Checkup on Health: Varicose veins are a common problem

One in four adults has a venous disease of the leg

woman at gym
Exercise can help prevent and manage varicose veins.

By David Dawson, M.D. 

One in four American adults has some form of venous disease of the legs. In fact, it is ten times more common for a patient to see a physician for vein problems than for arterial disease, like the atherosclerosis that is often associated with high cholesterol or diabetes.

About the author

Dr. Dawson is a professor of vascular and endovascular surgery affiliated with UC Davis Vascular Center. 

Varicose veins can simply be an unsightly nuisance, but people may have pain, leg swelling, or other symptoms that negatively affect quality of life. In some cases, vein problems can lead to chronic skin changes such as dermatitis, darkening of the skin, itching, bleeding, or the formation of a leg ulcer.

Both men and women can get varicose veins, though they are more common in women. Women can have varicose veins that worsen with pregnancy, due to the effects of hormones and related circulatory changes. Vein problems can also run in families. A patient with varicose veins may have a parent or other family member has similar problems. 

Normally, small one-way valves within the veins help to maintain blood flow in the normal direction, back towards the heart. If the valves don’t work, there can be a reversal of the blood flow or “reflux” that causes pooling and increased pressure within the leg veins. It is this pressure that causes the symptoms and stretches the veins, resulting in the dilation and elongation typical of varicose veins.

Self-care for vein problems

Although an individual may be predisposed to varicose vein or other vein problems, there are actions that can minimize the symptoms, avoid complications, and reduce the risk of new varicose veins developing. Patients learn about the importance of the three “E’s”: exercise, elevation, and the use of elastic compression.

  • Walking, swimming, and other physical activities can help to circulate the blood in the legs. 

  • Elevating the legs (by sitting with feet propped up or lying down with the foot of the bed elevated) can help to reduce the pressure in distended veins. 

  • Importantly, the use of special compression stockings can provide needed support to weakened vein walls, reduce swelling, and provide relief from the aching pain associated with varicose veins.

Treatment options

There are a variety of treatments available to patients with vein problems. A vascular specialist will review medical history and conduct a physical evaluation, and an ultrasound imaging study of the leg veins helps identify areas of abnormal function. The physicians will tailor treatment plans to the individual’s condition.

  • Removal: If varicose veins on the surface of the legs result from reflux in one of the principal superficial or shallow veins, treating the source of the reflux can eliminate the problems or associated symptoms. Traditionally this involves the surgical removal of the veins, a known as “vein stripping.”

  • Ablation: Many patients with reflux in superficial veins benefit from a less-invasive approach known as endovenous ablation. With ablation, a small catheter heats the vein from the inside (with either laser or radiofrequency energy). The heat causes the vein to constrict and close, interrupting the reflux. The UC Davis Vascular Center Clinic performs ablation procedures on an outpatient basis, and local anesthesia and light sedation makes the procedures simple and nearly painless. 

  • Sclerotherapy: Small reddish and purple veins within the skin are called “spider veins” or telangiectasias. These are often too small for surgical removal, and may be present even without reflux in one of the larger veins. These can sometimes be treated with sclerotherapy, an injection of an irritant solution into the abnormal vein that causes it to scar shut. Sclerotherapy can sometimes help in treating vein abnormalities as well, especially after surgery or endovenous ablation.

Chronic venous insufficiency

Leg symptoms can sometimes be related to problems with veins deep in the limb. Chronic vein-related symptoms sometimes develop after blood clot has affected deep veins. Surgery is rarely helpful for vein problems related to the failure of deep vein valves, or to relieve blockage within the deep veins of the legs. The three “E’s”, including the use of prescription compression stockings, can still provide relief. 

The UC Davis Vascular Center is dedicated to providing comprehensive care to patients with vascular problems, including arterial disease and vein problems. Its primary goal is to promote a comprehensive, collaborative and interdisciplinary approach to treating vascular disorders. Contact the Vascular Center Clinic