When Should I Worry About Varicose Veins?

There are those veins that you've seen your whole life, like the one in your upper forearm that's often used for an IV tap.

But what about that weird clump of veins that's recently popped up — perhaps literally — somewhere else on your body, such as your legs?

"Varicose veins are normal veins that have become enlarged because something is causing the veins to hold more blood than usual," says Dr. Tony Lu, a vascular surgeon at Houston Methodist. "They can be very small to start with, but over time they can grow larger and larger — to the point that you see them underneath your skin."

Speaking of seeing them, they look like dark blue or purple veins that are often twisted and bulging from your skin. This is different from spider veins, the much smaller red or blue vein lines you may see at your skin's surface.

"Generally speaking, varicose veins aren't terribly dangerous, but they do typically progress and can eventually cause pain, ulcerations and other symptoms," says Dr. Lu.

What causes varicose veins?

Veins are the blood vessels that carry blood from your organs and extremities back to your heart and lungs. Here, blood gets re-oxygenated and is then pumped back out to your body via your arteries, a cycle — known as your circulatory system — that takes place continuously.

"Varicose veins occur when a section or segment of veins aren't working properly to bring blood back to the heart," explains Dr. Lu. "As a result, blood begins to collect in these veins, expanding their size."

This is typically due to issues with the tiny valves in your veins that prevent blood from flowing backwards after your heart pumps — opening to let blood rush through and then quickly shutting behind it.

"If the valves in your veins aren't working properly — for instance, if they're a little too slow to close — blood starts backing up," says Dr. Lu. "The veins in your legs are particularly susceptible to this because, when you're standing, the valves have to work harder as they fight against the downward pull of gravity."

Over time and like all other mechanical things, these valves can fail if they're stressed. And that's why one of the risk factors of varicose veins is having an occupation that requires being on one's feet often, such as teachers or delivery workers.

It's not just mechanical failure that can cause varicose veins. Changes in certain hormone levels can increase the size of veins, which is why varicose veins occur more commonly in women than men.

"The estrogen fluctuations that can occur during a woman's life can affect her veins," Dr. Lu explains. "For instance, during pregnancy, estrogen levels increase as does blood volume causing veins to dilate and pushing the valves have to work harder. After menopause, the imbalance in estrogen can further weaken the veins, affecting how well these valves function."

Lastly, Dr. Lu points out that there's a genetic predisposition to getting varicose veins.

"Regardless of gender and occupation, having a family history of varicose veins on your mother's side means that you're more likely to develop them as well," adds Dr. Lu.

Are varicose veins dangerous?

They can be somewhat unsightly, but are varicose veins actually anything to worry about?

Yes and no.

Varicose veins fall on a spectrum of venous problems. They begin as spider or reticular veins. At this point, the veins are more visible than usual, but are still very tiny and painless. As they continue to enlarge, they progress into varicose veins but may not cause any symptoms yet.

"In these early stages, when you can see varicose veins but don't have any accompanying symptoms, it's mostly a superficial issue that poses little risk — although you may be bothered by their appearance," says Dr. Lu.

In fact, accidentally nicking one that's close to the skin may be the only risk of early-stage varicose veins. This can cause a lot of bleeding, but Dr. Lu says that it typically stops with pressure.

"The issue, though, is that it's a progressive problem that doesn't go away on its own and typically continues to get worse over the years," says Dr. Lu.

Left untreated, varicose veins can cause a range of symptoms, including:

• A feeling of heaviness in your legs
• Fatigue
• Swelling in your legs
• Pain
• Bleeding
• Permanent discoloring of the skin due to iron deposition
• Skin that can easily rip or tear, leading to frequent wounds and even ulcers

There's some good news, though.

"Varicose veins typically aren't life-threatening or limb-threatening, and they generally don't increase your chance of deep vein thrombosis (DVT) or developing blood clots, which is what a lot of people worry about," says Dr. Lu. "However, the progressive symptoms they cause are troublesome. And even for those not bothered by these symptoms, it can still get to a point where you have to do something about varicose veins since frequent wounds are difficult to manage."

And it's worth reiterating: Varicose veins won't go away on their own.

"If you start noticing varicose vein symptoms — even the earlier ones like heaviness in your legs and fatigue — that's when you should consider coming in for an evaluation because it's a venous issue that does tend to progress, especially if you're not doing anything about it," says Dr. Lu.

Who treats varicose veins? It's likely best to start by consulting a vascular surgeon.

While a vascular procedure isn't always needed to treat this issue, a vascular surgeon can help evaluate where you fall on the varicose vein severity spectrum, advise you on the most effective first steps to getting relief and explain which varicose vein treatment options you may want to consider in the future.

What are the treatment options for varicose veins?

When it comes to how to get rid of varicose veins, treatment almost always starts with compression stockings, also called varicose vein stockings. These are stockings that apply pressure to the veins in your legs, helping to empty and shrink the varicose veins back to a normal size.

"Compression stockings can help manage early-stage varicose veins, keeping them from progressing," says Dr. Lu. "And sometimes treatment is as easy as just wearing these stockings. They're also what we usually try before recommending a procedure to more permanently treat symptomatic varicose veins."

If your varicose veins are painful and compression helps relieve those symptoms, it's a sign that you may benefit from a more permanent varicose vein treatment, such as ablation.

"During an ablation procedure, we use either heat, a laser or a specially-formulated glue to collapse or block the segment of vein that's failing to move blood," explains Dr. Lu. "This forces blood to re-route through other veins deep in your leg — of which there are plenty. Since blood can no longer back up in these veins, this procedure relieves the pain, swelling and potential for bleeding."

Additionally, ablation shrinks the veins so that they're no longer visible, which is why it's also sometimes used as a cosmetic procedure even if varicose veins aren't yet causing any symptoms.

"Ablation therapy for varicose veins isn't a major surgery, and it can be performed in a doctor's office or as an outpatient procedure," says Dr. Lu. "But, it is still a procedure and not everyone is immediately ready for that. About half of my patients will go for it right away and the other half choose to stick with compression stockings, coming back for the procedure only if symptoms aren't improved."

March 2, 2022