Varicose veins are large, swollen veins that often appear on the legs and feet. They happen when the valves in the veins do not work properly or leak. Dysfunctional valves cause venous blood to flow in the reverse direction leading to a variety of problems. This is a common disorder, with about 1:4 adults being affected. Females, for a variety of reasons, are more likely to have them.
Some of the more common risk factors of acquired varicose veins are gender, obesity, family history, occupation, and previous blood clots in the legs.
Many people with varicose veins experience no symptoms. In this population, they may be more of a cosmetic concern. However, a significant percentage of patients with varicose veins have symptoms such as leg pain, leg fatigue and heaviness, leg swelling, skin coloration changes of the legs, thickening of the skin along the ankle area, and in some cases skin breakdown, ulcers and cellulitis.
The diagnosis is relatively straight forward. Your vein specialist will take a thorough medical history and perform an appropriate physical exam, which may include an ultrasound of the veins. Determining the cause of the varicose veins is more involved and usually requires imaging studies such as ultrasound, CT, and sometimes MRI.
Treatment for asymptomatic varicose veins is usually focused on preventing the worsening of the condition. This may involve wearing compression stockings when performing prolonged standing activities, weight loss, exercise, and control of sleep apnea if present. For some patients there are cosmetic concerns so getting rid of the veins is their preference. Fortunately this can be done with minimally invasive procedures such as ultrasound-guided sclerotherapy and/or micro-phlebectomy.
Patients who are symptomatic usually require more extensive treatment. The goal in these patients is not cosmetic but rather reduction of symptoms. Addressing abnormal flow patterns in the superficial veins of the legs (which the varicose veins drain into) before treating the varicose veins is important. If the source of the problem is not addressed first then new varicose veins will appear, even after the initial ones are removed.
Previously, treatment of symptomatic varicose veins required vein stripping procedures. These procedures were done in the hospital under general anesthesia and resulted in a rather lengthy recovery. We now have several minimally invasive office procedures that are as effective as vein stripping, require only a local anesthetic, and have virtually no or minimal downtime.
We strongly encourage patients with this condition to set up a consultation. Varicose vein disease always progresses over time. In most cases the long-term complications can be avoided if the condition is recognized and treated early.