What Is the Best Treatment for Varicose Veins? (video)

Varicose veins — those swollen, twisted veins that form on the lower legs — may be unsightly and painful, but are they harmful?

In this video, San Diego Health host Susan Taylor talks with Jeffrey Weiss, MD, a vascular surgeon at Scripps Clinic Anderson Medical Pavilion in La Jolla, about what causes varicose veins, who gets them and what you can do about them. Some treatments can provide long-lasting results.

To understand how varicose veins form, it helps to first understand what veins do. A vein brings blood back to the heart through a series of valves that form a staircase-like path. If one of the valves doesn’t function properly, the blood can reverse direction and go backwards, which causes the vein to fill with blood and become swollen. 

According to the American Heart Association, roughly 23 percent of adults in the US have varicose veins.

They are most common in people who have a higher risk of valve problems or blood clots. If you have a family history of varicose veins, you may be more likely to develop them.

In addition, women who have multiple pregnancies have a greater chance of varicose veins, because increased blood flow to the lower body causes the veins to expand more than usual.

“We also see varicose veins more often in patients who have a profession that puts them at risk,” says Dr. Weiss. “Anyone who’s on their feet for a prolonged period of time, such as nurses or food servers, can develop varicose veins.”

Though varicose veins are commonly confused with spider veins, they are not the same. Unlike varicose veins, which swell and create a bulge on the legs, spider veins are flat veins visible beneath the skin and spread out like the tentacles of a spider. Moreover, spider veins do not cause pain.

Signs and symptoms of varicose veins vary from person to person. Some people may only have swollen, twisted veins. Others may experience significant itching, burning or aching. Often, symptoms worsen throughout the day.

In some cases, varicose veins can be a sign of a more serious problem.

“The main thing were worried about with patients who have longstanding varicose veins is changes at the ankle,” says Dr. Weiss.

“The skin can become brown and discolored from ongoing high venous blood pressure in that location,” he says. “Eventually you can end up with an ulcer that requires months of wound care and can be very difficult to heal. It can be a sign of some compressive effect of the veins in the pelvis, so we’d want to check that out and evaluate it.” 

According to Dr. Weiss, most people seek treatment for varicose veins because of itching, pain or cosmetic concerns. Wearing compression hose and elevating your legs as much as possible can help relieve uncomfortable symptoms and slow the progression of varicose veins, but other treatments can provide longer-lasting results.

The first step in treating varicose veins is an ultrasound exam to identify the problematic vein.

The most common treatment for varicose veins is sclerotherapy, which involves injecting a salt solution directly into the vein using a very fine needle. The salt solution kills the vein, and it eventually shrinks. 

Other treatments for varicose veins include laser or radiofrequency ablation, which use heat to destroy the vein, or a glue-based treatment that seals off the diseased vein and reroutes the blood to healthy veins.

These procedures involve inserting a thin tube called a catheter into the vein through an incision in the leg and passing the treatment through it to the vein. They are usually performed in the doctor’s office and take about 30 minutes. Most patients return to usual activities within a day or two.

Large, unsightly veins can be surgically removed through a series of small incisions called a phlebectomy. Recovery time is usually several days.

“If you have pain or swelling, or you just want to get rid of your varicose veins, get them checked out,” says Dr. Weiss. “We can make sure it’s not something more serious and discuss your treatment options.”