Varicose Veins: Are They Harmful?
More than one third of Americans suffer from varicose veins. Similar to spider veins (which are smaller and right on the surface of the skin), varicose veins no longer perform their original function, which is to return blood to the heart. Instead, blood pools in them. For some people, they’re just a cosmetic nuisance, for others, a painful indicator of other circulatory issues.
Julie Lahiri, MD, a vascular surgeon specializing in the treatment of venous disease at The University of Vermont Medical Center, and an associate professor at UVM's Larner College of Medicine, explains more about what causes them and what you can do to find relief.
Why do varicose veins become bulgy under the skin?
Dr. Lahiri: The function of our veins is to return blood to the heart, which means they are working against gravity when we are standing or sitting. Our veins have valves that open up to let blood go up the heart and then quickly close again to prevent blood from going back down toward the feet. If those valves don’t close fast enough, the blood pools in our veins; over time, varicose veins can start to bulge out from all of that back pressure.
Are there symptoms besides the bulges?
Dr. Lahiri: Most patients will describe aching pain, worse with prolonged standing or sitting, especially at the end of a long day. Throbbing, heaviness, leg fatigue, itching and burning are also common. For some people, nighttime cramping or restless legs can be the most distressing symptom. Swelling can occur as well, and often becomes worse in hot weather or with travel.
Are varicose veins related to bigger issues?
Dr. Lahiri: Most patients with varicose veins will come in for evaluation when they have the symptoms I just described or are concerned with the appearance of their legs. About 20% of patients will develop swelling, and then some go on to develop skin changes of the ankle and calf related to the longstanding pressure in the veins. This high venous pressure causes the skin and soft tissue in the lower leg to harden or become inflamed or discolored. This is called venous stasis, and if untreated, can lead to the development of open sores called venous ulcers. These ulcers are painful and can lead to infection and hospitalization; they also frequently recur, so it is really important to intervene before they develop.
About 5% of patients will also develop clots in their leg veins. Most of the time the clots will stay in the varicose and superficial veins, but if the clot goes closer to -- or into -- a deep vein, it can be life threatening. Blood thinners are sometimes used for superficial vein clots and always for deep vein clots.
Do varicose veins occur just in the legs, or can they develop in any part of the body?
Dr. Lahiri: Varicose veins primarily occur in the legs, but women can develop varicose veins inside their pelvis or externally in the vaginal area. This typically occurs when there is a similar valve problem in the ovarian veins or in the veins around the uterus. Women with this type of venous problem typically have dull pelvic pain and heaviness that is worse with exercise or menses, but they may also have pain during or after intercourse, or painful, sensitive external vaginal varicose veins. Vaginal varicose veins are common with pregnancy, and unfortunately they doesn’t always resolve. Chronic pelvic pain is common, and some women with chronic pelvic pain do have a venous cause for their symptoms.
Who typically develops varicose veins?
Dr. Lahiri: Anyone can develop varicose veins, but if they run in your family, you are twice as likely to get them. They are more common in females and also increase as we age, but even teenagers can develop varicose veins. Although pregnancy itself doesn’t cause them, it is often the trigger that makes them apparent, and then they usually get worse with subsequent pregnancies. Trauma and blood clots can also result in varicose veins.
What about people who are on their feet a lot, like food servers or people who work in retail?
Dr. Lahiri: Having a job that requires prolonged standing or sitting may not cause varicose veins, but in patients with venous problems, it can make symptoms a lot worse. When we exercise and contract our calf muscles, like with walking, running, or hiking, that calf-muscle squeeze generates a tremendous amount of good, healthy pressure for our veins. This helps the blood get back to the heart, even if the valves aren’t perfect. Staying active is a great way to keep our legs healthy. Taking time to elevate your legs during the day or at the end of the day can also be helpful.
What’s the easiest treatment?
Dr. Lahiri: Assuming you are already being active and elevating as needed, the easiest treatment is to use compression stockings. To be effective, they need to extend at least to just below your knee but are available in thigh-high or full-length options as well.
How do compression stockings work?
Dr. Lahiri: Compression stockings are not like regular socks. They are fitted based on the size of your leg, not the size of your foot. When fitted correctly, the compression at the ankle is a little firmer than at the upper calf, so wearing them should be comfortable and provide some degree of relief. The compression prevents the varicose veins from getting painfully dilated and pooling with blood. They only work when you wear them, and unfortunately, for many it just isn’t enough relief – plus it can be hard to wear them in hot weather.
What are the treatment options beyond the compression stockings?
Dr. Lahiri: Before we can talk to patients about treatment options, we first need to examine them and have a detailed ultrasound test. The technologist will put gel on the legs and use a probe to look at all the veins in their legs, checking if their valves are healthy or not. We have a few veins in each leg from which varicose veins might develop, so it is important to know what the underlying source is for what we see on the surface. Only after that test can we talk about treatment options.
The most common procedures are minimally invasive, not like the vein-stripping procedure done routinely decades ago. We now insert a small catheter through a puncture in the skin directly into a vein and use heat or a sealant to close up the vein. Since the vein is unhealthy and not working well, closing it up takes care of all that abnormal pooling and pressure and can relieve symptoms. Over time, your body reabsorbs the vein. Often we can also take care of the large, bulging veins at the same time; we make a small puncture and pull the vein out.
Is there anesthesia involved?
Dr. Lahiri: The options for procedural pain control or anesthesia depend on the type of procedure and extent of the varicose veins. Sometimes a procedure can be done with a little local anesthesia, sometimes we add some sedation to that, and some patients are best treated with a general anesthesia, especially if they have a lot of large, bulging veins. Each person talks to their doctor about their options and preferences and they make a decision together. Regardless of the approach, recovery time after the procedure is about 1 to 1½ hours.
Is the recovery painful?
Dr. Lahiri: After the procedure, most patients take an over-the-counter pain reliever like ibuprofen for a couple days after the procedure, but some find they don’t need it at all. One week after surgery, most patients experience a significant relief in, or even resolution of, the symptoms that they had. For others it may take a little longer; everybody is different with how they recover.
Are there any risks?
Dr. Lahiri: There are risks to any procedure. The most serious risks with varicose veins are fortunately also the most uncommon. The risk for a blood clot to develop and travel to the lung is about 0.1%. When we evaluate patients, we ask questions about their specific risk factors, review imaging studies and make sure we understand what the risk is for each individual patient.
More minor risks can include bruising, inflammation, injury to tissues around the vein, or hypersensitivity/allergy to an adhesive sealant. These are also uncommon. One thing we always tell patients is that we are treating venous disease. The word disease can be alarming to some, but what it indicates is that if a person is prone to getting vein problems, they should understand that surgery won’t alter that underlying biology. We can take care of a problem now, but there is a chance that more issues could develop, so staying healthy and active and wearing compression will still be recommended.