Who gets varicose veins and why.
Both women and men can develop vein disorders at any age. It can affect the healthiest of individuals, but there are some conditions that increase your risk of developing varicose veins. They are mostly inherited; if both of your parents had varicose veins, you have a 90% chance of also having them. Other factors that increase your chance of developing vein disorders include being female, hormonal changes, pregnancy, getting older, having a job that requires many hours standing or sitting, being overweight, and a history of leg injuries.
- Increasing age. As you get older, the valves in your veins may weaken and not work as well.
- Heredity. Being born with weak vein valves increases your risk. Having family members with vein problems also increases your risk. About half of all people who have varicose veins have a family member who has them too.
- Hormonal changes. These occur during puberty, pregnancy, and menopause. Taking birth control pills and other medicines containing estrogen and progesterone also may contribute to the forming of varicose or spider veins.
- Pregnancy. The hormones during pregnancy greatly influence the leg veins. Varicose veins can even be a symptom of pregnancy and can show up during the first trimester. As pregnancy progresses, there is a huge increase in the amount of blood in the body. This can cause veins to enlarge. The growing uterus also puts pressure on the veins. Varicose veins usually improve within 3 months after delivery. More varicose veins and spider veins usually appear with each additional pregnancy.
- Obesity. Being overweight or obese can put extra pressure on your veins. This can lead to varicose veins.
- Lack of movement. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This may be a bigger problem if you sit with your legs bent or crossed.
- Leg Injuries
How long until you can make them go away?
Many patients see same day, immediate results, while others may require multiple visits.
The veins are shut down immediately, but it can take several weeks for the veins to completely break down within the body. The body’s healing process will vary from person to person. No two people’s vein condition are the same. Your doctor can better assess your timeline at your consultation. In general, your legs will feel better before they look better. The cosmetic benefits follow the health benefits of vein treatment.
Do I have to get surgery?
No! We’ve performed thousands of surgery-free treatments.
Surgery is rarely performed these days to eliminate varicose veins. Modern ‘endovenous procedures’ have replaced surgery for most patients and can be done in a doctor’s office. At our facility, we offer multiple non-surgical treatment options so that vein care is individualized and based on what is best for the patient rather than on what is available.
Will my insurance pay for this?
It depends on the type of vein issue you are having.
Most insurance and Medicare will cover varicose vein treatments that are considered “medically necessary care” but not for “cosmetic care”. Medically necessary signs and symptoms include pain, heaviness, swelling, varicose vein rupture, ulceration and others. Underlying venous insufficiency must be documented by ultrasound examination. The ultrasound study to determine the treatment and the physician visits are covered benefits with most insurance types.
In most cases, insurance require that conservative measures have been tried for several weeks. Conservative measures include compression stockings, leg elevation, exercise, weight loss, anti-inflammatory medication such as ibuprofen and hot/cold packs. Many insurance types REQUIRE 6 to 12 weeks of wearing medical grade compression stockings prior to being approved for treatment. Over the counter compression is not accepted. You should have your consultation as soon as possible and begin implementing conservative management into your lifestyle. You should begin keeping a daily log documenting that you are using conservative treatments (download attachment).
Treatments that are not covered by insurance because they are considered to be ‘cosmetic services’ include:
- Varicose veins that do not cause any symptoms
- Small, surface varicose veins (without evidence of underlying venous insufficiency on ultrasound)
- Spider veins
Do I have to see a specialist?
Learn more about our difference.
Vein conditions deserve specialized care and you deserve more than a doctor who ‘dabbles’ into vein treatments. At La Jolla Vein Care, our doctors are board-certified, fellowship trained specifically in venous and lymphatic disorders (phlebologists). Our practice is dedicated exclusively to the diagnosis and treatment of a variety of vein disorders. As a result, we are able to offer all diagnostic ultrasound evaluations and a variety of leading edge vein treatments on-site.
Stocking Troubles? Tips, tricks and an easy guide to living in harmony with compression stockings
Applying stockings with ease:
- Turn your stocking completely inside out
- Locate the smaller foot hole of the stocking and tuck the foot in until you reach the heel
- Place your thumbs on either side of the tucked in foot hole, with the heel located on the bottom
- Put your foot in the stocking until the heel of the stocking has met your heel
- Grab the larger hole or top of the stocking (it should be hanging off your foot) and pull the stocking up onto your leg
- Inch and pull the stocking until it has reached either below the crease of your knee for knee highs, or the highest portion of your thigh for thigh highs.
