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Varicose veins are a symptom of “venous insufficiency,” a condition where veins are dilated or enlarged due to pooling blood when they do not circulate the blood back to the heart properly.  Most commonly found in the legs, these veins can dilate so much that they become visible like budging, knotty ropes along your leg.  They are not life-threatening although if not treated, they may lead to ulcer formation or spontaneous hemorrhaging (bleeding).  More often, they look worse than they feel.  They almost always are “the tip of the iceberg" and represent a sign of more serious venous insufficiency, also called varicose veins disease.  If your parents have them, chances are you’ll have them too.

The majority of patients have symptoms of venous insufficiency without having visible varicose veins.  These symptoms include leg fatigue, achiness, heaviness, pain, itchiness and frequently, nighttime cramps.  These symptoms can affect one or both legs and seem to be worse at the end of the day.  They may feel better if you walk around a little or "put your feet up".

In our office, we offer a free screening to see if your complaints sound like a vein problem.  If so, then we order an ultrasound evaluation which is performed in our office.  The ultrasound exam is noninvasive and gives us a detailed description of how your veins function in your legs.  Based on the results of your ultrasound, we can discuss what treatment options might be best for you.

No.  Venous insufficiency is when your veins cannot return the blood from your legs to your heart.  (It pools in your legs and makes them sore, fatigued, crampy, etc.).  Peripheral Arterial Disease (PAD) is a problem with arteries (not veins) that are narrowed or clogged and thus cannot deliver enough blood to your extremities.  PAD is more common in people who may have diabetes or elevated cholesterol or who smoke cigarettes. 

The venous ultrasound is covered by insurance, though you are responsible for your normal co-pays.  If a procedure is required for treatment, those costs are also generally covered by your insurance carrier.  As long as you are having symptoms, the ultrasound and procedures will be covered by insurance.  The only costs that are not covered by insurance are for cosmetic surgery.  Cosmetic surgery is offered to people who are concerned about the appearance of their legs but have no symptoms.  If your legs cause you problems (achiness, swelling, pain, leg fatigue, heaviness or night cramps), then insurance companies cover the cost for most treatments.

If we think you have venous insufficiency, our first line of treatment is called “conservative therapy".  This includes elevating your feet, increasing your walking, using analgesics like Ibuprofen or Tylenol for pain and, most importantly, wearing prescription compression stockings.  (Over-the-counter stockings, borrowed stockings or even stockings you may have received in the hospital are not sufficient.)   You must be properly measured and fitted for these higher compression hose.  In fact, almost all insurance companies mandate that you try conservative treatment for three months prior to having a procedure.

If you have venous insufficiency and conservative measures don't seem to help, there are several office-based procedures that can be used alone or in combination to effectively treat your problem.  Endovascular laser ablation is an office-based alternative to the in-patient hospital-required "vein stripping" surgery of years ago.  Endovascular laser ablation is performed in the office while you are awake and usually takes less than one hour to complete.  You then walk out of the office and resume normal activity "within reason" during the next few days.  People generally resume all activities within one week.  One important guideline to recovery is to “keep moving”.

Other procedures like sclerotherapy, microphlebectomy or superficial skin laser are also safely performed in the office and have a quick recovery.

Like any procedure, there are always risks. The chance that you will have a complication with any of these procedures is very rare. The most serious complication is formation of a deep vein thrombosis (DVT) which occurs less than 1% of the time following the laser procedure.  The risk of infection or other serious complications is near zero.   We schedule follow up appointments to make sure you are recovering as expected.

There are many near painless procedures that we can do in our office to improve your appearance.  We can easily treat small spider veins on your nose or cheeks with a superficial laser.  We can also use this technique along with sclerotherapy to treat spider veins on your legs.