4 minute read
Most varicose veins are not dangerous. They ache, they itch, they look worse at the end of a long day, and for most people that is the whole story. A small number of signs mean the vein is doing damage underneath, and those are worth a visit. One of them means today.
About one in four US adults has some degree of chronic venous insufficiency, the valve problem behind most varicose veins, according to a review in the journal Circulation. That is a lot of people living with something that is usually harmless. Here is how to tell whether yours is one of the harmless ones.
The five signs that mean you should be seen
Each of these means the vein has moved from a cosmetic problem to a medical one. None of them is an emergency on its own, but none of them settles on its own either.
- A sore or open patch of skin near the ankle that has not healed in two weeks. The NHS puts the same two-week line on it. A venous ulcer is a vein problem wearing a skin problem’s clothes, and treating the vein is what closes it.
- Skin around the ankle that is turning brown, red or hard. That is stasis dermatitis, and it is the stage before an ulcer. It is one of the symptoms Medicare’s Illinois contractor lists as qualifying for covered treatment in its coverage policy, which tells you how seriously insurers take it.
- A hard, tender cord along the path of a vein, sometimes warm and red. That is superficial thrombophlebitis, a clot in the surface vein. It is usually not dangerous by itself, but it needs to be looked at, because a clot near the groin or knee can extend into the deep veins.
- One leg swelling more than the other, especially if it came on quickly. Swelling in both legs by evening is typical of vein disease. Sudden swelling in one leg is a reason to rule out a deep vein clot the same day.
- Any bleeding from a varicose vein. This is the one that goes to the top of the list.
What to do if a varicose vein bleeds
Lie down, raise the leg above the level of your heart, and press firmly on the spot with a clean cloth for ten minutes. Then call us, or if the bleeding will not stop, go to an emergency department. The vein sits right under thin skin with the full weight of the blood column behind it, which is why a small knock can bleed a lot. The NHS classes bleeding from a varicose vein as a reason for immediate care. Once it has bled once it tends to bleed again, so it is also the strongest single argument for treating the vein.
What is normal, and what you can live with
Aching, heaviness, and legs that feel tired by evening are the standard symptoms. So is mild swelling around the ankles that is gone by morning, itching over the vein, and night cramps. These are real symptoms with a real cause, and they are treatable, but they are not signs that anything is going wrong quickly. If they are the only symptoms you have, you get to decide when, or whether, to do something about them.
Two things are worth knowing while you decide. Symptoms tend to get slowly worse rather than better, because the valve that failed does not repair itself. And the treatment for a vein that is only aching is the same in-office procedure as the treatment for a vein that has started to damage the skin, so waiting does not buy you a simpler procedure later.
Are varicose veins dangerous?
Rarely, and almost never suddenly. The serious complications are venous ulcers, which develop over years, and deep vein thrombosis, which is uncommon and usually announces itself with the one-leg swelling described above. The NHS lists bleeding, varicose eczema, leg ulcers, superficial vein thrombosis and deep vein thrombosis as the complications to know about. What varicose veins do not do is spread to the heart or turn into something else. They are a plumbing problem confined to the leg.
The honest part: what a visit can and cannot tell you
An ultrasound will tell you whether the valves in your saphenous veins are refluxing and by how much. It will not tell you how fast things will progress, because that varies from person to person, and anyone who gives you a timeline is guessing. What we can tell you is which of the signs above you have, which treatment fits, and what your insurance is likely to cover before you commit to anything. Our venous ultrasound is done in the office and takes about half an hour.
If you have none of the five signs and the veins do not bother you, you do not need us yet. If you have one of them, you do.
What treatment looks like now
The 2023 guidelines from the Society for Vascular Surgery, the American Venous Forum and the American Vein and Lymphatic Society recommend treating the refluxing vein directly rather than sending symptomatic patients away for months of compression stockings first. The guideline wording is that they “suggest against a 3-month trial of compression therapy before intervention” (guideline 2.1.4). Insurers have been slower to catch up, and we cover that on our cost and insurance page.
The procedures themselves are done in our office with local anesthetic. Varithena is a microfoam that closes the failing vein through a single needle. Laser ablation seals it with a thin fiber. Both take under an hour and you walk out afterwards. Which one fits depends on what the ultrasound shows, which is why we do not quote a treatment over the phone.
Questions people also ask
Should I see a doctor for varicose veins that don’t hurt?
You do not have to. Painless varicose veins with no skin changes are a cosmetic issue, and treating them is your choice. An ultrasound is still useful if you want to know how far the underlying valve problem has progressed.
Can varicose veins cause a blood clot?
They can cause a clot in the surface vein, called superficial thrombophlebitis, which shows up as a hard tender cord. Deep vein clots are uncommon with varicose veins alone but are the reason sudden swelling in one leg should be checked the same day.
