Question: What are varicose veins?
Answer: Varicose veins are large, raised, irregular blood vessels that twist and turn. They are often painful and usually develop in the legs as one gets older and more often in women than men. Varicose veins are different from spider veins which are small, red, purple and blue vessels that might be unsightly but are not harmful.
Untreated varicose veins can progress to a more serious form of vein (venous) disease called chronic venous insufficiency (CVI). Occasionally, varicose veins can form a painful blood clot with inflammation of the vein called thrombophlebitis.
It is estimated that 30 percent to 60 percent of adults have varicose veins. Factors leading to the development of varicose veins include heredity, obesity, hormonal influences during pregnancy, puberty, menopause and occupations that involve a lot of standing, such as nurses, hair stylists, teachers and factory workers.
Many patients with varicose veins complain of aching or cramping in the legs. Other common symptoms include tiredness, restlessness, burning, throbbing, tingling, or heaviness in the legs. In women, symptoms could be worse during certain parts of the menstrual cycle or during pregnancy. Patients also could develop swelling, ulcers and an increase in the pigmentation or darkening of the color of their skin, especially in the ankle region.
There are many options for treating varicose veins. The most conservative approach is simply to wear medical grade compressive stockings. Exercise, elevation of legs and anti-inflammatories also help.
Sclerotherapy is a simple, relatively inexpensive procedure performed in the doctor's office. A medication is injected into the veins, causing the vein to scar and disappear gradually over three to six weeks.
Radiofrequency ablation is generally performed under local anesthesia or with sedation in an outpatient setting. During this procedure, a small catheter is inserted into the vein to deliver radiofrequency energy to the vein wall, causing it to heat, collapse and seal shut.
Surgery is generally used to treat large varicose veins. Surgical techniques include ligation (tying off of a vein), stripping (removal of a long segment of vein), and ambulatory phlebectomy (removal of large surface veins through very small incisions that do not need stitches).
Laser treatment is another treatment option that uses heat energy to selectively damage or destroy abnormal veins.
Many insurance companies cover the cost of treating deeper varicose veins, and most patients return home the same day.
Christopher Reising, M.D., F.A.C.S., is a fellowship-trained surgeon with Surgical Associates, S.C. Wausau.