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When is it necessary to treat varicose veins?

This question was asked in Chicago, Illinois and has 8 answer(s) as of 07/17/2013.
I have spider veins on the outside of one calf that I have had for years. Lately the center will 'pop' when I exercise or am on my legs for along time. Is this the start of a varicose vein? When do varicose become enough of a problem to do something about them? And what could be done?


Doctors Answers (8)

Good questions. This "popping" sensation may not be related to the actual veins but at times even spider veins can be uncomfortable (burning or aching) especially in women around their menstrual cycles. Treating spider veins is typically a cosmetic issue and appropriate whenever you feel it is time. The smaller the veins in size and area, the less treatment involved. If these veins start to bulge, become painful and your legs become heavy or achy, then a full evaluation with a vascular surgeon (experienced in treating vein superficial vein disease) including an ultrasound is advised. Typically varicose and spider veins are an inherited problem.

Spider veins are often the first warning sign of a more significant problem. If there is a family history of one parent with varicose veins then there is a 70% chance you will have them too, and if both parents have them, 90% chance or greater that you will too. When you have symptoms (i.e.) cramping, Charlie horse, itching, numbness, tingling, swelling and or restless legs, these are all symptoms that can and do occur with a more significant problem underlying those things you are calling spider veins. Insurance will cover treatment of symptomatic venous disease in most cases. Call for an evaluation of your legs so you can get a good preventive plan going now.

These small spider veins can be connected to larger feeder veins which can be easily seen on the ultrasound evaluation. These feeder veins will frequently show venous reflux which increases the venous pressure inside the veins. If you believe they are getting bigger or starting to generate symptoms, you should seek help from a physician with a special interest in venous and lymphatic disorders for further counseling .

Spider veins and varicose veins are inherited separately. Spider veins may be treated at any time the patient finds their appearance or discomfort objectionable. Simple out-patient effective treatment methods for leg spider veins include sclerotherapy (injections) and radiofrequency (VeinGogh).

Varicose veins are more apparent with prolonged standing and at the end of the day due to venous congestion. These veins are seen as a bluish colored bumps or may be rope-like bulges just under the skin. The best way to evaluate the veins is by ultrasound evaluation at a vein clinic to determine the cause and extent of the varicose veins on your legs. Treatment for veins that have no symptoms and the appearance is not a concern is optional and wearing compression hose/stockings can help. If treatment is needed because of symptoms such as sore aching sensations or because of the way they look, then they can be treated in an office setting using endovenous ablation with a fiber optic laser, or a microphlebectomy or possibly even injection sclerotherapy depending on the size and location of the vein(s).

As a general rule, varicose veins should be treated when they are symptomatic on a daily basis.

The medical reason to fix your varicose veins is to eliminate symptoms. When the symptoms associated with your veins progress to the point that the are affecting your activities of daily living, treatment is an option. Some people will opt to treat their veins because they do not like the look of them, but this would be considered a cosmetic treatment. As far as the treatment options go, it would all depend on the underlying problem. A consultation with a vein specialist will help you understand your underlying problem and the treatment options that are suited for you.

Medical reasons to treat varicose veins would be if the veins are causing you leg discomfort, swelling, cramping, heaviness, fatigue or other symptoms. The most conservative thing you can do is wear a compression stocking and remain active with walking. There are compression socks available which are beneficial when exercising. Treatment of your varicose vein would require first a thorough evaluation with ultrasound to determine where the vein is coming from. Treatments include vein ablations (ex. EVLT, VNUS Closure), sclerotherapy with or without foam, and stab avulsion phlebectomy. It depends on the size and source of the varicose vein.

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