Neil M. Khilnani, MD
c, phlebologist at Weill Cornell Vascular and associate professor of interventional radiology at Weill Cornell Medical College and New York-Presbyterian Hospital/Weill Cornell Medical Center, all in New York City.
Up to 25% of all women in the US and about half of women age 55 and older have varicose veins. Men also get them but much less often.
What goes wrong: Veins, unlike arteries, are not simply hollow. They’re lined with a series of one-way valves. Pressure — from the movement of muscles, for example — pushes blood upward through the valves. The valves intermittently open and close, allowing blood to move upward without being pulled back down by gravity.
In people with varicose veins, the vein walls dilate and lose elasticity, causing the valves to weaken. Result: Blood flows backward, rather than circulating to the heart. The veins may appear blue from deoxygenated blood. If enough blood accumulates, the veins enlarge, causing unsightly bulges and twists. “Spider veins” are similar to varicose veins, but they are smaller and closer to the skin’s surface.
Most varicose veins occur in the legs because gravity exerts more pressure on those rising columns of blood.
People with a family history of varicose veins are more likely to get them. These veins often occur during pregnancy. The surge in progesterone that occurs during the first trimester causes blood vessels and valves to weaken. Obesity and prolonged standing also increase the risk.
For many people, varicose veins are primarily a cosmetic concern and unlikely to cause discomfort. Exceptions: Large varicose veins are more likely than spider veins to cause leg fatigue, itching, sensations of heaviness and cramping. Even small veins, however, may cause symptoms.
Caution: In rare cases, pools of stagnant blood in varicose veins can damage the overlying skin and cause ulcers, usually on the ankles. There’s also a small risk of thrombophlebitis, which causes a potentially dangerous blood clot.
People who aren’t bothered by their varicose veins usually can manage them with exercise, weight loss and compression stockings, which are worn all day and steadily squeeze the legs, helping veins and leg muscles move blood more efficiently. Veins that cause symptoms, however, should be checked by a doctor.
Many varicose veins are caused by weakness or leaks in the saphenous vein, a blood vessel that runs through the leg and thigh. Blood from this vein can cause multiple varicose veins to form “downstream.”
Most varicose veins can be treated with laser and/or chemical therapy. A vascular surgeon or a phlebologist, a physician who specializes in the treatment of veins, makes small nicks in the skin (about 3 millimeters long) to insert a tiny laser fiber into the saphenous vein. Heat from the laser seals the vein shut (laser ablation). That section of the saphenous vein eventually fades and disappears over six months to a year. The visible varicose veins may seem smaller almost right away.
The laser procedure takes about an hour and requires only a local anesthetic.
Any remaining varicose veins are then treated with a sclerotherapy or a microphlebectomy…
Insurance doesn’t usually cover the expense of elective cosmetic surgery for varicose veins. But if you have symptoms such as swelling and bleeding that are affecting your quality of life, insurance often will cover the procedures. The insurance company may require that you try other measures first, such as wearing compression stockings.
Improving circulation and muscle tone can reduce your risk for developing varicose veins…
Myth: Doctors used to tell patients with varicose veins not to cross their legs. It was thought that this might constrict the veins and reduce circulation. Not true. There’s no evidence that crossing the legs has any effect on varicose veins.