Varicose veins affect approximately one thirds of all adults in the Unites States. These are superficial vessels that are abnormally lengthened, twisted, or dilated, and are seen most often on the legs and thighs. Spider veins have similar features but are smaller.

Varicose veins bulge and rise above the skin’s surface. They may be uncomfortable and result in swelling of the legs. If left untreated, varicose veins may lead to more serious medical problems, such as phlebitis, inflammation, or leg ulcers.

At Vascular Care Specialists of Los Angeles, Dr. Mathew Cheung and Dr. Peter Lin answers some of the frequently asked questions about varicose and spider veins. In this post, you will learn what are the causes of varicose veins and spider veins. You will learn treatments for these vein conditions.

Varicose veins are enlarged “rope-like” veins — blood vessels — that are swollen and raised above the surface of the skin. They can be flesh-colored, dark purple, or blue, and often look like a cluster of grapes. They are commonly found on the back of the calves or the inside of the legs. However, they can form anywhere on the legs, from groin to ankle.

Spider veins are similar to varicose veins, but they are smaller and closer to the surface of the skin. They are often red or blue, and look like tree branches or spider webs. They can occur anywhere on the legs, and can cover either a very small or very large area of skin. They don’t bulge like varicose veins, but are often more noticeable. 

Varicose veins result from abnormal inner walls or abnormal valves in these blood vessels. Blood is carried through arteries from the heart to the rest of the body, and returned to the heart through the body’s veins, called the venous system. Veins have valves that act as one-way flaps, preventing blood from backing up and pooling. When these one-way valves don’t work properly, blood then may flow backwards, causing the veins to dilate (enlarge) and become varicose. The technical terms for this condition are venous reflux or venous insufficiency.

More than 80 million Americans suffer from disease of the veins. About 50-55% of women and 40-45% of men suffer from some form of vein problem. Varicose veins affect 1 out of every 2 people older than the age of 50.

No. There are three venous systems—deep, superficial and perforators—all of which can be affected by varicose veins. Many factors contribute to the severity of varicose veins, including what system is affected, risk factors and the individual’s unique anatomy. As such, vascular surgeons rate the severity of varicose veins as one of six classes corresponding to the severity of the condition. Every individual is different, and no one treatment is the best for all situations. 

No. Varicose veins can affect all individuals of any age and gender. Although they are more common among women over the age of 40, we have treated many patients in their 20s and 30s. The patients we have treated range in age from 21 to 92. It is also a misconception that varicose veins only affect women. We have treated numerous men for the issue. Over 10 million men in America suffer from varicose veins. 

Common risk factors for varicose and spider veins include:

• Increasing age
• Family history
• Pregnancy and hormonal changes
• Obesity
• Prolonged standing
• Prior deep venous thrombosis

In many cases, varicose and spider veins cause no symptoms. However, these veins are often unattractive and may become painful. Prolonged sitting or standing tends to make legs with varicose veins feel worse. Some common symptoms of them include:

• Aching pain
• Itching
• Burning
• Leg swelling
• Easily tired legs
• Numbness in the legs
• Leg heaviness
• Darkening of the skin
• Rash on the legs
• Skin ulcers

Varicose veins do not just go away on their own, but they can sometimes become less visible. You may reduce the symptoms temporarily by losing weight or increasing physical activity. But, most likely, the symptoms will return over time. Here are some things that will help reduce varicose vein symptoms:

• Exercise
• Reduce your weight (takes unnecessary pressure off your veins)
• Elevate your legs often
• Avoid long periods of sitting or standing in one place

If your varicose veins are becoming uncomfortable and decreasing your quality of life, it may be time to see a doctor. Varicose veins are a progressive disease process. Look for these symptoms:  

• Continuous pain and swelling in the legs 
• Heavy or dull, achy legs especially after exercise or at the end of the day 
• Varicose veins that are tender, red, and feel warm to the touch 
• Varicose veins that are prone to bleeding
• Skin changes such as discoloration, redness, thickening, or ulcerations

No. Closing a dysfunctional varicose vein will actually improve blood flow back to the heart. The human body is extremely adaptive and normal veins will take over to more effectively return blood back to the heart. 

Varicose veins can grow worse over time. If left untreated, varicose veins may cause conditions such as inflamed veins or chronic wounds or ulcers. 

Yes. Minimally invasive options exist, and most problem veins, from the tiniest spider veins to larger varicose veins, can be treated without surgery. 

There are several treatment options available. They include:

• Compression Stockings which increase blood flow and reduce pain and swelling.
• Radio Frequency Endovenous Ablation which heats the vein wall to shrink, collapse, and seal it.
• Sclerotherapy which is a concentrated solution injected into the vein to collapse it. 
• Varithena which is a mix of polidocanol, nitrogen, and oxygen injected into the vein usually used to treat larger or deeper veins that cannot be treated by using catheter ablation or phlebectomy.
• Ambulatory Phlebectomy which involves numbing the skin and removing surface veins through very small incisions. 

Varicose veins can range from mild to severe. If neglected, varicose veins can have major implications for the patient’s health. Here are several things that can happen to varicose veins when left untreated:

• Hyperpigmentation – excess blood leaking into the tissues of the leg that can cause painful swelling and inflammation dark and discolored skin. 
• Lipodermatosclerosis – hardening of skin, pain, redness, swelling, and a tapering of the legs above the ankles. Legs may become increasingly tender. 
• Venous Leg Ulcer – varicose veins usually result in a condition known as chronic venous insufficiency or CVI which can result in a venous leg ulcer. These open wounds tend to get larger over time leading to increasing pain and irritation.
• Spontaneous Bleeding – varicose veins tend to break down the walls of the skin over time  bringing the varicose veins closer to the surface of the skin. Small scratches or scrapes can result in excess blood loss. 
• Superficial Thrombophlebitis – inflammation of the veins just beneath the surface of the skin which may include redness of the skin, increasing tenderness of the vein, and ongoing pain or swelling of the legs.
• Deep Vein Thrombosis – this is the most serious condition related to varicose veins. DVT results from pooling of blood forming a clot in the deep vein system with symptoms of  progressive leg pain, swelling, redness, and increasing pain with walking. If the blood clot travels further up the body, the condition could be life-threatening.

Unfortunately, there is no way to completely prevent varicose veins, but you can control some of the symptoms by maintaining a healthy body weight, exercising regularly, avoiding standing or sitting for long periods of time when possible and wearing prescription-grade compression stockings. 

Most insurance companies cover treatments for varicose veins that are medically necessary, and in cases when conservative therapy with “compression” stockings has failed. Any treatment for cosmetic reasons, including sclerotherapy, is not covered.

At Vascular Care Specialists of Los Angeles, we strive to provide the best service, care, and results possible. If you are interested in varicose vein treatment, give us a call at 626-275-9566 to schedule an appointment. You can also visit us at www.vcsla.com for more information.