What Are Varicose Veins

Varicose veins can affect up to 70% of females in some form, including spider veins, varicose veins, and venous insufficiency. Varicose veins are unnatural abnormal dilations in our leg veins due to venous insufficiency. The abnormal veins may appear blue or purple veins on the skin and are commonly seen with other signs of vein disease. 

Fortunately, a large number of affected individuals remain asymptomatic and treatment is mostly conservative to prevent progressive disease.  However, symptoms including leg pain, especially after prolonged sitting or standing, swelling, restless legs and heaviness may indicate compromised venous circulation.  On the skin, this can manifest as spider veins (telangectasias), reticular veins, skin discoloration, skin eczema, and venous ulcers.   If you experience any of these physical or subjective symptoms, early evaluation by a vein specialist is advised. 

What Causes Varicose Veins?

Varicose veins results from the failure of one-way valves in our leg veins.  As a result, blood pools in the lower extremities and leads to increased tension in our leg veins (venous hypertension).  The cumulative effect is disruption in the normal return of blood from the legs back to the heart leading to congestion.  With time, abnormal blood vessels can form including varicose veins that present on the skin.

Genetic predisposition is the main factor in the development of varicose veins.  Family history is important to consider with early signs of vein disease.  Additional considerations include medications, prolonged standing or sitting, hormonal therapy, smoking, obesity and pregnancy.

When To Consider  A Vein Evaluation

• Leg pain especially after prolonged sitting or standing
• Swelling in the ankles, feet, and calves (i.e edema)
• Venous eczema
• Skin discoloration 
• Restless legs at night associated with cramps
• Pelvic discomfort or pelvic congestion syndrome

Vein Treatment

The management of venous disease with symptoms is a mix of conservative treatment and sometimes minor medical procedures.  The main intent is to reduce symptoms by minimizing blood pooling in the lower extremities. 

Conservative Treatment

• Compression stockings
• Leg Elevation
• Comfortable shoes (avoiding high heels)
• Warm compresses especially if the veins feel tender or painful
• Diosmin (medical food that improves venous dynamics)
• Horse chestnut extract

Medical Interventions

When symptoms persist or advanced conditions such as swelling, skin discoloration or skin eczema are present, vein interventions are strongly considered.  The appropriate treatment is selected based on the expertise of the vein doctor and findings on venous ultrasound.  A map of the abnormal veins can be obtained with what is referred to as a venous reflux study using ultrasound. 

• Vein Ablation
• Ultrasound-guided Sclerotherapy
• Venaseal 
• Ambulatory Phlebectomy 

The gold standard for treatment of saphenous vein disease is vein ablation.  The minimally invasive procedure is performed in a simple office setting using local anesthetic. The procedure takes about 30 minutes and uses heat energy to re-route blood to healthier veins in the legs.   
Vein glue provides similar results, however is done using catheter based delivery of a medical glue to seal the abnormal veins shut.  At this time, insurance coverage is limited for the new vein glue, but will likely increase with continued adoption of this minimally-invasive technique that is favored by many patients due to improved procedural comfort. 

To determine if you are a good candidate for vein treatment, reach out to your local vein clinic for a consultation.