When Should You Worry About Varicose Veins?

Varicose veins. They’re visible and often unsightly. You may be resigned to just covering them up. But do they pose a health risk? Should you worry about varicose veins?

What are varicose veins?

Varicose veins appear as swollen or raised leg veins and are often blue or dark red in color. They result from a weakness in the vein walls. They almost always occur in the legs (because gravity makes it harder for blood to flow upward), but they can show up anywhere on the body. A milder version of varicose veins usually seen in the legs is often called “spider veins,” which are typically smaller and thinner.

While the condition sounds scary, it’s very common – especially as we get older, according to Uwe Fischer, MD, a vascular surgeon at Lawrence + Memorial and Westerly hospitals and assistant professor of Surgery at Yale School of Medicine. Dr. Fischer treats patients for a variety of vascular conditions in addition to varicose veins, including aneurysms, carotid disease, peripheral arterial disease and lower extremity limb preservation, through Lawrence + Memorial Hospital’s Limb Preservation Program. The multidisciplinary program is part of Yale New Haven Health's Heart and Vascular Center.

“Approximately 30 percent of adults have varicose veins, and they rarely lead to significant health problems,” he said. “However, in the most severe cases, varicose veins can cause pain, aching, heaviness, swelling and even ulcers. They can also bleed if damaged.”

Risk factors for varicose veins

The most common risk factors for varicose veins include age, family history, pregnancy, menopause, obesity, tobacco use and prolonged sitting or standing.

Many females develop varicose veins during pregnancy because of hormonal effects on the vein walls. “If varicose veins don’t develop during pregnancy, women who have had children are still more vulnerable to varicose veins later on, because the additional stress of pregnancy has weakened the veins,” he said.

When should I see a doctor?

While varicose veins usually are not dangerous, an increase in swelling or pain in your legs may be a sign of a more serious problem, Dr. Fischer said. Other signs of worsening symptoms include skin discoloration, ulceration or if the skin feels hot to the touch.

“If you are concerned, make an appointment to get clarity and peace of mind,” Dr. Fischer said. “Every patient who comes in gets an ultrasound test to ensure there are no underlying concerns, such as blood clots. This can also give us additional information about the veins in your legs.”

Treatment options

According to Dr. Fischer, the first step in treating varicose veins is what vascular surgeons refer to as conservative management.

“We begin with having patients wear special compression socks or stockings that can help the blood flow to your heart. They also decrease swelling,” he said.

Additional lifestyle changes such as exercise and diet are also recommended. If you don’t notice improvement and lifestyle changes aren’t working, other treatment options are available depending on your symptoms and the size and location of the varicose vein.

Options may include:

• Sclerotherapy, which involves injecting a solution into the vein. The solution irritates the vein, causing the walls to collapse. The vein closes off and harmlessly remains in the body.
• Ambulatory phlebectomy, a mini-surgical technique that involves removing varicose veins through multiple, small (less than 2 mm) slits made in the skin overlaying the vein.
• Endovenous laser ablation therapy (EVLT), which uses light energy to collapse a vein.
• Radiofrequency ablation (RFA), which relies on heat and radiofrequency waves to close off a vein. 

“All of these treatments are minimally invasive and very well tolerated, and can be performed right in our office,” Dr. Fischer said.

Can I prevent varicose veins?

Some of the risk factors — such as family history or age — are obviously impossible to avoid. While you may not be able to prevent them, Dr. Fischer recommends several steps you can take to keep them from becoming worse:

• Avoid standing or sitting for long periods of time. Take frequent breaks to stretch and walk around, especially if you have a job that requires you to be on your feet. 
• Lose weight or maintain a healthy weight. Getting rid of extra weight helps reduce pressure inside your veins.
• Drink water throughout the day. Proper hydration helps with healthy blood circulation.
• Exercise to improve your circulation. Walking, cycling, swimming and yoga are good options.  
• Wear compression socks or stockings. 
• Elevate your legs. Whenever you're resting, put your feet up.

YNHHS uses the terms "female" and "male" to reflect biological status typically assigned at birth, and "women" and "men" when referring to gender. According to the Human Rights Campaign, a doctor or midwife assigns a child's sex as male, female or intersex at birth based on their external anatomy. Gender identity is one's innermost identification of self as male, female, a blend of both or neither. Gender identification may differ from birth sex.