WHAT ARE VARICOSE VEINS?

Part of that answer is obvious.  Varicose veins are abnormal veins that become more and more visible because of their color and/or size. 

Blood flows through the veins on its way back to the heart.  The blood must flow through the veins against gravity.  To help with the movement of blood against gravity the veins have valves to keep the blood from flowing down toward the feet.  Varicose veins are veins with broken valves that allow the blood to flow the wrong direction.  The blood flowing in the wrong directions stretches the vein longer and bigger.  Stretching the vein longer makes it begin to curve back and forth in the leg.  Stretching bigger makes the vein bulge out from the surface of the leg.  So, the bottom line is varicose veins have leaky or broken valves.

DO I HAVE VARICOSE VEINS?

If you think you might have varicose veins you probably do.  Even the tiny red web-like veins referred to as spider veins are a form of varicose veins.  20% of people with “just spider veins” actually have problems with their larger veins.  These larger veins need to be treated to make treatment of the spider veins more effective.

WHAT IS THE DIFFERENCE BETWEEN SPIDER VEINS AND VARICOSE VEINS?

Spider veins are small, sometimes tiny, and varicose veins are big.  That is basic the difference.  Both are caused when valves are damaged and the veins begin to get larger.  Both are treated by removing the veins from the circulation.  When you understand that varicose veins and spider veins are part of the same disease it is not surprising that 20% of patients who have “just spider veins” will actually have significant reflux (reverse or backward flow) in the larger veins.  In these individuals treatment of the spider veins will be unsatisfactory as they will quickly recur.  For all these reasons it is important to have your veins carefully evaluated by a Phlebologist.

Although spider veins often cause some discomfort such as itching, burning, throbbing, they may not cause discomfort or medical problems so your insurance company probably will not reimburse you for treatment.  Varicose veins caused by refluxing blood in the larger veins usually cause symptoms and may cause significant medical problems so your insurance company often will reimburse you at least partially for the cost of treatment.

DO MEN GET VARICOSE VEINS?

Yes.  Approximately 30% of the population gets or has varicose veins.  This estimate depends on many factors.  We see more women in our practice than men but there are many reasons for this.  Basically women’s legs are seen more often than men’s.  Women also have different expectations about the looks of their legs than men therefore they  generally want their varicose veins treated sooner in the disease process than men do.  When we see men with varicose veins it is often at a later stage of the disease.  Their veins look a lot worse and they may have more symptoms or actual problems with the veins.

WHY ARE VARICOSE VEINS HARMFUL?

The blood travels from the heart out the arteries, into the capillaries where oxygen and nutrients are released into the tissues, and carbon dioxide and other waste products are picked up to be taken back to the lungs, liver, and kidneys to be removed.  Veins carry blood back to the heart from the legs.  By the time the blood travels through the arteries and capillaries there is not much force left from the pumping of the heart to push the blood back up the legs against gravity.  So, to get the blood to travel back to the heart requires a pump.  The leg muscles are the pump.  When the muscles contract the blood is forced through the veins.  But, to make the blood flow in only one direction, toward the heart, you need a mechanism to stop the flow away from the heart.  That’s what the valves are for.  There are valves in all the veins, even the tiny venules that if damaged cause spider veins.  When there are damaged valves the blood can flow back down the veins.  This refluxing blood is full of carbon dioxide and other waste products.

If valves are damaged, blood refluxes, and stays in the legs longer than it should.  When the blood pools in the damaged veins the concentration of “bad stuff” increases and will become damaging to the tissues. 

This damage starts by making your legs feel bad, i.e. itching, throbbing, burning, fatigue, or restless legs.  Then it begins to cause real damage i.e. swelling, thickening of the skin, high risk of dangerous blood clots, skin discoloration, and skin damage leading to open sores on the ankles and lower legs.  The open sores are called venous stasis ulcers.  These are the reasons it is important to treat varicose veins before they become severe, even if you are not very concerned about the looks of your legs. 

HOW DID I GET VARICOSE VEINS?

