Varicose Veins: What You Need to Know

The Vascular Center at Mercy features board certified physicians, including Dr. Alain Tanbe and Dr. Vincent Noori, who address a variety of circulatory problems including leg pain and swelling, blood clots in legs and lungs, aneurysms, varicose veins and circulatory disease. Drs. Tanbe and Noori recently responded to a request from FORBES magazine, to address questions regarding “Varicose Veins: What You Need to Know.” Here are their responses:

What are varicose veins?

Dr. Tanbe: Varicose veins are veins close to the skin surface that become dilated and enlarged due to increased pressure.

Dr. Noori: Varicose veins are twisted and dilated veins that develop when the veins are not working properly. Normally veins have valves to help keep blood moving in only one direction (toward the heart). When these valves are damaged or don’t work well, blood starts to pool in the legs leading to the development of varicose veins. 

What causes varicose veins?

Dr. Tanbe: Our leg veins have plenty of valves in them, when these valves stop doing their job, meaning closing too fast, the blood in the veins start leaking back down instead of going up causing the blood to pool into these veins and increase the pressure in them leading to the enlargement.

Dr. Noori: Varicose veins can affect anyone, and there are several factors that contribute to its development. These include family history of varicose veins, prior history of clots, injury to the leg, previous pregnancy, especially when more than one (due to hormonal changes that weaken vein valves) and weight gain. 

What is the difference between varicose veins and spider veins?

Dr. Tanbe: Spider veins are smaller veins that also have a slight increase in pressure, but they do not bulge.

Dr. Noori: Spider veins are small, usually less than one millimeter in diameter, red or purple veins that typically appear in clusters on the skin surface. People often refer to these as "broken veins''. They are typically benign. Varicose veins tend to be larger, raised, swollen veins that bulge against your skin in twists and curls. While typically benign, they can cause health issues without appropriate medical intervention. 

What are the symptoms of varicose veins?

Dr. Tanbe: The symptoms can vary, but most commonly are aching, throbbing, cramps in the legs at night, feeling of heaviness in the legs, swelling, discoloration on the skin around the ankle, and restless leg at night.

Dr. Noori: Varicose veins can cause a number of symptoms ranging from the common visible varicose veins seen on the legs to leg pain or achiness, heaviness, fatigue, swelling, and a dark brown skin discoloration called stasis dermatitis. In the most severe form, open sores called venous ulcers can form.

What are the risk factors of varicose veins?

Dr. Tanbe: The main risk factors are sitting and standing for a long time, not exercising, trauma, and pregnancy. The most common factor is hereditary.

Can varicose veins be prevented? How?

Dr. Tanbe: They can to a certain degree, mainly by wearing compression stockings, leg elevation and exercising. If the job requires sitting for long hours, it is a good idea to get up every couple of hours and walk for 5 to 10 minutes.

Dr. Noori: There are several simple measures that can be taken to prevent varicose veins. This includes avoiding prolonged periods of sitting or standing, wearing compression stockings, lifestyle modification including weight loss and exercise, diet modification including avoiding foods high in salt and staying hydrated, and sleep positioning for pregnant women (sleeping on your left side can help prevent varicose veins from forming by reducing pressure of the uterus on the pelvic veins). 

What are surgical options for varicose veins? 

Dr. Tanbe: Surgical options for varicose veins has evolved significantly. We used to perform vein stripping, but now we perform what we call a venous closure procedure on one of the veins in the legs that most of the varicose veins are connected to. This is a minimally invasive office procedure that is done through a needle hole. Once that procedure is done, a good portion of the varicose veins will disappear. If not we can proceed with a procedure called phlebectomy which requires a micro-incision and taking these veins out; both are outpatient procedures with minimal pain afterwards.

Dr. Noori: There’s a variety of minimally-invasive procedures that can be performed in the office setting to treat varicose veins completely. Endovenous ablation procedures are minimally invasive treatments that use radiofrequency, laser energy or even glue to close abnormal veins that lead to varicose veins. Microphlebectomy is a minimally invasive procedure that uses small, slit-like incisions in the skin to remove varicose veins. Sclerotherapy uses injections of a solution directly into small varicose veins and spider veins using a very fine, thin needle. 

What other treatment options are available?

Dr. Noori: Aside from procedural options, the key to treating varicose veins and vein problems is managing the symptoms and addressing risk factors. This includes avoiding prolonged periods of sitting or standing, wearing compression stockings, elevating the legs 3 to 4 times a day for 30 minutes at a time, weight loss, exercise, and diet modification.

How are compression socks helpful? 

Dr. Tanbe: Compression stockings are very helpful due to being tight. With tightness, they prevent the blood from pooling in the lower leg and help push the blood back up; they are supposed to be warn all day and then be taken off at night. They need to be knee high with a compression of 20 to 30 mmhg (millimeters of mercury). Another part of conservative management is leg elevation, exercise, drinking a lot of water and avoiding salt.

Dr. Noori: With varicose veins, blood is retained in the legs, and you have diminished venous return to the heart. Compression socks help promote better blood circulation and increased blood flow by placing pressure on veins in your legs and feet helping move blood forward, towards the heart. In addition, they help reduce and prevent swelling, and also can help prevent blood clots.

What happens if varicose veins are not treated? Do they put a person at risk for other health conditions?

Dr. Tanbe: Fortunately, varicose veins are not dangerous, meaning they will not lead into Deep Venous Thrombosis (DVT), but if they progress they can cause a lot of discomfort and limitation to lifestyle. They also might bleed and get inflamed.

Dr. Noori: While varicose veins may often be asymptomatic, if they go untreated, blood continues to be retained in the veins in the legs and this can cause further problems down the road. This includes increased pain and swelling, leg heaviness and fatigue, skin changes, including stasis dermatitis and lipodermatosclerosis, venous ulcerations, phlebitis, etc.

Drs. Tanbe and Noori are Registered Physicians in Vascular Interpretation (RPVI). RPVI indicates a high-level certification that signifies advanced skills in reading and interpreting vascular imaging. Drs. Tanbe and Noori see patients in The Vascular Center at Mercy, under the medical direction of Dr. Paul Lucas.