Everything to Know About Varicose Veins

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After I had a baby last year, I noticed a little skin-colored bulge on my right calf that hadn’t been there before, and, like many of us tend to do, I panicked that it was something ominous. I asked my doctor who said, let’s do an ultrasound to err on the side of caution, but I’m 99-percent sure that’s just a vein. And that’s exactly what it was: a non-threatening, sometimes-throbby varicose vein that I now see in the mirror every day. Though I find it frustrating, it’s an incredibly common thing: The American College of Phlebology estimates that 55 percent of American women will suffer from varicose veins during their lifetimes. Here’s everything to know about varicose veins, according to doctors who treat them.

What Are Varicose Veins?

“Varicose veins refer to superficial blood vessels that becomes enlarged, dilated, overfilled, or twisted as the walls or small valves that prevent backflow of blood weaken,” says Campbell, CA dermatologist Amelia K. Hausauer, MD. “The veins can vary in size from tiny, red and net-like to ropey, elevated bulges.”

Different from spider veins, which New York vein specialist Luis Navarro, MD says are “little blue, red and purple veins that look like a spider or little branches, and are usually on the thighs or around the knee,” varicose veins are big, tortuous veins that are green or blue, and many times they bulge above the level of the skin. “Oftentimes, you don’t see the color of the vein, but rather a protruding bump that is the result of the vein pushing in that area. When you see a bump or deformity like this, you should have your doctor do an ultrasound and find out if it is a varicose vein or not, just to be safe. You can have spider veins, varicose veins or both. About 60 percent of the time, if you have varicose veins, you have some spider veins too.”

What Causes Varicose Veins?

According to West Palm Beach, FL dermatologist Kenneth R. Beer, MD, gravity, genetics and occupation all play a role. “If you are on your feet all day, you are more predisposed to getting them,” he says. “Another contributing factor is valvular incompetence, which means that the valves that normally guide the blood to deeper vessels are too close to the surface.”

Dr. Navarro says varicose veins are most frequent in women and can become apparent in one’s early 30s, oftentimes because of pregnancy. “There is a congenital predisposition to develop veins that tends to run in families and most frequently on the mother’s side,” he explains. “If you have this predisposition, then certain accelerating factors may make them appear sooner, such as pregnancy, hormonal birth control or hormone replacement therapy.” But why are women more prone? “Female hormones weaken the vein walls,” Dr. Navarro adds. “Pregnancy has a big effect because of the increase in hormones, the increasing weight of the uterus against the veins in the pelvis, and the increase in blood volume because you need to feed the child. Many of the varicose veins happen because the main superficial vein—the Great Saphenous Vein (GSV)—in the front of the leg, or the Small Saphenous Vein (SSV) in the back of the leg, is involved.”

Though not necessarily a contributor to varicose veins, surprisingly, your hair supplement may be contributing to your spider veins, too. “Biotin is good for the hair because it increases the formation of capillaries, but then of course that affects the capillaries of the legs also,” says Dr. Navarro.

Are Varicose Veins Dangerous?

“It can take a long time to develop complications from varicose veins, but if you’ve had them for many years and they’ve gone untreated, they can cause swelling and skin discoloration and create ulcers on the ankle,” Dr. Navarro says. “They can also form blood clots in the vein, and though these types of clots are more superficial and usually not dangerous because they’re not in the deep venous system, they can still cause the area to become red, hot and tender, and it can take a couple of weeks to go away. Also, if you’re going on a long car ride or flight and will be sitting for several hours, you should wear compression stockings with 15 to 20 millimeters of pressure, or mmHg, to help minimize any discomfort.”

Will Varicose Veins Go Away on Their Own?

“Varicose veins typically do not self-resolve, although compression stockings can help temporarily manage or prevent their worsening,” says Dr. Hausauer. Dr. Navarro agrees, saying once you have varicose veins, the body cannot deal with them naturally. “One valve fails, another valve fails, and this increases the depletion of the venous blood inside the vein and the vein distends and forms a varicose vein.”

How To Get Rid of Varicose Veins

Unfortunately, as Dr. Navarro educated me, lymphatic drainage techniques like massage and dry brushing will not help minimize the appearance of varicose veins (or spider veins, for that matter). “It can help you feel better and might relieve a little bit of swelling, but it’s not curative,” he says.

However, if the appearance of the veins in your legs bother you, Dr. Hausauer says there are different ways to treat these varicose veins, aka varicosities, depending on the size of the blood vessel. You may have heard of a procedure called sclerotherapy, which, as Dr. Beer explains, involves injecting saline (salt water) or a special medication into the vein, which causes the vein wall to expand, stick together and scar, allowing the vein to be reabsorbed by the body and fade over time. “In general, if the vein is wider than a paper clip, it is OK to treat it with sclerotherapy. This treatment has to be repeated a few times for it to succeed, but it can easily be done in the office and only takes about 10 minutes.”

At Dr. Navarro’s office, he’s developed a painless sclerotherapy treatment where cryotherapy and vibration are also used so the patient doesn’t feel the needle. “Usually in one treatment, we give you 40 injections, so although it’s a very little needle, if you needed two treatments, after 30 or 40 needles in each one, it was torture. Now, we use cold air to the numb the skin, as well as vibration, and most patients say they don’t feel anything.”

Dr. Navarro says sclerotherapy is predominantly used to treat spider veins, but it can be used to treat some small and midsize varicose veins as well. “In other cases where the varicose veins are larger, we use newer procedures like endovenous laser ablation, which we developed in my office,” he explains. “We pass the laser inside the vein and then use the hot laser energy to close the vein. It uses local anesthesia and takes 35 minutes, and then we wrap your leg and you can go back to work. There’s no scarring because the needle is very tiny and only big enough to pass the laser fiber, which is 1 millimeter, into the vein. Any time you inject a vein there will be some bruising, but it depends on the patient whether it’s a little or a lot, and it goes away within a couple of weeks. And if necessary, we can give the patient a treatment to make the bruising go away much faster.”

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