You probably inherited them from someone in your family.  Some of us have inherited weak or dysfunctional valves in our veins.  Sometime during our lives this begins to show itself as varicose veins.  Since the valves don’t work correctly or not at all in some areas, the blood is actually allowed to flow away from the heart.  This causes increasing pressures in the veins, and the veins stretch.  The veins increase in diameter, and length.  Since your leg does not get longer the veins have to bunch up, curve back and forth and eventually look like the bulging tortuous veins we know as varicose veins.

There are factors that increase your likelihood of developing venous reflux (blood flowing in the wrong direction) such as standing or sitting for long periods of time without moving much, hormonal changes, pregnancy, or doing a lot of lifting while standing.  These factors only speed up the process in someone who already has the inherited tendency for varicose veins.  It has been said that obesity is a risk factor but there is now data to show that by itself obesity may not be a risk factor.  Inactivity is a risk factor, and this often is associated with obesity.

Sometimes direct trauma to the leg, such as a blow to the leg can rupture a vein valve and start the process of varicose veins.  Surgery can also damage veins. 

Can Varicose Veins be prevented?

You cannot change an inherited tendency for any specific condition.  But, there are things you can do to slow the progression of varicose veins if you have the inherited tendency to get varicose veins.  Maintaining a healthy weight, and exercise program is probably the most important preventive measure.  If you have a job where you sit a lot, or stand in one place for long periods of time you should get up and move around as frequently as possible.  You will also feel better at the end of the day if you wear medical grade compression stockings.  These are different than support hose you buy at the department store.  Compression stockings should be bought at a pharmacy or medical supply store so they are fitted properly.  There are several internet stores that specialize in selling compression stockings as well.

Some herbal preparations that may decrease the discomfort from varicose veins.  Most of these are probably extracted from or include Horse Chestnut extract.

WHAT SYMPTOMS ARE CAUSED BY VARICOSE VEINS?

Chronic venous insufficiency can cause a number of symptoms.  These may include itching, burning, throbbing, pain, day or night cramps, heaviness, fatigue, and even restless legs.  Some skin rashes on the lower legs may be caused by chronic venous reflux.  Sometimes the discomfort is worse just before or during menstruation, during or after exercise, or when the weather is especially hot.  Varicose vein disease can also cause swelling, skin discoloration, skin rashes, severe bleeding from veins that are very close to the surface, permanent scarring of the skin especially around the ankles, and can lead to painful, and dangerous skin ulcers around your ankles. 

DOES PREGANANCY CAUSE VARICOSE VEINS?

Yes and no.  Many women go through pregnancy without getting varicose veins.  But, many women without varicose veins develop venous reflux and varicose veins during the pregnancy.  Why do some women get them and some don’t?  Women must have the inherited weakness in the valves that predisposes them to varicose veins.  Then during the pregnancy as the level of progesterone rises to maintain the pregnancy and get the pelvis ready to stretch during the birthing process the veins stretch more easily as well.  When the veins get larger in diameter the valves don’t reach all the way across the vein, and reflux will begin.  If the reflux lasts long enough it may permanently damage the valve.  This is why varicose veins sometimes go away after the pregnancy is over.  Repeated insults to the valves may result in permanent damage.  This is why women who become pregnant several times increase the likelihood of having permanent damage to the valves and developing varicose veins that do not go away.  

SHOULD I WAIT UNTIL ALL MY PREGNANCIES ARE OVER BEFORE GETTING MY VEINS TREATED? 

The evidence says no.  Varicose veins carry several risk factors; one of the most dangerous is an increased risk of blood clots.  Pregnancy also increases your risk of blood clots.  The two together compound the risk.  Having the veins treated before the next pregnancy will probably decrease this risk.

If you have your varicose veins treated between pregnancies you will most likely protect yourself from more severe varicose veins, and you will decrease your risk of blood clots.  You will also be more comfortable through your pregnancy and be able to stay more active.  All this is good for you and your baby.

BUT WON’T THE VARICOSE VEINS JUST COME BACK WHEN I GET PREGNANT AGAIN?

It is true varicose veins may show up during your next pregnancy.  But, the veins we treat will not come back.  Those veins are gone.  The number and severity of the veins you get with your next pregnancy will be reduced if you get them treated before your get pregnant again.  This is because you had the venous hypertension (high pressures in the veins that result from varicose veins) has been treated.

