Vein Treatment FAQ

If you don't feel comfortable with the recommendations you get, especially if you have not seen the actual doctor, then get a second opinion from a highly reputable vascular surgeon who specializes in vein disease.

Indications for treatment of venous insufficiency include symptoms that interfere with the quality of your life, advanced skin changes, or swelling in the lower legs and episodes of superficial blood clots. A thorough history and exam will determine if treatment is necessary for you.

The term "varicose veins" is often used to describe everything from smaller, spider veins (red or blue veins on the surface of the skin) to true varicose veins (swollen, bulging veins with a rope-like appearance). Varicose veins are quite common, affecting one in three women and one in five men. Varicose vein symptoms can include swelling, a tired, heavy feeling, leg fatigue, leg pain, burning, and itching sensations.

Varicose veins are almost always associated with venous reflux, which occurs when the valves in the leg veins don't work properly, causing backward blood flow and pooling in the lower leg. Without treatment, the pressure this creates may increase over time, causing additional varicose veins and symptoms. People with a family history of varicose veins, as well as those who are older, obese, or pregnant, may be at increased risk of developing this condition.

It is unclear if varicose veins can be prevented, but certain actions may help limit the disease’s progression and symptoms. Routine exercise, maintaining a normal weight, avoiding excessively long periods of standing or sitting, and the use of compression stockings may all help alleviate symptoms.

If you have underlying venous disease (such as venous reflux), the pressure created by backflow of blood and pooling in the lower legs may create a progressive condition that worsens over time. This can lead to additional spider veins and varicose veins, and in some cases, cause swelling and venous ulcers at the lower calf and ankle. A trained vein surgeon can effectively evaluate your spider veins or varicose veins to determine appropriate treatment.

Sometimes the same factors that contributed to your first spider veins or varicose veins (such as family history, age, obesity, female hormones, etc.) may predispose you to develop additional vein conditions. If a specific vein is properly treated, it usually does not recur, but it's possible that other veins may become diseased. This is why it's important that even if you have what appear to be simple, cosmetic spider veins, you should consult a vein specialist who can determine if you have an underlying condition like venous reflux. If you do have an underlying condition and don't treat the cause of the problem, additional spider veins or varicose veins are likely to develop.

Procedures like sclerotherapy, EVLA, and chemical ablation work by closing down faulty veins. These veins are dysfunctional and allow blood to flow backwards and pool, so leaving them open only worsens the condition. Your body contains numerous other healthy veins that remain functional and can easily handle the additional blood flow. Treatment of the faulty veins almost always results in improved circulation throughout the entire venous system.

Procedures like EVLA, microphlebectomy, and chemical ablations, when shown to be medically necessary, are commonly covered by Medicare and insurance providers. Sclerotherapy for spider veins is generally considered a cosmetic procedure and usually is not covered. You should consult your local insurance provider to determine your exact eligibility, coverage, and cost.

There is a newer physician specialty called phlebology which focuses on vein treatment. This specialty has its own society (American College of Phlebology) that provides board certification and specialty training. However, at this time, it is not recognized as an official certifying body. Vascular surgeons, with their extensive training and experience in all aspects of vascular disease, surgery, and intervention, are usually well qualified to treat any vein condition. You should consult with your individual physician to determine whether they have any such specialty training or certification.