 What are varicose veins and what causes them? Varicose veins are large dilated veins just underneath the surface of the skin. They're at least three millimeters in size and are associated with pain, swelling, discomfort at the end of the day, skin color changes, or open wounds. There are several different causes of varicose veins. However, the underlying reason are dysfunctional valves within the veins. Every single vein in your body has valves to bring blood in the correct direction from your body back to the heart. When there's chronic strain on these valves, they become dysfunctional. When they become dysfunctional, they lead to the symptoms we discussed. Can varicose veins be serious? When should I see a doctor about varicose veins? Varicose veins can range in symptoms from being completely free of symptoms to being associated with painful varicose veins or even being associated with open painful wounds. However, varicose veins rarely are life-threatening conditions. They may affect their quality of life, but they're not dangerous. I would recommend seeing a physician sooner rather than later, preferably a vascular surgeon. You can discuss lifestyle changes, compression stockings, and even treatment strategies to help manage your varicose veins and to prevent them from getting any worse. What are the differences between varicose veins and spider veins? I actually get this question a lot. So the main differences between varicose veins and spider veins are the size and associated symptoms. Varicose veins are at least three millimeters in diameter and are associated with pain, swelling at the end of the day, itching, skin color changes, and open ulcers. Spider veins are very small. They're bluish discolorations of tiny little veins just underneath the surface of the skin and they're about one millimeter in diameter. Usually they are free of symptoms and many patients seek care just because they don't like the visual appeal of them and they don't like the cosmetic aspect of them. In that case they may be treated. Occasionally, however, spider veins may be associated with itching, burning, and discomfort and in that case treatment would certainly be warranted. Who is most at risk for varicose veins? Do they only affect women? There are several different risk factors for varicose veins. Mainly, if you're on your feet for long periods of the day or sitting for long periods of time, you may be at risk for varicose veins. Furthermore, if you're struggling with your weight, this may be a risk factor. If your mom or dad has varicose veins, it runs in the family and you may have varicose veins at that point as well. If you're a smoker, if you're a female, if you had prior pregnancies, if you had leg injuries, or even prior blood clots, this can affect your chances of getting varicose veins. Now, varicose veins affect men and women, although they affect females twice as much as men. So in the United States, about 22 million females and 11 million men between the years of 40 and 80 are affected by varicose veins. Will treating varicose veins affect the circulation in my legs? That's a good question. So circulation refers to the flow of blood from the heart to the rest of your body. So your body is made up of arteries and veins. The arteries bring nutrient rich blood from your heart to the rest of your body and that is absolutely not affected by any varicose vein surgery. The veins are mainly responsible for bringing blood back from the body and bringing it back to the heart. Now, superficial veins are very close to the skin surface and they are not major veins associated with the circulation in your body. The targeted dysfunctional veins are treated and this, again, does not affect your circulation whatsoever. Are the procedures done in the hospital? How long do they take and is more than one treatment needed? Varicose vein treatments are usually performed in the office setting. At the NYU Winthrop Vein Center, we have a dedicated vascular lab and a state-of-the-art procedure room in which we perform all the various varicose vein procedures that one may need. Depending on the type of treatment that you are being offered as well as the targeted vein, the time of treatment varies. It can range from 10 to 15 minutes up to an hour. Most of the treatments may be performed only once. In the case of endovenous laser treatments or stabs lobectomy, usually only one treatment is needed. However, for sclerotherapy, when multiple tiny little veins are being targeted for injection, this may take multiple sessions to get the cosmetic result that one desires. How do you treat varicose veins? The first line therapy for treating varicose veins is always nonoperative therapy. You can try lifestyle changes such as weight loss and increased exercise as well as the use of compression stockings to prevent pooling of the blood in your legs. This may provide many patients with relief. However, if nonoperative conservative management fails and does not work, your physician can work with you to work up the exact problem that you have in order to provide you with several different treatment strategies. The first step in treating varicose veins is to perform a comprehensive ultrasound in which the physician will look at the size of your veins and the way your valves are functioning within your body. Once that is determined and evaluated, there are several different treatments that may be offered to patients. The first line treatment that we often use is endovenous ablation therapy. This has largely replaced vein stripping and vein ligation in many practices. What it basically consists of is placing a very thin little fiber into the problematic vein and sealing it shut with heat. The heat may be in the form of laser or radiofrequency. When laser is used, it's called EVLT or endovenous laser therapy and when radiofrequency is used, it's called RFA or radiofrequency ablation. Another ablation technique is called mechanochemical ablation or MOCA. This is a newer way of sealing off the vein without using heat. It basically uses a rotating catheter and the injection of a solution to close down the problematic vein. It's generally quicker than EVLT or RFA and a little less painful. The third major treatment option is stab fluectomy. Stab fluectomy involves using very tiny 1 millimeter incisions over each of the vein branches or prominent veins. In that case, a small tiny vein hook is placed within underneath the skin and the vein is removed. The patients can have this procedure in the office with local anesthesia and very minimal discomfort. And finally, sclerotherapy is a way of treating spider veins on a cosmetic basis most of the time. It involves using a very small needle that is barely perceptible to the patient when it is injecting the solution that causes inflammation in the vein and closes it down. Again, with sclerotherapy, you may need more than one session to help achieve the cosmetic results that you desire, but it's virtually painless. How quickly will I get results and will the varicose veins come back? So how quickly you see results depends on the type of vein being treated and the type of treatment that is offered to you. In the case of endovenous laser therapy or stab fluectomy, it may take you up to a few days to a few weeks to have complete resolution of your symptoms. For sclerotherapy, you may need multiple sessions to get the cosmetic result that you want, so it may take up to a month to actually see the type of results that you're looking for. Are these treatments covered by insurance? If your varicose veins are symptomatic and conservative non-operative therapy has failed you when you still have symptoms, usually insurance companies will cover any procedures needed to help treat your varicose veins. However, if you're seeking treatment for cosmetic reasons, many times insurance companies will not cover those costs. I definitely recommend you see a physician to discuss different procedures and their pricing options in greater detail. Where can I get more information about varicose vein treatment? For more information about the NYU Winthrop Vein Center, call us at 1-866-WINTHRUP or visit us online at nyuwinthrop.org.