What You Need to Know About Varicose Veins

It’s summer in the Pacific Northwest, and if you’re stressing every time you put on shorts, skirts or dresses that show your veiny legs, you are not alone.
By the age of 70, about 60-70% of women will have some varicose veins, estimates Dr. Mark Meissner, a surgeon at the Vascular and Endovascular Surgery Clinic at UW Medical Center – Montlake. 

The bad news: there isn’t much you can do to prevent them. 

The good news: Although varicose veins can cause symptoms, serious complications are rare and there are treatment options available. 

What are varicose veins?

Varicose veins, and their milder counterpart spider veins, are enlarged, twisted veins. They can affect both men and women and most commonly involve the legs (due to gravity).

In normal veins, flow is directed toward the heart by one-way valves in the veins. Over time, patients with varicose veins lose elastic tissue in the vein wall and the vein wall dilates. This can cause the valves to become leaky and allows blood to pool in the dilated veins, causing them to become enlarged (hence their raised and visible appearance).

Although uncomfortable and embarrassing for some, varicose veins rarely cause serious health problems. 

What’s the difference between spider veins and varicose veins anyway?

Spider veins and varicose veins often get confused. Here’s the difference.

There are six classes of lower extremity venous disease, with six being the most severe. Spider veins (class one) and varicose veins (class two) are both at the “no need to panic” end of the spectrum. 

Spider veins, named for their weblike appearance, are a milder type of varicose vein. They are often 1 millimeter in diameter and red to purple in color. They are not raised and you can’t feel them with your finger. Mostly these veins are asymptomatic but may be a cosmetic concern. 

Varicose veins are slightly larger, greater than 3 millimeters in diameter. They are raised and can be either skin-toned or blue. In most patients, symptoms are limited to aching, swelling and itching. However, a few patients — Meissner estimates about 1-2% of people — may experience ulcers or sores around their ankle.

Are varicose veins preventable?

The short answer: no.

The long answer: no, and here’s why …

“For most people, the two biggest determinants are genetics or pregnancy,” says Meissner.

Family history, for both men and women, plays an important part in your likelihood of developing varicose veins and is genetically multifactorial, meaning no single genetic problem can be identified but both genetic and environmental factors can trigger it.

Pregnancy can cause varicose veins to worsen in people who are predisposed. Meissner notes that although the veins often get better after pregnancy, they are often still worse than before pregnancy. 

Other risk factors you might hear talked about with vascular disease, conditions that affect the arteries and veins, are birth control and obesity. 

Birth control and oral contraceptives do not raise your chances of getting varicose veins, but they do raise your risk of complications, like blood clots, if you already have or develop varicose veins.

Some studies suggest obesity could be a risk factor while others don’t. Even though the data is inconclusive, we do know staying active and healthy is the best preventative measure.

Are spider and varicose veins treatable?

Although varicose veins are not preventable, at-home care can calm minor symptoms. If your pain is more severe or you want to remove the veins for aesthetic purposes, you have treatment options.

At-home treatments

If your varicose veins are not causing you any pain or swelling, then surgical treatment is usually not necessary. At-home treatments, like leg elevation and compression stockings, can help symptoms such as aching or swelling. 

Raising your feet above your heart — try laying on your bed with legs propped up against the wall or use a foot stool and some pillows — three or four times a day for about 15 minutes at a time can help reduce swelling and improve circulation. 

Or you can wear compression stockings, elastic stockings that squeeze the veins and prevent blood from pooling.

Surgical treatments

If you are experiencing more severe symptoms, or if you are not aesthetically vibing with your veins, you can talk to your doctor about surgical treatments. Meissner says that one of the most common aesthetic procedures for spider veins is sclerotherapy. 

“Sclerotherapy requires injections of a medical-grade detergent called sclerosant into the veins. Usually a patient needs about two to three treatments,” says Meissner. “It is effective, done in the office, the needles are small and the procedure is usually well tolerated.”

Generally, the in-office procedure takes 30-45 minutes and patients are expected to wear compression stockings for two weeks after the procedure. 

There are many other options out there for you to discuss with your doctor, like endovenous ablation or radiofrequency ablation, a minimally invasive procedure that uses thermal heat to destroy the vein, or a microphlebectomy, where a hook-like tool is inserted through small incisions to remove the varicose veins.

“The treatment and technology has evolved so rapidly over the last 20 years,” says Meissner. “Time to recovery used to be five to seven days after vein stripping operations. The average patient now has only a few days of mild discomfort and often can go back to work within a day or two.”

Meissner says that if you are considering surgery, your biggest decision factor should be how bad your veins are interfering with your quality of life. So, if you are not feeling like your best self because of your veins, start the conversation with your doctor.

“If compression stockings don’t work or your veins are uncomfortable to the point where you can’t play with your kids, then that is a consideration that you should take care of them,” says Meissner.

The bottom line

Compression stockings and in-office procedures are not preventative, they only treat your symptoms at the time. And, as Meissner explains, spider and varicose veins tend to progress over time, so even if you do receive treatment you might develop more as you age.

That said, if your varicose or spider veins are impeding your quality of life, it’s time to give your doctor a call.