It is important to realize that people, who get varicose veins, get varicose veins.  What this means is if you have weak valves in your veins other valves in veins that now seem normal may become damaged and other veins will become dilated and visible.  But, when veins are treated the overall pressures in the veins are decreased and the rate of deterioration slows.  It will probably be many years before you have significant problems again.

HOW ARE VARICOSE VEINS TREATED?

In general varicose veins are treated by blocking blood flow through the diseased veins, or removing the diseased veins from the circulation.  This removal or blocking can be done in a variety of ways.  In the past veins were removed with a surgery called ligation and stripping.  It was a major surgery and was not nearly as effective as today’s methods.  Most Phlebologists use a form of endovenous thermal ablation to cause veins to collapse and scar closed.  Sclerotherapy, a procedure where solutions are also injected into veins to make them collapse is also used by most Phlebologists.

Once the diseased veins are removed the venous system functions much more efficiently.  The veins work better even though some of them are gone.

To learn more about the specific treatments used at bod:evolve veins go to the procedure pages for EVLA, Sclerotherapy, and Ambulatory Phlebectomy.

DON’T I NEED THOSE VEINS THAT ARE BEING BLOCKED OR REMOVED?

No.  Those veins are causing problems in your circulation.  Since you have a lot of “extra” veins in your superficial vein system removing the diseased veins will increase the effective function of your venous system and the overall health of your circulatory system.  

Will my insurance plan cover the costs of the treatment?

Your health insurance will often pay for at least part of your treatment.  If you have vein disease that is interfering with your normal activities, causing pain or discomfort, or secondary problems such as swelling, leg cramps, scarring, or other changes it is usually considered a medically necessary treatment by your insurance company.  Insurance companies want to make sure that conservative treatments such as compression stockings, over the counter pain medications, elevating your legs, regular exercise, and maintaining a fairly normal weight have not been effective treatment before paying for more expensive treatments such as endovenous laser ablation.  Usually conservative treatment will not permanently treat varicose veins, and more aggressive treatment will be needed.

How much does it cost?

It depends.  We need to see your legs, and usually we will need to do an ultrasound exam before we can give you a better idea of how much it will cost.  If you are using your health insurance to pay for part of your treatment it will depend on the terms of your insurance. We do have cash prices we can discuss at the time of your initial office visit.  The key is to get your vein disease properly diagnosed, and then we will be able to discuss the cost of your treatment. 

Are the treatments painful?

Current treatments for varicose veins are minimally invasive and cause some discomfort.  Pain is perceived differently by every person so your perception may be that the treatment is somewhat painful.  Many descriptions of varicose vein treatment say things like nearly painless, painless, or minimal discomfort.  These descriptions assume a comparison to ligation and stripping procedures which require general anesthesia and leave the patient’s leg very sore and bruised. 

Office based varicose vein treatment involves a number of injections.  There are injections of the numbing medication around the vein before the laser treatment is done.  This is the most uncomfortable part of the EVLA procedure.  During sclerotherapy there are again a number of injections.  After a sclerotherapy injection there may be a mild burning sensation that lasts from a few seconds to a minute or two.  This is usually mild.

After an EVLA, since the goal of the procedure is to permanently damage tissue, there will be an inflammatory reaction that will cause bruising, swelling, and some pain for up to two weeks.  After the first two weeks as the scar inside your leg matures there is often a pulling sensation when you first get up to move around.  This loosens up quickly just by walking. 

Being this descriptive about the discomfort may not be seen by some centers as good marketing.  At bod:evolve veins we want to be as truthful as possible.  If your expectations are realistic your experience will be more pleasant.  After experiencing an EVLA many of our patients say something like, “that was much easier than I expected” or “are you done already?”

What about facial veins?

Especially in Colorado we are exposed to high doses of solar radiation causing sun damage to the face.  This causes small veins on the face to become dilated and much more visible as we get older.  Some people are more prone to developing spider veins on the face than others.  These veins can be treated with very pleasing results.  Most facial veins are treated with superficial lasers.  For larger veins sclerotherapy or even microphlebectomy can be used.  Bod:evolve veins has a comprehensive range of treatments available.  If there are veins that need more aggressive treatment one of our associated plastic surgeons will be happy to consult and treat if needed.  

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