Those bulging, knotted blue veins that appear in your legs, called varicose veins, rarely lead to health problems. But many people want them gone anyway. “For most of my patients, the reason they want to get rid of them is because they don’t look good,” says vascular surgeon Bauer Sumpio, MD, PhD.

In the most severe cases, however, varicose veins can cause significant pain, swelling, and even ulcers. The good news is, with today’s minimally invasive surgical procedures, patients won’t need to plan their lives around major surgery. Varicose veins can usually be taken care of by a short visit to an outpatient clinic, with no need to go to the hospital.

At Yale Medicine, patients with varicose veins are matched with a doctor from our multi-disciplinary team—including vascular surgeons, interventional radiologists, and cardiologists—to ensure that each receives the personalized treatment best for him or her. 

Varicose veins almost always occur in the legs because those veins tend to be under the most pressure. However, they can pop up elsewhere in the body. Later in life, varicose veins become quite common, due simply to the aging process. Your blood, which is pumped from the heart down to your feet and legs, must somehow get back up to the heart. To do this, blood travels through what is called the great saphenous vein, located just beneath your skin. Within that vein is a system of valves that, when you contract your calf muscles (as you do when you walk), pushes the blood upwards. Over time, after years of holding blood, those valves get weaker. They may become leaky, causing blood to pool around the valve and leak into smaller veins. This, in turn, results in bulging and knotting, called varicosity, or varicose veins.

This may look unattractive but it’s rarely dangerous. That’s because you also have another vein, located deeper in your leg, performs the same function. Therefore, it’s not a problem when varicose veins are closed off or removed.

“If you want to think of your vein system as a tree,” Dr. Sumpio says, “when the main vein with valves, or the tree trunk, doesn’t work as well, then the pressure gets transmitted to smaller branches off the trunk.”

Many women get varicose veins during pregnancy, because of the baby’s weight and constant pressure on the uterus. This increases pressure on leg vein valves and speeds up the vein-weakening process. The valves become fatigued as they push harder to get blood back up to the heart. If they don’t develop during pregnancy, women who’ve had children are still more vulnerable later on, because the additional stress has weakened the valves.

Risk factors for varicose veins can vary. They include pregnancy, menopause, being over age 50, standing for long periods of time, obesity, or a family history of varicose veins.

Spider veins are different from varicose veins. Spider can be red, blue or purple. They usually appear in a spider web-like pattern. While varicose veins are caused by weak or damaged vein valves, spider veins usually crop up due to a backup of blood in capillary, or supporting, veins. Both can be treated by the same procedures.

Besides the visual appearance of a knotted vein, varicose veins can cause such symptoms as radiating pain around the affected vein, swelling and itching.

Your doctor will conduct a physical exam and ask questions related to your condition. He or she may also conduct an ultrasound test to ensure there are no underlying health concerns, such as blood clots.

The treatment of varicose veins has improved tremendously in recent years. An older procedure, called vein stripping, required surgical incisions along the leg or body part, followed by removal of the vein from the body. Now a wide variety of minimally invasive treatment options are available. 

These include: 

• Sclerotherapy, which involves injecting a solution into the vein. The solution (which may be hypertonic saline, sodium tetradecyl sulfate or polidocanol) irritates the vein. This causes the walls to collapse. The vein closes off and remains in the body, harmlessly.
• Ambulatory phlebectomy, a mini-surgical technique that involves removing varicose veins through multiple, small (less than 2 mm) slits made in the skin overlaying the vein.
• Endovenous laser ablation therapy (EVLT), which uses light energy to collapse a vein.
• Radiofrequency ablation (RFA), which relies on heat and radiofrequency waves to close off a vein. 

A combination of the above treatments is often needed. “I routinely use phlebectomy in addition to endovenous ablation and sclerotherapy,” says Angelo G. Marino, DO, a vascular interventional radiologist in the Department of Radiology & Biomedical Imaging.

Patients are usually able to go home or back to work immediately with instructions to take small walks that day to keep circulation moving. You’ll also be provided with compression hose to wear for a period of time (your doctor will provide instructions). After the procedure, it’s important to avoid hot showers for 24 to 48 hours.

“Most insurance companies will not approve this kind of procedure until the patient has had a trial of compression stockings,” Dr. Sumpio says. If compression stockings do not produce positive results and/or if the varicose veins are causing significant pain, then insurance companies may provide coverage for the procedure, he adds.

Yale Medicine doctors use a multidisciplinary approach to treating varicose veins, enabling each patient to receive the optimal care for his or her particular problem. We also offer on-site purchase of custom-fit compression stockings, ensuring that patients get the correct size and receive instruction in their proper use. 

“We offer patients a way to be measured immediately for and purchase compression stockings rather than getting a prescription for them to be filled elsewhere,” Dr. Sumpio says. This makes life easier for varicose vein patients, who must usually wear compression stockings before and after their treatment.