Varicose Veins The Latest in Treatment and Prevention

There is good news for those who have varicose veins or are worried about developing them in the future. Today’s treatments for removing these enlarged veins are much less invasive than in years past. And taking steps early on may even help you minimize or avoid them altogether.

What Causes Enlarged Veins in Legs and Feet?

In most cases, weakened veins are to blame. Varicosities and their smaller cousin, spider veins, can occur anywhere in the body, but they are far more common in the lower extremities.

That’s because gravity is a factor. Blood has a long uphill journey from the feet back to the heart. To keep it flowing upward, your leg veins—unlike those in your upper body—have valves along the way. These act like one-way doors, opening and closing as blood pushes upward with each muscle contraction. Healthy valves close tightly. But weakened ones let blood flow backward, putting extra pressure on the veins. That can create stretching and distortion, which leads to purple, cord-like veins bulging just beneath the skin’s surface.

Varicose veins are extremely common, more so in women, and typically harmless. Common risks include having a family history of them, aging, pregnancy (especially more than one) excess weight and long periods of standing on a regular basis. A history of more serious clotting, known as deep vein thrombosis, can also increase your risk.

In addition, some people are born with a condition called May-Thurner syndrome that can lead to varicosities, often in the left leg alone. This happens when an artery in your pelvis presses on an underlying vein carrying blood to your left leg. Although the condition is rare, it’s something we look for during the initial ultrasound when we evaluate each patient’s veins and valve function.

Are They Cause for Concern?

For many people, varicose veins are just an unattractive nuisance. But for others, they eventually cause bothersome symptoms, such as burning, bleeding, itching, aching pain and/or a feeling of heaviness in the legs and feet. Sometimes, minor blood clots develop, which can be treated with pain reliever and warm compresses until the body resorbs them. In severe cases, skin sores erupt.

While the condition isn’t generally harmful to your health, it can be uncomfortable and negatively impact your quality of life. With the minimally invasive treatments we offer today, there’s little risk in having them removed.

How Are They Treated?

The most common way we treat varicosities today is with radiofrequency ablation. This minimally invasive technique involves injecting the area with numbing medication, then using a tiny needle to gain access to the problematic vein. A very thin, flexible tube (catheter) is inserted into the vein, with ultrasound imaging used to guide it into place.

As we slowly draw it backward, the catheter uses radiofrequency to send out heat, which seals off the vein as it goes. Any veins attached to the main branch that we treat also tend to regress over the next three months or so. Blood flow naturally reroutes to healthy veins, and the body eventually resorbs the treated veins over the next few months.

Radiofrequency ablation takes less than 30 minutes, requires no anesthesia or downtime and is highly effective for removing symptomatic veins with little risk. Most patients don’t need any further procedures and are happy with the results long-term.

This technique works for most patients, whose varicose veins tend to branch from the superficial leg veins known as the greater saphenous, small saphenous or anterior saphenous. These long, straight veins can easily accommodate the thin catheter.

A newer procedure we offer for treating veins like these is called VenaSeal^TM. It works much like radiofrequency ablation but, instead of using heat inside the vein, VenaSeal involves injecting a medical-grade adhesive to close it. The benefit is that no local numbing medicine is needed along the vein, so there are fewer injections overall, which some patients prefer. Occasionally, patients have a skin reaction to the adhesive, but for the most part, studies show it works well.

Radiofrequency ablation and VenaSeal aren’t for every vein problem. For much smaller varicose or spider veins, we offer sclerotherapy. This involves injecting a solution into the vein that causes it to collapse and fade away over a few weeks. Some centers treat these smaller veins with laser therapy. While the laser can be effective, it’s actually more painful than sclerotherapy injections. It also takes more time, which means you may need multiple visits for laser treatments.

Extremely dilated veins, which look like thick grapevines under the skin, sometimes require more complex treatment. For these, we may recommend a surgical phlebectomy. This requires general anesthesia at the hospital and involves making small incisions over the affected veins and actually removing them one by one. While surgical phlebotomy is more complex and invasive, it’s also highly effective for advanced cases.

Does Health Insurance Cover Treatment?

Most insurance plans do not cover treatments that are purely cosmetic. But if your varicose veins are causing symptoms—such as the burning, itching, pain or heaviness mentioned earlier—insurance plans will usually cover the ultrasound evaluation and treatments if venous disease is confirmed.

Can Varicose Veins Be Prevented?

Compression stockings are the gold standard approach for minimizing varicose veins. I highly recommend them if you already have these veins or any risk for developing them, such as pregnancy or a job requiring lots of time on your feet. These tight-fitting knee-highs or thigh-highs keep blood moving instead of pooling or backflowing. In order for them to be effective, however, they must be worn consistently every day, putting them on in the morning when you get dressed and taking them off when you go to bed at night.

Medical-grade compression stockings require a prescription and can be purchased online or at local medical supply stores. (Typically, a pressure of 20 to 30 mmHg is a good start.) If these are too uncomfortable, however, non-prescription varieties are less snug and cost less; you can often find these online. The key is to choose compression stockings that you will commit to wearing regularly.

If you’re sitting for long periods, try to elevate your legs to 90 degrees when you can. Maintaining a healthy weight can also help to minimize pressure and swelling on your legs. Regular walking and other leg exercise are another plus, since the muscle stimulation helps keep blood flowing and veins healthy. I recommend avoiding herbs and supplements you see advertised, as there’s no good evidence that they can prevent or help varicosities.

At the Hospital Center

While medical treatment for varicose veins isn’t always a must, varicosities do tend to worsen over time for most people. Coming in early for an ultrasound evaluation and a conversation about prevention and treatment options is ideal.

MedStar Washington Hospital Center addresses the full range of vascular problems, so we are able to look for the obvious causes of varicose veins as well as the more complex. And our team is multidisciplinary, so we easily consult with or refer to other specialists as needed—assuring you the most comprehensive care.