Conditions we treat
Varicose veins: symptoms, causes, and treatment
Varicose veins are enlarged, ropey leg veins caused by valves that no longer keep blood moving toward the heart. They are common, they tend to get worse without treatment, and they are treated in our office without surgery.
Symptoms
Causes and risk factors
Vein walls or vein valves can be damaged or stretched and weakened by high pressure in these veins. As blood is pumped back to the heart, veins act as one-way valves to prevent the blood from flowing backwards. If the one-way valve becomes weak, some of the blood can leak back into the vein, collect there, and become congested. This congestion will cause the vein to abnormally enlarge.
No one knows the exact cause, but several factors make a person more likely to develop them: heredity, hormonal changes during puberty, pregnancy, and menopause, aging, obesity, leg injury, and prolonged standing, such as long hours on the job. As many as 60% of American adults have some form of vein disorder, and women are affected more often.
How it develops
How a varicose vein forms.
Varicose veins are a mechanical problem with a vein valve.
- Step 01
One-way valves
As blood is pumped back to the heart, veins act as one-way valves to prevent the blood from flowing backwards.
- Step 02
A valve weakens
High pressure can stretch and weaken a valve, and some of the blood leaks back into the vein.
- Step 03
The vein enlarges
The blood collects and congests the vein, and the congestion makes it enlarge and turn ropey.
- Step 04
What you feel
Heavy, tired, or aching legs, worse by evening, and swelling around the ankle that improves overnight.
Simplified, not to scaleSimplified drawings. An ultrasound in our office shows what is happening in your own legs.
When to see a vein specialist
Typically, symptoms from varicose veins are heavy, achy, drawing pains, swelling, tenderness to touch, and a tired feeling in the legs. Untreated, varicose veins may lead to worsening venous insufficiency, blood clots (thrombosis), vein inflammation (phlebitis), leg ulcers, bleeding, infection, and skin changes in the legs. If your legs ache or swell most days, if the skin near your ankle is changing color, or if a vein has bled or become hard and tender, it is time for an ultrasound.
How we diagnose it
A venous ultrasound in our office maps the veins in your leg and measures reflux, the backward flow that causes varicose veins. It takes 30 to 45 minutes, is painless, and is usually covered by insurance. The physician reviews the images with you in the same visit and, if treatment is appropriate, builds a plan around what the ultrasound shows.
Treatment options
Treatment depends on what the ultrasound shows. These are the options we use most for varicose veins.
Varithena
Ultrasound-guided foam that closes varicose veins, often in one visit.
Sclerotherapy
Quick injections that fade spider veins and small varicose veins.
Laser Therapy (ELAS)
A thin laser fiber seals the vein that causes most varicose veins.
Micro-Phlebectomy
Bulging surface veins removed through tiny nicks. No stitches.
Support Stockings
Relief for heavy, swollen legs, and part of long-term care.
Insurance and cost
Evaluation and ultrasound are usually covered. When the ultrasound shows reflux and you have symptoms, the treatment itself is usually covered as medically necessary, including by Medicare Part B. Most plans want a compression-stocking trial documented first. We handle the paperwork and tell you where you stand before anything is scheduled.
Referred by your podiatrist?
Bring the referral and any notes. We do the ultrasound and consultation in one visit and send a written report back to your referring doctor.
Common questions
Are varicose veins dangerous?
Most are not an emergency, but they are progressive. Over years they can lead to venous insufficiency, skin changes, ulcers, superficial clots, and bleeding. Treating them early is simpler than treating the complications.
When should I worry about varicose veins?
See a vein specialist if you have daily aching or swelling, skin that is darkening or hardening near the ankle, a vein that has bled, a tender hard cord along a vein, or a sore that will not heal.
Can varicose veins go away on their own?
No. Varicose veins are a mechanical problem with a vein valve, and there are no effective medications. Compression, exercise, and elevation relieve symptoms; closing the vein resolves it.
Can varicose veins come back after treatment?
Current treatments have very high success rates. Treated veins do not return, but new varicosities can develop over time, which is why we recommend support hose, exercise, and follow-up ultrasound when indicated.
Is varicose vein treatment surgery?
Not anymore. Vein stripping has been replaced by office procedures: Varithena foam, laser ablation, micro-phlebectomy, and sclerotherapy. You walk in and walk out the same day.
Do varicose veins hurt?
Many do. The usual feelings are aching, heaviness, throbbing, burning or cramping, and legs that tire easily. It is typically worse after standing and by the end of the day, and better with your legs raised. Some varicose veins cause no pain at all, but the faulty valve behind them is still there. Sudden pain and swelling in one leg, or a vein that turns hot, hard and tender, should be checked the same day.
How do you get rid of varicose veins?
By closing or removing the faulty vein, so blood reroutes through healthy veins. In our office that means Varithena foam, laser therapy (ELAS), micro-phlebectomy or sclerotherapy, chosen after an ultrasound shows which vein is leaking. Compression stockings, exercise and raising your legs ease the symptoms, but they do not make the veins go away.
Do varicose veins itch?
They can. Itching around a varicose vein, often near the ankle, usually comes from blood pooling in the lower leg and irritating the skin. Itching together with skin that is darkening, flaking or hardening is a sign of venous insufficiency and is worth an ultrasound, because untreated it can lead to a sore that will not heal.
Are varicose veins genetic?
They run in families. If a parent had varicose veins, your chances are higher. Age, pregnancy, years of standing at work and extra weight add to the risk. A family history does not mean you will get them, and it does not change how they are treated.
Our physicians
Thomas Francis Drost, M.D.
Board Certified Surgeon
Dr. Drost is a board certified surgeon who performs in-office, non-surgical vein treatments at our Oak Park office.
Kristen Hayes, M.D.
Board Certified Emergency Medicine Physician
Dr. Hayes is a board certified physician with more than two decades of clinical experience who treats varicose and spider veins at our Wilmette office.
Your legs have places to go.
Two offices in Oak Park and Wilmette, serving Evanston, Berwyn, River Forest, Skokie, Glenview, and all of Chicagoland. All procedures are performed in the office without surgery.