When to Start Worrying About Varicose Veins

We often hear from patients they are concerned about varicose veins developing on their legs. Its a very common concern to wonder when to start worrying about what to do when spider veins or varicose veins occur. This is especially a concern when you have risk factors for vein disease, varicose veins or spider veins from family history or prior injuries.

Varicose veins are not normal.

If you look at a child’s leg its very rare to see veins at all. This is because all of there veins are normal. With time, genetics or a history of deep vein thrombosis (DVT) some may develop twisted blood vessels on their legs known as varicose veins. All varicose veins and spider veins are abnormal and represent veins that have lost normal blood flowing due to a loss of normal venous valve function. Medically this is known as chronic venous insufficiency.

Do All Need Varicose Vein Treatment?

A varicose vein, although abnormal, does not always necessitate treatment. These dilated, twisted varicose veins can occur due to weakened valves in the veins, leading to blood pooling and abnormal blood flows. Here are varicose vein symptoms to consider when deciding on treatment:

Leg Swelling:

If a patient experiences significant leg swelling, it may indicate impaired blood pooling in the lower legs due to varicose veins.

Leg Ache and Heaviness:

Painful symptoms such as feeling of heaviness may can result as the vein stretches.

Skin Itching:

Itchy skin and changes in skin color could be due to inflammation or poor blood flow.

Leg Rash (Stasis Dermatitis):

Skin discoloration, characterized by red, scaly skin near the ankles, often results from venous congestion.

Venous Leg Ulcers:

Serious complications such as painful ulcers on the legs can develop.

Varicose Veins can cause bleeding from the skin

Varicose veins may lead to blood clots, causing severe pain or life-threatening risks.

Other risk factors such as a family history of thrombosis in veins deep in the leg or life threatening pulmonary embolism are important. Remember, individualized assessment by a vascular specialist or vascular surgeon can be helpful in understanding what veins can and should be treated. If you notice varicose veins and none of the above applies, then you many not need or benefit from treatment.

What are the causes varicose veins develop?

It is all about gravity. Arteries carry blood to the legs. We all have veins that help bring blood flow from the tissues and return it to our hearts. Leg veins in particular have a hard job as they have to return blood from the legs against gravity. The veins are like an upside down tree with lots of branches in the lower leg and more and more larger vein branches as the veins get to the pelvis.

When a patient walks, the muscles squeeze the veins and push the blood up toward the heart. When the patient relaxes, the tiny valves close to prevent blood pools and stretches the vein walls.

There are two main systems in the leg that contribute to develop varicose veins. One is the deep and the other is superficial just under the skin’s surface. Most of the blood comes up the deep veins. Varicose veins are primarily from tiny valve dysfunction in the superficial vein walls.

The primary superficial veins that impact the development of varicose veins are the saphenous veins and its branches. Such when people have varicose veins on the skin’s surface most of the time its from failure of the valves of the saphenous veins (which are just below the skin). There are three types of saphenous veins. This includes the great saphenous veins, the anterior saphensous veins and the small saphenous veins.

When you see a vein specialist they can perform a venous ultrasound to map out all your veins and determine the sources of blood pooling in the lower legs.

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Ultimately the main cause of impaired valve function in the spahenous veins is usually genetic. This is called primary venous insufficiency. Or in some cases it can be damage from prior clots (like DVT or phlebitis after injuries or trauma). This is called secondary venous insufficiency. Ultimately the cause does not matter much as people do not have much control over either by the time the varicose veins develop.

The Causes of Varicose Veins

The risk in developing varicose veins is usually genetic or acquired. The genetic form is called primary venous insufficiency. This means the genes for varicose veins were inherited.

In some cases risk factors can be acquired from vein valve damage from prior blood clot (like developing deep vein clots or superficial phlebitis after injuries or trauma). This is because blood clot in vein deep in leg can damage vein valves. When patients have a history of superficial blood clot on the skin’s surface varicose veins or deep vein it is known as secondary venous insufficiency.

When to worry about varicose veins?

Some people simply see new varicose veins but they have no symptoms from them. These are called asymptomatic varicose veins. When they are asymptomatic varicose veins…meaning there are no symptoms of pain, swelling, leg pain, muscle cramps, skin changes or wounds, they do not necessarily have to be treated.

However, the data suggests that over time, they generally will get worse and at a later date they may become symptomatic. Nevertheless, it is not generally felt by experts that asymptomatic varicose veins need to be treated for medical purposes or to prevent progression. Sometimes patients wish to have these treated for cosmetic concerns. This can be done.

On the other hand, many people start to worry about varicose veins once they start to have symptoms. Typical varicose veins symptoms include ache, swelling, tenderness along the veins and skin changes or blood clots (known as phlebitis). Ache, swelling, and tenderness or throbbing are usually the earlier symptoms. A lot of times the patients will say their legs feel heavy or tired. This is because there is extra blood that is pooling in the legs.

More advanced varicose veins symptoms include skin changes, such as ankle discoloration or stasis dermatitis. Another advanced complication is blood clots in the veins, known a phlebitis.

Additionally, skin changes such as ankle discoloration can occur where the skin becomes red, irritated, brown and itchy. This can be around varicose veins or spider veins.

The ultimate stage of this is bleeding from the veins or wounds that open that do not heal. This is known as venous leg ulcers which occurs when the skin is so damaged by the foot and ankle it cannot heal properly.

What if your veins do not bother you?

Have you ever noticed those winding, bulging veins on your legs but the varicose veins or spider veins don’t ache, itch, or throb, and you’ve never experienced swelling, skin rashes, wounds, or bleeding? In such cases, you might wonder if treatment is necessary for cosmetic concern.

The good news is that if your varicose veins are not causing discomfort or posing a medical risk, you don’t have to rush into treatment. You may be able to prevent varicose veins occur by maintaining a normal blood volume, do not stand for long periods, avoid sitting for long periods, treating any serious health problems, and maintaining a healthy weight.

Varicose Vein Treatment Options:

Medical Indications:

When varicose veins or spider veins impact your quality of life—causing pain, heaviness, or other symptoms—it’s essential to seek medical advice. Treatment can improve blood flow, prevent complications, and alleviate discomfort.

Cosmetic Indications:

Some individuals choose to treat their veins for cosmetic reasons.While cosmetic treatments aren’t typically covered by insurance, they offer a way to enhance the aesthetics of your legs.

Patient Choice and Expectations:

Patients often worry: Are varicose veins dangerous? The best say to know is with a consultation with a healthcare professional where you can explore options such as compression stockings or procedures, discuss expectations, and decide whether treatment aligns with your goals.

What can be done to treat varicose veins?

The good news is that for most patients there are numerous treatment options that can significantly reduce blood vessels symptoms and improve overall vein health. Wearing compression stockings can help stop blood pooling. There are also procedures to remove veins in the out patient office setting in quick procedures with minimally invasive treatments that require little or no downtime for varicose and spider veins. This includes RFA, Laser ablation, Venaseal, Varithena, or Sclerotherapy or ambulatory phlebectomy to remove veins.

Will Insurance Cover My Minimally Invasive Procedure?

When indicated for leg pain, leg ulcer other symptoms, treatments are often covered by insurance with most plan when the patients follow their insurance companies treatment policies. Some require compression stockings first.

When the primary indication is appearance, most plan do not cover treatment for a cosmetic procedure.

If you are concerned or worried about your varicose veins, or if you are worried about developing blood clots why not make an appointment to see a vascular specialist and have a physical examination? In speaking with a vascular surgeon or other type of see a doctor like a vein specialist you can learn more about your options. If you have questions about other veins like pelvic congestion syndrome that can be addressed as well.