varicose veins, although rare, can include:

  • Ulcers. Painful ulcers may form on the skin near varicose veins, particularly near the ankles. A discolored spot on the skin usually begins before an ulcer forms. See your doctor immediately if you suspect you’ve developed an ulcer.

  • Blood clots. Occasionally, veins deep within the legs become enlarged. In such cases, the affected leg may become painful and swell. Any persistent leg pain or swelling warrants medical attention because it may indicate a blood clot — a condition known medically as thrombophlebitis.

  • Bleeding. Occasionally, veins very close to the skin may burst. This usually causes only minor bleeding. But any bleeding requires medical attention.

How do we treat them?

Lifestyle changes may help prevent varicose veins from forming. These changes include:

  • elevating legs while sitting or sleeping

  • wearing compression stockings or dressings

  • avoiding standing for extended periods of time

  • losing weight

  • exercising to improve leg strength

If lifestyle changes do not alleviate symptoms or the pain is severe, your doctor may recommend treatment options, including:

  • Sclerotherapy: this minimally invasive treatment injects a solution directly into the vein that causes the vessel to shrink and eventually disappear. For larger veins, foam is injected to close and seal the vein.

  • Endovenous thermal ablation: this image-guided procedure uses radiofrequency or laser energy to heat and seal off an incompetent vein. Ultrasound helps visualize the incompetent vein, allowing the physician to guide a laser fiber or radiofrequency electrode through a catheter in the vein where heat is applied.

  • Phlebectomy (also known as vein stripping): this minimally invasive procedure uses a small scalpel or needle to remove varicose veins on the surface of the leg through tiny incisions in the skin.

  • Vein stripping surgery: a surgical procedure performed under general anesthesia that involves stripping or removing the entire superficial vein in the leg. Due to advances in minimally invasive procedures, this procedure is rarely done today.

We most commonly perform sclerotherapy under ultrasound and/or fluoroscopic guidance.  Depending on the extent of the varicosities, the procedure may be done in the hospital as an outpatient procedure with moderate sedation.

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