Frequently Asked Questions
Varicose Vein & Venous Disease Questions:
What are varicose veins and spider veins?
Varicose (VAR-i-kos) veins are enlarged veins that can be blue, red, or flesh-colored. They often look like cords and appear twisted and bulging. They can be swollen and raised above the surface of the skin. Varicose veins are often found on the thighs, backs of the calves, or the inside of the leg. During pregnancy, varicose veins can form around the vagina and buttocks.
Spider veins are like varicose veins but smaller. They also are closer to the surface of the skin than varicose veins. Often, they are red or blue. They can look like tree branches or spiderwebs with their short, jagged lines. They can be found on the legs and face and can cover either a very small or very large area of skin.
How common are abnormal leg veins?
About 50 to 55 percent of women and 40 to 45 percent of men in the United States suffer from some type of vein problem. Varicose veins affect half of the people 50 years and older.
What causes varicose veins and spider veins?
Varicose veins can be caused by weak or damaged valves in the veins. The heart pumps blood filled with oxygen and nutrients to the whole body through the arteries. Veins then carry the blood from the body back to the heart. As your leg muscles squeeze, they push blood back to the heart from your lower body against the flow of gravity. Veins have valves that act as one-way flaps to prevent blood from flowing backward as it moves up your legs. If the valves become weak, blood can leak back into the veins and collect there. (This problem is called venous insufficiency.) When backed-up blood makes the veins bigger, they can become varicose.
Spider veins can be caused by the backup of blood. They can also be caused by hormone changes, exposure to the sun, and injuries.
What are the signs of varicose veins?
Varicose veins can often be seen on the skin. Some other common symptoms of varicose veins in the legs include:
- Aching pain that may get worse after sitting or standing for a long time
- Throbbing or cramping
- Rash that’s itchy or irritated
- Darkening of the skin (in severe cases)
- Restless legs
What factors increase my risk of varicose veins and spider veins?
Many factors increase a person's chances of developing varicose or spider veins. These include:
- Increasing age. As you get older, the valves in your veins may weaken and not work as well.
- Medical history. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have varicose veins have a family member who has them too.
- Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
- Pregnancy. During pregnancy, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus also puts pressure on the veins. Varicose veins usually improve within three months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
- Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
- Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
- Sun exposure. This can cause spider veins on the cheeks or nose of a fair-skinned person.
Are varicose veins and spider veins dangerous?
Spider veins rarely are a serious health problem, but they can cause uncomfortable feelings in the legs. If there are symptoms from spider veins, most often they will be itching or burning. Less often, spider veins can be a sign of blood backup deeper inside that you can’t see on the skin. If so, you could have the same symptoms you would have with varicose veins.
Varicose veins may not cause any problems, or they may cause aching pain, throbbing, and discomfort. In some cases, varicose veins can lead to more serious health problems. These include:
- Sores or skin ulcers due to chronic (long-term) backing up of blood. These sores or ulcers are painful and hard to heal. Sometimes they cannot heal until the backward blood flow in the vein is repaired.
- Bleeding. The skin over the veins becomes thin and easily injured. When an injury occurs, there can be significant blood loss.
- Superficial thrombophlebitis (throm-bo-fli-BYT-uhs), which is a blood clot that forms in a vein just below the skin. Symptoms include skin redness; a firm, tender, warm vein; and sometimes pain and swelling.
- Deep vein thrombosis, which is a blood clot in a deeper vein. It can cause a “pulling” feeling in the calf, pain, warmth, redness, and swelling. However, sometimes it causes no significant symptoms. If the blood clot travels to the lungs, it can be fatal.
Are varicose veins hereditary?
Heredity is a primary factor in over 80% of varicose vein cases. Other contributing factors may include pregnancy, obesity, hormone therapy, standing or sitting for long periods of time and injury.
Do men get varicose veins as well?
Although women are affected at a higher percentage than men, men can also be troubled with varicose veins and their associated symptoms (and benefit from treatment).
Should I see a doctor about varicose veins?
You should see a doctor about varicose veins if:
- The vein has become swollen, red, or very tender or warm to the touch
- There are sores or a rash on the leg or near the ankle
- The skin on the ankle and calf becomes thick and changes color
- One of the varicose veins begins to bleed
- Your leg symptoms are interfering with daily activities
- The appearance of the veins is causing you distress
If you’re having pain, even if it’s just a dull ache, don’t hesitate to get help. Also, even if you don’t need to see a doctor about your varicose veins, you should take steps to keep them from getting worse (see How can I prevent varicose veins and spider veins?).
What are spider veins?
Spider veins are dilated vessels that form just under the skin and result in red, blue or purple clusters of veins visible on the skin's surface. Besides the appearance of the veins, other symptoms may include skin redness; a firm, tender and warm vein; and for some patients, pain, and swelling.
What causes spider veins?
Spider veins can be caused by pregnancy, heredity, weight gain and standing or sitting for long periods of time. These are the same things that cause varicose veins.
Are all the veins I see on my legs spider veins?
Not necessarily. Some of your visible veins may be larger size reticular or even varicose veins. Each of our patients receives a screening ultrasound prior to treatment so that we can determine exactly what venous problems exist and develop an appropriate treatment plan. You may call our office to schedule a consultation to learn if you have spider veins and the right treatment for you.