Varicose veins and spider veins develop gradually and progressively. They are unsightly and are often a source of considerable discomfort. Both varicose veins and spider veins can cause symptoms. Symptoms often become worse during the menstrual cycle and pregnancy for women. The symptoms can include:
- Aching, tenderness
- Heaviness, fatigue
- General restlessness in the legs
- Burning pain
- Throbbing pain
- Leg cramps, particularly at night
- Ankle swelling
- Skin discoloration at the ankle
- Skin ulcers above the ankle
The great saphenous vein (GSV), previously referred to as the long saphenous vein, is a superficial leg vein that runs from the top of the thigh near the groin, down the inner thigh all the way to the inner ankle. The top blue arrow in this diagram points to the location of the great saphenous vein.
The Great Saphenous vein is responsible for varicose veins about 80% of the time. When varicose veins appear in the inner thigh or calf areas, the GSV is often the culprit (see picture). The other superficial vein largely responsible for varicose veins in the small saphenous vein. The small saphenous vein (SSV) runs along the back of the calf. The SSV was previously referred to as the short saphenous vein. Varicose veins on the backside of the leg are often caused by leaky valves within the small saphenous vein.
Varicose and spider veins may be treated with lifestyle changes or medical procedures.
The goals of treatment are to relieve symptoms, prevent complications and for some to improve appearance. Lifestyle changes can ease the symptoms but do not cause the veins to vanish. These include:
- Avoid standing or sitting for long periods of time: To keep blood moving when you have to sit or stand for long periods, try these tips: at work, take walking breaks and try walking during your lunch hour. While sitting, try flexing your feet up and down 10 times an hour. When standing, raise yourself up and down on your toes or rock back and forth on your heels.
- Exercise: Exercising is good for your veins because it improves blood flow. Walking, cycling, or swimming are great exercises for vein health. But be sure to check with your doctor before starting any exercise program.
- Weight loss or maintaining a healthy weight: Being overweight puts extra pressure on your veins.
- Leg elevation: Use leg elevation three or four times a day for about 15 minutes at a time. Even elevating your legs on a step stool or ottoman is beneficial. If you need to sit or stand for a long period of time, flexing (bending) your legs occasionally can help keep blood circulating. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms.
- Compression stockings: These elastic stockings squeeze or compress the veins and prevent blood from flowing backward. Compression stockings must be graduated, medical grade compression to be beneficial. Over the counter support hose or TED hose are not adequate to reduce symptoms in venous disease for active patients.
- Supplements such as horse chestnut and grape seed extract can help reduce symptoms of venous disease
- Anti-inflammatory medications such as ibuprofen
- ice packs can be applied to veins that are tender to reduce inflammation
Choosing Between Anti-Embolism & Compression Stockings
Anti-embolism stockings, also known as TED hose, are designed specifically for non-mobile patients or those confined to a bed. These are the white stockings used for hospital patients. They are low cost temporary solutions commonly used for patients in nursing homes and post-surgery to prevent deep vein thrombosis (DVT).
However, for ambulatory (walking patients who are not bed bound), TED hose do not offer sufficient support to counter the effects of gravity. They are not graduated compression and only offer about 8-18mmhg compression. TED hose do not help the symptoms of venous disease and varicose veins. TED hose cannot be used for vein treatment and should not be used for daily support in walking patients.
In comparison, graduated compression stockings are medically therapeutic and designed for people who are mobile. Graduated compression means that they are tightest around the ankle and gradually ease as they go up. These can help reduce the risk of DVT in patients who travel by plane or car, and reduce symptoms such as leg swelling (edema), aching, heaviness, fatigue, pain from varicose veins and useful for pregnant women to reduce pain from varicose veins.
Are varicose veins associated with heart problems?
Varicose veins are not associated with heart disease and do not indicate a problem with the heart. With varicose veins and venous insufficiency, the vein valves are weak and leaky. But, only the valves in the leg veins are affected. These valves are different than heart valves. Additionally, heart disease often refers to problems with the arteries of the heart or the heart muscle itself, not veins. In sum, if you have varicose veins, it does not mean that you are more likely to have problems with the heart.
At La Jolla Vein Care, we offer a cosmetic spider vein clinic staffed by our Registered Nurse or Physician’s Assistant, who perform the treatment of those small, pesty spider veins. Everyone is different, and each person will have individual needs. Therefore, the cost depends on how much solution is required to obtain best results. The treatment starts at $100 for the first vial of solution. One vial will treat approximately a ‘tuna can’ size cluster/s of spider veins. Each additional syringe is $75. The maximum solution that can be used during a single treatment is 5 syringes. Most people will need more than one treatment session for best results. Everyone is different, so the amount used each treatment and how many treatments will be necessary depend on the individuals vein condition. The national average is 2-5 sclerotherapy treatment sessions. Call 858-550-0330 to speak with our staff for more information.
