Varicose veins appear raised above the surface of the skin, are flesh colored, are often twisted and turning, and are larger than the diameter of a pencil. The most common locations for medical varicose veins are the inner thigh or calf, or behind the knee and calf. You may experience pain or discomfort such as heaviness, tiredness or aching, especially with prolonged standing. Other symptoms of varicose veins are swelling, throbbing, restlessness or cramping at night. Varicose veins are often accompanied by spider veins – small pink or purple veins, raised greenish blue veins, or even a bleeding surface vein. For information regarding spider or surface veins and their treatment, click here.

Heredity is the most common factor, and is aggravated by prolonged sitting or standing, pregnancy, excess weight, and hormonal changes, among other factors. Surface varicose veins develop due to underlying venous insufficiency of the saphenous veins, located between the muscle and surface fat layers. With insufficiency, the saphenous veins do not function properly due to faulty valves. This allows the blood to flow downward instead of only upward. The downward pressure causes varicose veins to eventually appear. These veins typically increase in severity over time and may contribute to significant medical issues such as chronic swelling and pain, thinning and discoloration of the skin, increased risk of blood clots, and poor healing, which can lead to venous ulcers of the legs.

If your vein screening indicates venous insufficiency, you will be seen for a medical diagnostic ultrasound. This can be performed in the office in about one hour and is painless. You receive the results immediately, along with your personalized treatment recommendations. Many insurance companies consider an ultrasound and necessary treatment to be an insured procedure, but you will need to check your policy regarding coverage.

When venous insufficiency of the saphenous veins is diagnosed, the treatment of choice is an out-patient procedure called endovenous laser ablation, or EVLT. Surgery is now rarely required to treat these veins. With EVLT, after local numbing with lidocaine, a laser is moved through the saphenous vein to heat it till the vein is damaged and shut down. There is no cutting – the laser fiber is inserted into the vein through a needle. Anesthesia is with local numbing – so you can actually drive yourself home. Compression stockings are worn after treatment, and you are able to return to normal activity with the exception of heavy lifting and strenuous exercise.

Once the underlying venous insufficiency is treated, your surface varicose veins may still be apparent due to blood flow from other low pressure veins. At this time sclerotherapy is performed to shut down the remaining surface vein, as well as any spider veins. Click here to link to sclerotherapy information.