Why do spider veins seem to creep up in the winter?
Spider veins don't actually increase during the winter but at the beginning of summer, our tans have faded so the spider veins may be more obvious. Once we get into our summer clothes and begin wearing shorts, capris or swim suits, we become more aware of them. Many women are not comfortable with the cosmetic appearance of their spider veins and will continue to wear long pants in the summer.
Why do varicose veins and spider veins usually appear in the legs?
Most varicose and spider veins appear in the legs due to the pressure of body weight, force of gravity, and task of carrying blood from the bottom of the body up to the heart.
Compared with other veins in the body, leg veins have the toughest job of carrying blood back to the heart. They endure the most pressure. This pressure can be stronger than the one-way valves in the veins.
Insurance and Treatment Questions:
How are varicose veins diagnosed?
Your doctor may diagnose your varicose veins based on a physical exam. Your doctor will look at your legs while you’re standing or sitting with your legs dangling. He or she may ask you about your symptoms, including any pain you’re having. Sometimes, you may have other tests to find out the extent of the problem and to rule out other disorders.
You might have an ultrasound, which is used to see the veins’ structure, check the blood flow in your veins, and look for blood clots. This test uses sound waves to create pictures of structures in your body.
Although less likely, you might have a venogram. This test can be used to get a more detailed look at blood flow through your veins.
If you seek help for your varicose veins, there are several types of doctors you can see, including:
- A phlebologist, which is a vein specialist
- A vascular medicine doctor, who focuses on the blood system
- A vascular surgeon, who can perform surgery and do other procedures
- An interventional radiologist, who specializes in using imaging tools to see inside the body and do treatments with little or no cutting
- A dermatologist, who specializes in skin conditions
Each of these specialists do some or all of the procedures for treating varicose veins. You might start out by asking your regular doctor which specialist he or she recommends. You also might check with your insurance plan to see if it would pay for a particular provider or procedure.
How can I prevent varicose veins and spider veins?
Not all varicose and spider veins can be prevented. But, there are some steps you can take to reduce your chances of getting new varicose and spider veins. These same things can help ease discomfort from the ones you already have:
- Wear sunscreen to protect your skin from the sun and to limit spider veins on the face.
- Exercise regularly to improve your leg strength, circulation, and vein strength. Focus on exercises that work your legs, such as walking or running.
- Control your weight to avoid placing too much pressure on your legs.
- Don’t cross your legs for long times when sitting. It’s possible to injure your legs that way, and even a minor injury can increase the risk of varicose veins.
- Elevate your legs when resting as much as possible.
- Don’t stand or sit for long periods of time. If you must stand for a long time, shift your weight from one leg to the other every few minutes. If you must sit for long periods of time, stand up and move around or take a short walk every 30 minutes.
- Wear elastic support stockings and avoid tight clothing that constricts your waist, groin, or legs.
- Avoid wearing high heels for long periods of time. Lower-heeled shoes can help tone your calf muscles to help blood move through your veins.
- Eat a low-salt diet rich in high-fiber foods. Eating fiber reduces the chances of constipation, which can contribute to varicose veins. High-fiber foods include fresh fruits and vegetables and whole grains, like bran. Eating less salt can help with the swelling that comes with varicose veins.
Can varicose and spider veins return even after treatment?
Current treatments for varicose veins and spider veins have very high success rates compared to traditional surgical treatments. Over a period of years, however, more abnormal veins can develop because there is no cure for weak vein valves. Ultrasound can be used to keep track of how badly the valves are leaking (venous insufficiency). Ongoing treatment can help keep this problem under control.
The single most important thing you can do to slow down the development of new varicose veins is to wear gradient compression support stockings as much as possible during the day.
Can the treatment be done during pregnancy? Or how soon after if not during?
No, usually need to wait 2 months after delivery.
Is there a dedicated amount of time spent per leg, per treatment or do you hit every visible vein per treatment?
Each session will be 30 minutes unless the maximum volume of medication has been reached.
Will insurance cover my treatments?
Insurance will reimburse a high percentage of the treatment cost if there is a documented problem of venous insufficiency with associated symptoms. We can provide the diagnostic and procedure codes for pre-certification by your insurance company. It is important to note that each insurance company reimburses different amounts for these treatments. We will work with you to help you understand your coverage.
Do you have consultations to determine what procedures are needed?
Yes, this is the first step to tailoring a treatment plan that is right for you. During your initial visit, the affected areas will be examined to determine if a Doppler Duplex Ultrasound Scan will be necessary. Once the appropriate treatments have been determined, we will review the costs and other relevant details with you to ensure you are fully informed.
Why do I need to get an ultrasound scan?
The first step in finding the right treatment for damaged veins is finding its source. A Doppler Duplex Ultrasound Scan provides a visual window, revealing the diseased, refluxing veins beneath the skin's surface. With this diagnostic capability, we can pinpoint the exact cause of varicose veins and customize a treatment plan for each individual patient - and each damaged vein. Because the problem is dealt with at its source, the treatments are quicker, more effective and less painful than traditional methods, such as vein stripping. The ultrasound scan is especially important if you have had previous vein treatment.