Varicose veins Diagnosis & treatment
Diagnosis
To diagnose varicose veins, your doctor will do a physical exam, including looking at your legs while you're standing to check for swelling. Your doctor may also ask you to describe any pain and aching in your legs.
You also may need an ultrasound test to see if the valves in your veins are functioning normally or if there's any evidence of a blood clot. In this noninvasive test, a technician runs a small hand-held device (transducer), about the size of a bar of soap, against your skin over the area of your body being examined. The transducer transmits images of the veins in your legs to a monitor, so a technician and your doctor can see them.
Treatment
Fortunately, treatment usually doesn't mean a hospital stay or a long, uncomfortable recovery. Thanks to less invasive procedures, varicose veins can generally be treated on an outpatient basis.
Ask your doctor if insurance will cover any of the cost of your treatment. If done for purely cosmetic reasons, you'll likely have to pay for the treatment of varicose veins yourself.
Self-care
Self-care — such as exercising, losing weight, not wearing tight clothes, elevating your legs, and avoiding long periods of standing or sitting — can ease pain and prevent varicose veins from getting worse.
Compression stockings
Wearing compression stockings all day is often the first approach to try before moving on to other treatments. They steadily squeeze your legs, helping veins and leg muscles move blood more efficiently. The amount of compression varies by type and brand.
You can buy compression stockings at most pharmacies and medical supply stores. Prices vary. Prescription-strength stockings also are available.
Additional treatments for more-severe varicose veins
If you don't respond to self-care or compression stockings, or if your condition is more severe, your doctor may suggest one of these varicose vein treatments:
- Sclerotherapy. In this procedure, your doctor injects small- and medium-sized varicose veins with a solution that scars and closes those veins. In a few weeks, treated varicose veins should fade.Although the same vein may need to be injected more than once, sclerotherapy is effective if done correctly. Sclerotherapy doesn't require anesthesia and can be done in your doctor's office.
- Foam sclerotherapy of large veins. Injection of a large vein with a foam solution is also a possible treatment to close a vein and seal it. This is a newer technique.
- Laser surgeries. Doctors are using new technology in laser treatments to close off smaller varicose veins and spider veins. Laser surgery works by sending strong bursts of light onto the vein, which makes the vein slowly fade and disappear. No incisions or needles are used.
- Catheter-assisted procedures using radiofrequency or laser energy. In one of these treatments, your doctor inserts a thin tube (catheter) into an enlarged vein and heats the tip of the catheter using either radiofrequency or laser energy. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. This procedure is the preferred treatment for larger varicose veins.
- High ligation and vein stripping. This procedure involves tying off a vein before it joins a deep vein and removing the vein through small incisions. This is an outpatient procedure for most people. Removing the vein won't adversely affect circulation in your leg because veins deeper in the leg take care of the larger volumes of blood.
- Ambulatory phlebectomy (fluh-BEK-tuh-me). Your doctor removes smaller varicose veins through a series of tiny skin punctures. Only the parts of your leg that are being pricked are numbed in this outpatient procedure. Scarring is generally minimal.
- Endoscopic vein surgery. You might need this operation only in an advanced case involving leg ulcers if other techniques fail. Your surgeon uses a thin video camera inserted in your leg to visualize and close varicose veins and then removes the veins through small incisions. This procedure is performed on an outpatient basis.
Varicose veins that develop during pregnancy generally improve without medical treatment within three to 12 months after delivery.
Lifestyle and home remedies
There are some self-care measures you can take to decrease the discomfort that varicose veins can cause. These same measures can help prevent or slow the development of varicose veins, as well. They include:
- Exercise. Get moving. Walking is a great way to encourage blood circulation in your legs. Your doctor can recommend an appropriate activity level for you.
- Watch your weight and your diet. Shedding excess pounds takes unnecessary pressure off your veins. What you eat can help, too. Follow a low-salt diet to prevent swelling caused from water retention.
- Watch what you wear. Avoid high heels. Low-heeled shoes work calf muscles more, which is better for your veins. Don't wear tight clothes around your waist, legs or groin because these garments can reduce blood flow.
- Elevate your legs. To improve the circulation in your legs, take several short breaks daily to elevate your legs above the level of your heart. For example, lie down with your legs resting on three or four pillows.
- Avoid long periods of sitting or standing. Make a point of changing your position frequently to encourage blood flow.
- Don't sit with your legs crossed. Some doctors believe this position can increase circulation problems.
Alternative medicine
A number of alternative therapies claim to be helpful treatments for chronic venous insufficiency, a condition associated with varicose veins in which leg veins have problems returning blood to the heart. These include:
- Butcher's broom
- Grape (leaves, sap, seed and fruit)
- Horse chestnut
- Sweet clover
Talk with your doctor before trying any herb or dietary supplement to make sure these products are safe and won't interfere with any medications.
Preparing for your appointment
There are no special preparations you'll need to make before your appointment. Your doctor will need to look at your bare legs and feet to diagnose varicose veins and figure out what treatment might be best for your condition.
Your primary care doctor may recommend that you see a doctor who specializes in vein conditions (phlebologist), a vascular surgeon or a doctor who treats skin conditions (dermatologist or dermatology surgeon). In the meantime, there are some steps you can take to prepare for your appointment and begin your self-care.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to varicose veins.
- Write down key personal information, including a family history of varicose veins or spider veins.
- Make a list of all medications, vitamins or supplements that you're taking.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions may help you make the most of your time together. Some basic questions to ask your doctor include:
- What's the most likely cause of my symptoms?
- Are there other possible causes for my varicose veins?
- What kinds of tests will I need?
- How are varicose veins treated? What treatment do you recommend for me?
- Will my insurance pay for varicose vein treatment?
- How can I best manage varicose veins along with other health conditions I have?
- Are there any activity restrictions that I need to follow?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you first notice the varicose veins?
- Do you have any pain? If so, how severe is your pain?
- What, if anything, seems to improve your symptoms?
- Does anything appear to worsen your symptoms?
What you can do in the meantime
Even before your appointment, you can begin self-care. Try not to stand or sit in one position for a long time, elevate your legs when you're seated, and avoid uncomfortable footwear and tight socks or hosiery.
