Varicose Veins

How do I Know if I Have Varicose Veins?

Varicose veins come in many forms. They can be visible in various sizes of protruding, rope-like veins. These often become more prominent with prolonged sitting or standing. Some varicose veins may primarily be noticed by feeling a series of knots or indentions in the leg just below the skin surface. Some varicose veins are not visible at the skin surface. Varicose veins that are not visible at the skin surface may still cause bursts of abnormal red, purple or blue smaller veins, as well as leg symptoms and skin changes of venous insufficiency. In addition to being unsightly, varicose veins are commonly associated with the following symptoms or signs:

  • Pain, Throbbing, or Cramping
  • Tiredness and Fatigue
  • Itching and Burning
  • Tenderness around the abnormal veins
  • Heaviness
  • Restlessness (Restless Legs Syndrome)
  • Swelling or Edema of the Ankles and Legs


Do I Need to get my Varicose Veins Treated?

The complications of untreated varicose veins and venous insufficiency may include:

  • Phlebitis or Thrombophlebitis
  • Thrombosis (blood clots)
  • Venous Ulcers
  • Venous Dermatitis
  • Spontaneous Phleborrhagia (bleeding from a vein with minimal or no trauma)

What are Varicose Veins?

Approximately 40 million Americans suffer from varicose vein disease. Veins are responsible for returning blood to the heart. The superficial venous system includes the veins closer to the skin surface that lie above the level of the muscles, whereas the deep venous system includes the veins that lie within the muscles. Varicose veins are more common in the legs and lower part of the body because they must function against the forces of gravity. The deep veins are well-protected by the muscles,  and they are the primary veins responsible for returning blood back to the heart. The superficial veins are poorly protected and are prone to dilation of the vein walls and valve failure. Simply put, varicose veins are abnormal veins of the superficial venous system that are not functioning properly and not returning blood to the heart. This failure is typically a result of broken one-way valves, weakened vein walls or a combination of both. Whenever the heart is above the level of the legs, varicose veins will have a backwards flow that siphons or steals blood from the deep veins. When the good veins are unable to compensate for the varicose veins, venous insufficiency results and can cause the various symptoms or complications noted above. With treatment of the varicose veins, the normal veins are no longer hindered, venous circulation is improved, and the symptoms of venous insufficiency can be relieved.


What Causes Varicose Veins?


Studies have shown that the tendency to develop varicose veins runs in families. Thus, genetic factors are felt to be the primary cause for most cases of varicose veins. The underlying inherited factors are the predisposition of one-way valves to fail, for vein walls to be weakened, or a combination of both. The presence of varicose veins in siblings, parents or grandparents indicates that you are at greater risk.


The prevalence of varicose veins is higher in women than men. One reason for the disparity is the hormonal influence of estrogen and progesterone. Fewer males have varicose vein disease; however, males are at higher risk of skin changes related to venous insufficiency.


Many women will first notice varicose and spider veins during pregnancy. Often, the varicose veins are noticed in the groin area. Increased circulating blood volume, hormonal influence, and mechanical compression of the abdomen are felt to be the contributing factors to the development or worsening of varicose veins during pregnancy. Most varicose veins will be less noticeable after delivery, but will become noticeable again with time due to irreparable damage to the veins.


With increasing age, our bodies lose elasticity in the vein walls, resulting in weakened vein walls, vein dilatation and damage to the venous valves. The prevalence of varicose increases with age in both men and women.

Occupations or Activities that Involve Prolonged Sitting or Standing:

Gravity plays an important role in the development of varicose veins. Occupations, activities, and lifestyles that involve sitting or standing for long periods of time can cause an increase in blood pressure and volume in the veins and contribute to the development or worsening of varicose veins.

Some common occupations of patients that develop varicose veins include:

  • Teachers
  • Medical professionals
  • Bank tellers
  • Restaurant and Retail professionals such as bartenders and cashiers
  • Hair Stylists
  • Factory Workers  – Prolonged standing or sitting

Significantly increased weight, particularly in the abdomen, impedes the venous circulation in the legs. The body must work harder to return blood to the heart, resulting in an increase in blood pressure and volume in the veins.

Congenital and Trauma:

Less common causes of varicose veins include congenital causes that are seen at birth such as Klippel-Trénaunay Syndrome and those that are a result of physical trauma.

How do you Treat Varicose Veins?

At Tennessee Vein Center, before initiating any vein treatment of the legs, we perform a comprehensive or screening duplex venous ultrasound, as indicated by your history and exam. Duplex venous ultrasound (mapping) can identify if underlying veins are not functioning normally. With venous mapping, comprehensive ultrasound study, the extent of the vein disease can be identified so we can provide comprehensive treatment. A treatment plan is tailored for each patient. Depending on the locations and size of the problem veins, many patients require endovenous thermal ablation treatment of underlying abnormal veins followed by a series of ultrasound-guided or visual sclerotherapy to eradicate your varicose veins. The outside of the leg does not have to look terrible for the varicose veins below the surface to be bad. The maps below show the progression of treatment as well as a before treatment and after treatment picture of the leg with varicose vein disease.
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