Expert advice on varicose vein prevention and treatment

Millions of Americans are affected by varicose veins. In some people, these bulging veins are unsightly but painless. For others, they can be uncomfortable and even incredibly painful. The good news is this common condition can be treated with same-day, minimally invasive procedures that do not require general anesthesia or a trip to the operating room.

Chelsea Dorsey, MD, a vascular surgeon at the University of Chicago Medicine and an expert in caring for individuals with arterial and venous diseases, weighs in on the different kinds of vein conditions and the treatment options available to patients.

UChicago Medicine: What are varicose veins? 

Dorsey: Varicose veins are bulging veins near the surface of the skin. Varicose veins are typically caused by venous insufficiency also called venous reflux. Veins are designed to pump blood back to the heart, and the veins in the legs have valves that help in this process. In patients with venous insufficiency, those valves aren’t working properly and cause a buildup of blood in the veins. This increased venous pressure leads to the development of varicose veins.

Some patients with varicose veins have no symptoms. For other patients, they may experience a number of symptoms including aching, throbbing, itching, heaviness and fatigue in the legs. Leg swelling is also a common symptom. Venous insufficiency is largely a benign condition (meaning it is not dangerous), but it can be quite frustrating as it starts to change the appearance of your legs and, in some cases, affect your ability to stand for long periods of time.

What causes varicose veins? Is crossing your legs to blame?

No, this is an old wives’ tale that has unfortunately persisted. There have been a number of large studies that specifically looked at the risk factors associated with varicose vein development. The data in those studies did not suggest that crossing your legs leads to the development of varicose veins.

Studies have suggested that a family history of varicose veins puts you at increased risk. If both parents suffered from varicose veins, then there may be as high as a 90% chance that their children will also have issues with venous insufficiency. Other risk factors include obesity, advanced age, prolonged standing, smoking, sedentary lifestyle, a history of blood clots and pregnancy.

Are women more likely than men to get varicose veins? Does pregnancy cause varicose veins?

Yes, women are four times more likely to suffer from varicose veins. The hormonal changes associated with pregnancy (especially multiple pregnancies) put women at increased risk for developing varicose veins. In addition, the increased blood volume and pressure from a growing uterus can cause veins to enlarge. Often the varicose veins resolve or at least improve in appearance within about three months of delivery.

Are varicose veins and spider veins the same thing?

No, but they are often the result of the same problem. Varicose veins are the large prominent veins seen and felt on the surface of the skin. They often have an associated blue or green discoloration. Spider veins, or telangiectasias, are the smaller veins with a web-like pattern visible on the surface of the skin. They are typically not raised. Reticular veins are another category of superficial veins that are often seen in patients. They are characterized by larger veins, often green in color, seen under the surface of the skin that aren’t quite bulging.

What is vein mapping?

Vein mapping refers to an ultrasound test that can be done to take a closer look at the veins in the legs. This test is non-invasive and painless. The study may also be referred to as a venous insufficiency (or venous reflux) ultrasound. This is different from a venous ultrasound study that is done to look for blood clots in the deep veins. Vein mapping will help the health care professional determine what, if any, procedures are appropriate for each patient. These studies tell us where the veins are malfunctioning, how large the veins are, and whether or not an invasive procedure is even feasible for the patient. For most, a vein mapping study is necessary before a procedure can be recommended. 

How do you treat varicose veins?

Treatment for varicose veins typically starts with medical management, which includes regular use of graduated compression stockings and leg elevation. If conservative measures don’t work, some patients require procedures to resolve their symptoms. Treatment options include sclerotherapy, thermal ablation procedures and/or phlebectomy.

Sclerotherapy involves injecting a solution into visible veins on the skin’s surface. This is typically used to improve the appearance of spider and reticular veins. Ablation procedures use either radiofrequency or lasers to close off malfunctioning veins. Phlebectomy is a procedure where varicose veins are surgically removed through small incisions in the skin. Often a combination of these procedures is necessary to achieve the desired result. Your health care professional can help you decide what treatment is right for you.

How do compression socks help varicose veins? 

Graduated compression stockings are used in both the prevention and treatment of varicose veins. Compression stockings are available in different pressure gradients. Individuals with moderate venous insufficiency are often prescribed a stocking with a "firm" 20-30 mmHg gradient. We typically recommend that patients wear their compression stockings daily—putting them on in the morning and removing them at the end of the day prior to heading to bed. Of note, the white “anti-embolism” stockings given to patients in the hospital are typically not adequate for patients with symptomatic venous insufficiency and typically have a gradient well below 20 mmHg.

Where are the medical procedures done? Will I have any scarring? 

Most of the procedures are done in an office setting. For some patients with more extensive venous disease, the procedures are done in the operating room on an outpatient basis that allows the patient to go home the same day. Most of the procedures involve very small incisions in the skin (1-3 millimeters). Again, it depends on the type of procedure that you pursue, but most patients have very little associated scarring. 

What are the risks and side effects? 

The risks vary slightly depending upon what procedure you are getting done. As with any invasive vascular procedure, there is a small risk of bleeding, infection or damage to surrounding structures, such as small superficial nerves. The vast majority of patients will have a smooth post-procedure course. Some patients experience bruising, swelling or mild discomfort at the site of the incisions. However, all of these are typically short-lived and resolve within days of the procedure.

Will varicose veins come back after surgery or treatment? 

Some patients do experience recurrence of their varicose veins. The likelihood of recurrence depends upon the type of procedure that you have and the degree of underlying venous insufficiency. It is important to be evaluated by an experienced vein specialist who will work with you to treat the underlying cause for your varicose veins. If recurrence does occur, it typically takes several years for new varicosities to develop.

Originally published April 2019. Updated November 2019.