Steven Friedman, M.D.

To understand varicose veins, one must first understand the venous system of the body. The venous system is the part of the circulatory system that returns deoxygenated blood through the veins back to the heart. The arterial system carries oxygenated blood away from the heart to be distributed to all tissues.

Two distinct and common complications that result from venous insufficiency include varicose veins and spider veins. Both of these progressive conditions generally create cosmetic concerns, but can also develop into medical issues as well.

Varicose veins are enlarged, rope-like veins that appear near the surface of the skin. While they can develop anywhere in the body, they are most commonly found in the legs and ankles. In normal functioning veins, tiny one-way valves open as blood flows toward the heart and then close to prevent blood from flowing backward. When these valves malfunction, blood pools in the veins, resulting in a buildup of pressure that weakens their walls and causes them to bulge. The increased pressure can eventually cause additional valves to fail. This venous insufficiency leads to the development of varicose veins.

Causes of chronic venous insufficiency that can lead to varicose veins include:

A genetic predisposition

The normal aging process

Any condition that puts more pressure on leg veins, including standing for long periods of time, being overweight, and pregnancy

Hormonal changes that relax vein walls during pregnancy, pre-menstruation, and menopause

Birth control pills and hormone replacement therapy

History of blood clots

Varicose veins appear most commonly between the ages of 30 and 70.  As the disease progresses, the legs begin to feel heavy, tired, and achy.  These symptoms worsen with prolonged periods of sitting or standing. Muscle cramping may be accompanied by a burning or throbbing feeling in the lower legs. Varicose veins can also cause a change in skin color (known as stasis pigmentation), dry and thinning skin, inflammation of the skin, skin ulcerations, and bleeding.

As bad as they may look and feel, varicose veins are not usually considered a serious medical problem. They may, however, indicate a critical blockage in deeper veins called a deep vein thrombosis that can be life threatening. Proper medical evaluation and treatment of varicose veins is therefore important. Because chronic venous insufficiency is a progressive disease, symptoms will worsen if left untreated. 

Evaluation typically includes an examination of the legs and feet looking for inflammation, changes in skin color, ulcerations, or other signs of skin breakdown. In most cases an ultrasound is ordered to determine if the valves in the veins are functioning properly and to check for blood clots.
For decades, the only option was a surgical ligation and stripping of the veins done under general anesthesia in a hospital. Today’s alternatives include less invasive procedures like the endovenous laser treatment (EVLT).  During EVLT, a thin fiber is inserted into the damaged vein and laser light energy is delivered causing the vein to close and seal shut.  Varicose veins treated with laser therapy are unlikely to recur and patients can return to normal activity immediately.

If you suffer from venous insufficiency or painful varicose veins, please discuss your options you’re your primary care physician.