by As you get older, it is not uncommon for large, tortuous veins to develop on your legs. According to the Society for Vascular Surgery, as many as 40 million Americans have so-called varicose veins.
But what causes varicose veins, and is there a way to prevent them? We asked vascular experts to break it down.
First of all: what exactly are varicose veins?
“Varicose veins are the larger, bulging, twisted veins that you often see running down someone’s legs,” says Dr. Justin Ha, a physician and vein specialist at Metro Vein Centers.
A common myth about varicose veins is that they are purely a cosmetic problem. Although some people experience only aesthetic changes, that is not always the case.
“They can be painful and show symptoms such as swelling, heaviness and even throbbing,” Ha said. “If left untreated, they can lead to serious complications such as blood clots or ulcers. It is a medical condition that may require clinical intervention, and often it is not just a cosmetic problem.”
He emphasized that varicose veins are not always visible on the surface of the skin.
“You may have underlying vein damage if you experience symptoms such as heaviness, swelling, pain, or restless legs,” Ha explained. “So if your legs don’t feel good, don’t ignore it.”
Many people confuse varicose veins and varicose veins, but in reality they are different.
“Varicose veins are much smaller,” Ha explained. “They are those thin, web-like veins that you often see on the surface of the skin. They are usually more of a cosmetic problem, but can sometimes be a sign of early vein disease. If they are accompanied by discomfort in the legs, it is typically the canary in the coal mine and you should visit a vascular doctor.”
What causes varicose veins?
“The cause of varicose veins is related to the valves in the veins not working properly and causing increased venous pressure in the veins,” says Dr. Tikva Jacobs, vascular and endovascular surgeon at Weill Cornell Medicine and NewYork-Presbyterian Hospital. “Veins are thin-walled, unlike arteries, and the extra pressure causes the veins to expand and become larger.”
She explained that arteries carry blood from the heart to the legs, but veins must work against gravity to bring blood back to the heart. The valves in your veins prevent blood from flowing back to your feet, but over time certain factors can lead to ‘leaky’ valves or insufficiency – allowing some blood to flow back to the feet and increasing blood volume.
“If those valves weaken or become damaged, blood can flow backward and pool in the veins of the legs,” Ha said. “This buildup can cause increased pressure in the veins, causing them to stretch, twist and bulge, which is what you see when someone has varicose veins.”
But what are the factors that cause such weakening or damage to your circulatory system over time?
“The main cause of varicose veins is heredity,” Jacobs said. “If a parent or grandparent has had varicose veins, you are at increased risk for developing varicose veins.”
Women are also more likely to develop them due to the hormonal changes caused by menstruation, birth control, pregnancy and menopause.
“Other things, such as age and working in occupations that require prolonged sitting or standing, increase the risk of developing varicose veins,” says Valerie Faryman, a nurse practitioner in the Division of Vascular Diseases and Surgery at The Ohio State University Wexner Medical Center. “Overweight, or obesity, causes extra pressure on the veins, which increases the risk of developing varicose veins.”
Age plays a role because veins naturally lose their elasticity over time, making them more susceptible to damage. But people can get varicose veins at any age.
“Things like frequent air travel, smoking and a history of leg injuries can all put extra pressure on the veins,” Ha added.
Dr. Sheila Blumberg, a vascular surgeon at NYU Langone Hospital-Brooklyn, noted that many people think varicose veins are caused by blood clots, which can be dangerous.
“They are not caused by blood clots, but can be seen in people with a history of blood clots in their legs,” she explained. “I assure people that varicose vein disease is not a limb-threatening or life-threatening disease.”
There is also a common myth that crossing your legs while sitting can cause varicose veins.
“Crossing your legs doesn’t cause varicose veins, but it can make symptoms worse if you already have them,” Faryman noted.
Is there anything you can do to prevent varicose veins?
“You can’t change your genetics or stop aging, but there are certainly ways to keep your veins healthy,” Ha said. “It’s all about managing your circulatory system.”
One of the most important things you can do to slow the development of varicose veins is to maintain an active, healthy lifestyle.
“Walking, swimming and yoga are good for your veins because they keep the blood moving,” he explained. “If you sit or stand for long periods of time, take breaks to stretch or move. Elevating your legs while relaxing can also reduce pressure on your veins.’
Other helpful approaches include quitting smoking and maintaining a healthy weight.
“Compression stockings are a great option, especially for people who are on their feet all day, as they help improve blood flow and reduce swelling,” Ha said, adding. “Varicose veins are more difficult to prevent, but the same tips apply: good circulation is the key!”
How do you treat them?
Taking all preventative measures can certainly help slow or reduce the development of varicose veins, but some can still form over time. The good news is that there are many treatment options.
“Treatments for varicose veins vary depending on the size and location and whether there are veins beneath the skin’s surface that we cannot see with the naked eye and that some veins cause,” Jacobs explains.
She noted that patients are evaluated with a physical exam and an ultrasound, which allows doctors to look at both deep and superficial veins and see which ones are working well and which ones may be causing the varicose veins. Then, the medical professionals develop a treatment plan, which may include a combination of procedures or just one procedure.
“Current treatments for varicose veins are much easier and more effective than people realize,” Ha said. “They are minimally invasive, outpatient procedures that help close damaged veins and keep your blood flowing through healthier veins.”
Varicose veins are often treated with sclerotherapy, in which the damaged vein is injected with a solution that collapses the vein and diverts blood to better functioning veins.
“Phlebectomy is a procedure that uses a microincision to remove surface varicose veins,” Blumberg noted.
Surface laser therapy is another way to collapse those small, superficial veins.
“Larger veins may need to be removed under local anaesthetic, but sometimes the veins causing the varicose veins – known as the axial vein – need to be treated with an ablation where a heat source is placed inside the veins and destroys the vein. from the inside out,” says Jacobs.
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In addition to radiofrequency ablation and laser therapy, Ha noted that other common treatments in his practice include injections of VenaSeal, which can close veins, and Varithena, a foam-based option that can also cause the vein to close.
Insurance typically only covers varicose vein treatments that are considered medically necessary due to painful symptoms. But that doesn’t mean you can’t explore your options if what you see in your legs bothers you.
“It is a myth that you should only treat your veins if you are in a lot of pain,” says Jacobs. “If you don’t like the look of your veins, that’s a perfectly valid reason to get evaluated and see what cosmetic options are available.”
