What can you do about varicose veins?

December 03, 2018
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  • Varicose and spider veins are veins that are no longer working properly. They cause a wide range of symptoms.
  • Compression therapy can be an effective home treatment, particularly when symptoms are mild.
  • The Swedish Vascular Surgery team offers a variety of varicose vein treatments.

Varicose and spider veins aren’t especially attractive — but there are more reasons than just that to go get them checked out. If left untreated, these problematic veins can lead to a variety of symptoms including swelling, pain, and even ulceration.

“Until people experience some of the complications and severe symptoms, they don’t realize that these veins can be lifestyle-limiting,” says Kira Long, MD, a vascular surgeon with Swedish Vascular Surgery. However, treatment options have advanced in recent years, leading to a range of less-invasive therapies. These days, open surgery is rarely performed on varicose or spider veins.

Dr. Long shares insights on varicose and spider veins: what they are, who is at risk, and what to do about them.

What are varicose and spider veins?

Varicose veins are enlarged, raised clusters of veins on your legs. Spider veins are tiny, very fine veins just below the skin surface. In both cases, they are veins that aren’t working properly.

We mostly see them in the legs, because that’s where gravity tends to send the blood. The veins are supposed to return all the blood to your heart; but when those venous systems start to fail, the increased pressure causes veins to become dilated, twisted and uncomfortable.

What symptoms do they cause?

There can be a range of symptoms. Some people will never experience symptoms at all. They’ll just notice they have veins visible on their legs. Others might notice some mild swelling. But even mild symptoms can progress to severe ones, such as heaviness and pain. Walking around or staying in any one position for a long period of time can become uncomfortable; and when the veins get really inflamed, there can also be itchiness, or ulceration which can become serious.

Varicose and spider veins have the reputation of being a cosmetic issue, but they can cause real problems. They are blood vessels that are under pressure, just like arteries, and when they get bad enough to bleed, it is a cause for concern.

Who is at risk?

In general, women are at higher risk than men. Pregnancy, weight gain, obesity, and any occupation that involves prolonged standing also increases risk.

Although a specific gene hasn’t yet been isolated, there is a strong correlation with family history. In other words, you might have a genetic predisposition that your veins will tire out over time. If you’re a woman and both of your parents had varicose veins, there’s around a 90% risk that you will develop them. If you’re a man, it’s slightly less. If just one parent had varicose veins, women have a 65% risk; for men, it is 25%.

Having a history of DVT (deep vein thrombosis, or blood clots) — whether the cause was a clotting disorder, cancer, surgery, or something else — is also a predisposing factor. There is also some evidence that people who have had varicose veins for a long time may be at increased risk for developing future blood clots.

The majority of people begin to develop varicose and spider veins in their middle or later years.

What can I do?

It is best to intervene early, and compression is the cornerstone of therapy. Over-the-counter compression stockings can be effective: try the sport ones that go from your toe all the way up to your knee. The calf sleeves (without feet) are not as effective and, in some cases, the foot can get even more swollen because you haven’t compressed the entire area.

If your swelling is severe, or if you have very visible varicose veins, you may need prescription strength compression stockings. These are stronger and tighter.

Other helpful things that you can do are to exercise regularly and lose excess weight. Also, leg elevation — putting your feet up at the end of the day and/or on a couple of pillows overnight while you sleep — will help ease the swelling.

What treatments for varicose veins does Swedish offer?

An evaluation at Swedish Vascular Surgery typically begins with a visit to our state-of-the-art vascular lab, where you receive an ultrasound and venous reflux duplex study. This involves lying on a table with your head tipped up, while technicians perform an ultrasound on the veins in the leg, or both legs, depending on your symptoms. They will look for reflux in the veins by asking you to do things like cough or bear down, to see if increasing that pressure causes the blood flow to reverse — which it shouldn’t. They will also assess for any blood clots.

Historically, therapies have involved open surgery. This meant removing veins through either a big incision or a number of smaller ones. Now, there are options, called endovenous procedures, which can be done right in the office.

There are a variety of therapies such as RFA (radio frequency ablation) or laser therapies. There are also injection therapies, such as sclerotherapy, using foam, chemical adhesive or medication injected directly into the veins in question in order to effectively “shut them down.”

Does insurance cover these procedures?

If your concern is not primarily cosmetic, most plans will cover these therapies once you meet certain qualifying criteria. If the main symptom is swelling, or pain at the site of the vein, most insurance companies require that you first try compression therapy on a daily basis for a varying amount of time. If you have ulceration, compression is often not effective, so insurance will generally cover one of the other therapies.

What next?

Learn more by visiting the American Venous Forum.

Ask your primary care physician for a referral to the Swedish Vascular Surgery clinic. You can find a Swedish physician in our online provider directory.

Subscribe to the Swedish blog and we’ll bring the health news to you. Read more of our heart and vascular articles.

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.