Complications of Untreated Varicose Veins and Venous Insufficiency #2: Cellulitis
Cellulitis is a bacterial infection of the skin and tissues beneath the skin. Cellulitis infections can occur in the legs of people with untreated varicose veins and chronic venous insufficiency. The reason for this is chronic venous insufficiency causes inflammation within the skin and underlying tissues. This inflammatory process causes the skin to become firm, eczema like, dry, itchy and fragile. Healthy skin acts like a barrier to bacteria, preventing infections. But, in chronic venous insufficiency, the skin is fragile and this barrier is susceptible to bacterial infections, that can enter the tissues through cracks or breakages within the skin. In chronic venous insufficiency, the skin around the ankles is most affected and infections can begin here.
Cellulitis usually begins as a small area of pain and redness on the skin. This area spreads to surrounding tissues, resulting in the typical signs of inflammation such as redness, swelling, warmth, and pain. Fever and chills may develop and the redness will spread affecting more of the leg. It is treated with antibiotics. If you believe you have signs of cellulitis, you need to contact your doctor right away as untreated cellulitis can spread rapidly.
This complication can be avoided by treating the varicose veins and eliminating underlying venous insufficiency, which will in turn reduce inflammation and improve the skin condition. Practicing good skin hygiene is important. Keep your skin moisturized so that it doesn’t flake or crack easily. If the skin is not broken or leaking fluid but is inflamed, your doctor may recommend an anti-itch cream, such as one containing hydrocortisone; a cream containing zinc oxide to protect the skin; or an antifungal cream to prevent fungal infections.
Skin that is leaking fluid is treated with wet compresses. If you have ulcers on your legs, your doctor will show you how to apply layered compression bandages to protect the skin and maintain blood flow.
What Possible Complications Can Occur From Untreated Varicose Veins?
Over time, complications can develop from untreated veins. These include:
- Superficial phlebitis
- Skin discoloration and eczema around the ankle
- Skin sores or ulcers usually near the ankle
- Burst or hemorrhaged vein
- Chronic venous insufficiency
- Infection of the skin, or cellulitis
This blog post will discuss phlebitis. Phlebitis refers to the painful swelling and inflammation within a vein, usually a varicose vein. A thrombophlebitis is swelling and inflammation of a vein caused by a blood clot. A phlebitis is common with varicose veins, and thrombophlebitis less common but still a potential complication from untreated varicose veins. A thrombophlebitis refers to a blood clot that has formed within the vein causing it to become painful and inflamed. The overlying skin becomes red, hot and painful to touch.
The blood clot forms because the blood is not circulating well in varicose veins. The blood is stagnant in varicose veins and is more likely to form clots. When blood clots are formed within varicose veins, this is called a superficial thrombophlebitis (since varicose veins sit near the skin surface). This is often referred to as an STP.
The following symptoms are often associated with thrombophlebitis:
- Inflammation (swelling) in the part of the body affected
- Pain in the part of the body affected
- skin redness (not always present)
- Warmth and tenderness over the vein
Thrombophlebitis of varicose veins can be avoided by wearing compression stockings daily (prevents pooling of blood), leg elevation, staying active and treating the varicose veins. If you think you have phlebitis, you should see a doctor. An ultrasound examination is may be necessary.
We have noticed a trend over the past year regarding insurance coverage for varicose veins; Insurance is increasingly becoming stricter with their policies for varicose vein coverage. Insurance policies vary from person to person regarding whether or not their policy will cover the actual vein treatment (office visits, diagnostic ultrasound examinations, and consultations are typically covered benefits by most). Most insurance types now require that an individual has worn and tried medical grade compression for over 3 months before they can be considered for varicose vein treatment. Specifically, the patient has to have been using medical grade compression for 3-months or longer and still has not had improvement in symptoms. The exceptions are Medicare and Anthem require only a six week trial of compression. Compression socks and stockings are part of conservative management for vein conditions. Medical grade compression socks are stronger than over the counter socks and may require a prescription. Because your insurance may require 3 months of wearing compression socks/stockings before they will pay for your medical vein procedure, you should start wearing them as soon as possible and document it. For example, ask your primary care physician for a prescription. Keep your receipts for the purchase, as sometimes insurance requires proof of when you started using compression. Insurance usually does not cover compression stockings but flexible health savings account can typically be used. Compression stockings should be used as a trial of conservative treatment in addition to leg elevation, exercise, weight loss and NSAIDS. We are happy to answer questions about insurance coverage for vein procedures. Please call us at 858-550-0330.