Etiology or Cause
Varicose veins are typically caused by problems with valves that are in veins. The vein valves can become incompetent from increased pressure causing the veins to stretch and dilate and to become bulging and then it is termed a “varicose vein”. Veins are aggravated by weight and pregnancy. The underlying cause can also be inherited.

Types of Varicose Veins
Varicose veins are a common problem effecting both men and women, but more commonly women. They can vary from small, asymptomatic veins such as spider veins which are fine blue or red lines on the legs or face; they can also appear as large, bulging, rope-like structures in the legs.

Signs and Symptoms
There is a continuum of signs and symptoms from small asymptomatic spider veins to large bulging painful veins that can also be associated with ulceration of the skin as well as irritation of the skin. Other common symptoms include dull, achy, heavy pain, swelling of the ankle and calf, dark discoloration on the inside of the ankle, inflammation and redness of the skin as well as open ulceration of the skin.

Treatment Options
T reatment for varicose veins depends on the type, stage and severity of the venous disease.

Compression Stockings
Compression stockings or surgical support stockings are the most common and conservative way to treat varicose veins. The stockings will help the symptoms of varicose veins and may help prevent aggravation of the varicose veins and some of the complications from them. This will not make the varicose veins go away, but may be a good option for some patients.

Sclerotherapy
Sclerotherapy or injections are a very common treatment for spider veins and most small varicose veins. A fine needle is used to inject a solution into the vein. A wrap is applied. This will cause the vein to seal shut. Over time, the vein is then reabsorbed by the body. It is a safe procedure with minimal complications. Rarely, some discoloration of the injection site may occur. This is usually temporary and may disappear within a matter of weeks to months.

Surgical Stripping
Stripping of varicose veins is a term that has been misapplied to the surgical treatment of all varicose veins. Stripping actually involves removing the main superficial vein called the greater saphenous vein. This vein is removed from the groin to about the mid calf and in years past was an excellent treatment of underlying cause of varicose veins. It is quite traumatic and recovery time can vary from weeks to approximately a month. This procedure has been essentially replaced by ablation of the greater saphenous vein

Ablation of the Greater Saphenous Vein
Ablation of the greater saphenous vein is a relatively new procedure done as an outpatient under local anesthesia. Instead of removing the vein, a catheter is inserted into the vein, energy is delivered to the vein lining which causes it to close and then disappear. The bulging branches off this main vein over time will then get small and disappear. The energy that is delivered is in the form of a laser (evlt—endovenous laser treatment) or radiofrequency (vnus closure). Both are an excellent procedure with minimal risks and usually only one to two days of recovery time.

Stab Microphlebectomy
Stab microphlebectomy involves removing parts of the bulging veins through tiny incisions. Many patients confuse this procedure with “stripping” of the veins, but microphlebectomy removes the branches of the main vein. This may be needed in conjunction with ablation or stripping. It is usually done in the office under local anesthesia, again with a day of down time.

Patients with varicose veins or spider veins may need a combination of treatments. Each patient is evaluated by a fellowship-trained vascular surgeon. A treatment plan is formed and discussed with each patient. Most of the procedures described above are covered by health insurance with the exception of spider veins which are a cosmetic procedure.