For many people, Carly Simon’s 1972 hit “You’re So Vain” is a running joke about the appearance of their bodies. However, the vanity of veins can be more than just cosmetic, as an estimated 80 million adults in America have vein problems. Chronic venous insufficiency affects many of these individuals, but is it serious and do all they need to be treated?
Understanding the Function of Veins
What do veins do? Veins collect blood throughout the body from organs and tissues after the arteries have delivered oxygen to the cells. The deep veins and superficial veins carry the blood, that now has CO2 instead of O2, back to the lungs where we exhale the waste gas and inhale more oxygen. This process is called respiration, and is essential for life.
In very broad terms, you can think of the arteries and veins as opposite sides of a highway, with the arteries going in one direction and the veins in the other. For example, in the legs, arteries bring the oxygen from the heart and lungs down towards the feet, and the veins return the blood back up to the heart and lungs.
The Role of Blood Vessels in Circulation
There are differences between the two types of blood vessels. Let’s walk through their specific roles and their effects on venous insufficiency.
Arteries
Arteries have thicker, muscular walls, which provide the necessary strength to handle the higher pressure of blood flowing directly from the heart. Over time, these arterial walls can develop plaque, a condition known as arteriosclerosis, which can significantly narrow or even block the vessels. This blockage disrupts the normal blood flow, leading to potential health crises. For instance, when arteriosclerosis occurs in the coronary arteries of the heart, it can result in a heart attack, a life-threatening condition that requires immediate medical attention. The robust structure of arteries is essential for their function, but it also makes them susceptible to such blockages, highlighting the importance of maintaining cardiovascular health through lifestyle choices and medical interventions when necessary.
Veins
Veins are very thin-walled and are dependent on external compression (from muscle contractions) to push the blood toward the heart. Inside the veins, there are tiny valves that prevent the blood from flowing backward (arteries do not have valves). But when these valves become incompetent, the valve doesn’t close and stops working properly, reversal of blood flow occurs and this can lead to pooling of the blood in the lower leg. This process is known as venous reflux (through the incompetent damaged valves) and results in the condition of venous insufficiency. A simple ultrasound test can confirm a diagnosis if you have signs or symptoms of venous disease.
Causes and Symptoms of Venous Insufficiency
Patients who have venous reflux are at risk of symptoms including edema, achiness, tired legs, heavy legs, pain, tingling, numbness, itching of the skin, burning sensation and pain. Most symptomatic patients have some, but not all of these symptoms. Other, less common, symptoms of long-standing venous insufficiency can include changes in the skin, blood clots, lymphedema and chronic swelling. Bulging varicose veins can be seen in many patients with underlying valvular venous reflux as well, due to the higher vein pressures backing up into the branch veins. I often explain this to patients as similar to the exit ramps on the highway being much more congested during rush hour due to the higher amount of traffic on the roadways. The bulging varicose veins are often both painful and unsightly.
When vein-related symptoms interfere with or limit your quality of life, that is an indication for treatment. Here are some important indications for when treatment may be necessary:
- Often, patients will need to elevate their legs several times a day and wear compression hose for temporary relief.
- In advanced cases, patients may be unable to perform a full day of work due to symptoms, may need to cut back on recreational activities, or avoid social events with friends.
- Other indications for treatment include advanced skin changes or skin breakdown (ulceration), and recurrent bleeding or blood clotting due to venous insufficiency.
Improvement in cosmetic appearance alone, in the absence of these indications, is not a reason to treat the incompetent veins, and can lead to additional problems. And if you have no symptoms or skin changes or blood clots, it is almost never appropriate to treat just the ultrasound findings, and insurance will usually deny payment.
Treatment for Symptomatic Venous Insufficiency
Well, there are several options, that include the following:
- Laser
- Radiofrequency
- Chemical injections
Each option has advantages and disadvantages, depending on the location of the vein problem, experience of the treating physician, cost, and individual patient circumstances. However, all of the mainstream treatments are able to be done in an office setting with local anesthesia (similar to having a dental procedure). The goal of treatment is to close the incompetent vein and allow the blood to be re-routed to the healthy veins. As there are many leg veins, an experienced vein specialist will explain that the blood flow automatically and instantly goes to other vein pathways after the diseased vein is closed. These procedures are often called ablations. For patients with mild symptoms, compression stockings and leg elevation may be recommended to improve blood flow.
Treatment for Spider Veins
Tiny red or blue spider veins, so named because they often appear like a spider’s web, are cosmetic and do not pose a health risk. As such, they can be easily treated for improved cosmetic appearance, but this is not covered by most insurance or Medicare. Most commonly these veins are treated with sclerotherapy, where an approved solution is injected into the tiny veins to cause the vein walls to collapse. A surface laser can also be used in some situations, so discuss the options with your medical provider.
Choosing the Right Vein Specialist
There are many vein offices to choose from. It is important that whoever you decide to go to for treatment, that you see the actual physician for an evaluation, as many seemingly unrelated medical issues could impact your treatment. A comprehensive history, physical examination, and ultrasound test should be done, and the treatment individualized to your specific concerns. The doctor should be board certified in a field that specializes in vascular treatment, such as a vascular surgeon, with specific experience in treating vein disease. Ask questions when you are seen so that you are comfortable with the surgeon and the staff who will be taking care of you. And if something doesn’t feel right, get a second opinion.
Too often, patients are afraid to question the recommendations because they are told that several procedures are necessary, and if you don’t get the recommended treatment, you could have serious complications. This is a scare tactic and is simply wrong. Left untreated, vein disease usually does get worse over time, but if you don’t meet the criteria of having symptoms or skin changes, then just treating the ultrasound findings is not necessary. Rather, periodic follow up, or returning when symptoms develop, is the better choice because many people can live perfectly normal lives with venous insufficiency and never need treatment. Finally, it is almost never an emergency to treat most types of vein problems. So, take your time to find the best vein office in your area, be comfortable with the doctor and staff, and understand your options and proceed on your terms.
Living Well with Vein Health
Chronic venous insufficiency ranges from minor cosmetic concerns to serious health issues requiring treatment. While venous disease may progress over time, intervention should focus on symptoms and quality of life, not just appearance. Many manage successfully with compression stockings and leg elevation to improve blood flow. For persistent symptoms like tired legs, skin changes, or deep vein thrombosis, consult a board-certified vascular surgeon for personalized recommendations. With proper knowledge and care, you can maintain healthy veins and enjoy an active lifestyle despite venous conditions.
Richard D. Kimmel, DO, FCCP, FACOS, RPhS is a board-certified cardiovascular and
thoracic surgeon who has been in practice in Boca Raton, FL, for over 33 years. He is
a past-president of the American College of Osteopathic Surgeons, and in his private
practice, The Kimmel Institute, he treats both symptomatic and cosmetic vein problems. Contact our office today to book a consultation.
