 Veins normally only go one direction up back to the heart but the problem with varicose veins are gravity is pulling the blood back down. As they become bigger they can now cause symptoms. The back pressure that's to stay out the veins can also push water out so you get swollen in your legs. The legs can ache and cramp after you've been on your feet all day. Most of my patients with large varicose veins, the vast majority, it's genetic. You have family members with it because other family members had the bad valves in the vein and you inherited that and you can't cause them, you can't prevent them. I have performed thousands of operations for varicose veins in surgery centers. The only reason I do a surgery center is if we need a general anesthetic. If it's local anesthetic we can do it right here in the office most of the time. Most of my patients they have very little pain and minimal scarring. For pain afterwards, Motrin, Ibuprofen, Advil, it's all you know all my patients require for control of pain. I have patients who have their own businesses who don't want to take time off and then I'll stage the procedure that I'm doing to accommodate their requests and needs.