The Hidden Danger of Varicose Veins

Varicose veins — gnarly, blue and bulging — are an unsightly nuisance that affects up to 40 million Americans. But they're also a potential health hazard that could put you at risk for blood clots, ulcers and worse.

Swollen and twisted, and visible just under the skin, varicose veins develop when the one-way valves inside your veins that keep blood moving toward your heart become weak or damaged. When these valves don't function properly, blood backs up and pools in your veins, causing them to swell. This occurs most often in the legs and ankles, but it can happen in other parts of the body as well. Hemorrhoids, for example, are a type of varicose veins. The tendency to develop varicose veins is often inherited and increases with age.

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They are often a side effect of pregnancy. "During pregnancy, hormones like estrogen and progesterone dilate your veins," says Dr. George Anton, vice chairman of the department of vascular surgery at the Cleveland Clinic. "When the fetus gets heavy, it increases pressure on the pelvis and that transfers to pressure on the veins in the legs."
 
Many men get varicose veins, too, says Sherry Scovell, a vascular and endovascular surgeon at Massachusetts General Hospital. "Anyone can get them if they work in certain occupations like nursing, waitressing or bartending where they're standing a lot," she says. But people who sit a lot and don't get up and move around enough are also at risk, as are those who are obese.
 
Not Just A Vanity Issue
 
Most people think of varicose veins as a cosmetic concern, but they can lead to other, more serious problems. For example, when blood pools in the vein, it can clot. "I use the analogy of a running stream versus a stagnant pond," Anton says. "This can cause phlebitis, a superficial clot that can be painful, but usually not life threatening."

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But if a clot in a superficial (close to the skin) vein grows, it can move into a deep vein. "People with superficial phlebitis have a 20 to 40 percent chance of having a deep vein clot at the same time," Scovell says. Such a clot, also known as deep vein thrombosis, can break loose and move through the bloodstream to the lung, where it can cause a pulmonary embolism, a sudden, potentially life-threatening blockage. Before such problems can arise, clots can be identified through ultrasound and then treated, typically with anticoagulants (blood thinners).

Varicose veins are also sometimes the first stage of a more serious, progressive condition. In some people, Scovell says, what starts as varicose veins may progress to swelling in the legs. Over time, the veins can also cause hyperpigmentation, or darkening of the skin, usually by the ankle. Ultimately, in such cases, a patient can develop painful, sometimes debilitating venous leg ulcers, which doctors consider the final stage of what's known as venous disease. These ulcers usually occur on the inner leg above the ankle.

Eliminating the Problem Before It Gets Worse
 
Treating varicose veins often begins with the use of compression stockings, which gently squeeze your legs to promote blood flow. In some cases, the stockings do the trick. But for people with more severe cases, a surgical procedure becomes necessary.

When Scovell began practicing medicine 11 years ago, she notes, removing varicose veins was a complicated procedure that involved stripping the veins in an operating room with a patient under general anesthesia. Today, it's done in a doctor's office, while the patient is conscious. (A local anesthetic is used to numb the area of the leg being treated.)
 
Many patients are treated with laser or radiofrequency ablation, which involves inserting a catheter through the skin and into the vein. Laser fiber or a radiofrequency electrode is then used to heat the vein, causing it to close, and blood flow to be diverted to healthy veins.

Small veins that have branched off a larger varicose vein may require tiny incisions in the skin for removal, but "the incisions are so small that we don't even use stitches," Scovell says. "We just use Band-Aids, and then the patient puts on compression stockings and walks out."

In the first 48 hours after a procedure, patients are advised to keep their legs elevated and walk once every hour. They also must wear a compression stocking for a few weeks.
 
Alison Ashton, 50, had her varicose veins treated with laser ablation seven years ago. "I had the surgery on a Saturday and returned to work the following Monday," says Ashton, a digital producer in Los Angeles. "It was outpatient surgery, not painful, though occasionally uncomfortable. I had to wear support hose for about a month, which was not too fun because I lived in Alabama at the time. But I was able to return to swimming and aqua-jogging a week after surgery."
 
Some patients with small or medium-sized varicose veins may opt for sclerotherapy, a procedure in which a surgeon injects a solution that irritates the vein lining, causing it to scar and close. After a few weeks, the treated veins should fade from view, though the treatment is sometimes repeated to achieve the desired cosmetic result.

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In about 15 percent of patients, varicose veins will recur and need to be treated as many as six times, Anton says. "You can grow new veins and get recurrences," he says. "It depends on the types of veins and how big they are. It also depends on the procedure and the patient."

Varicose vein removal is covered by most insurance plans, a reflection of the procedure's value beyond cosmetic concerns. "What we're trying to do is to prevent ulceration. Venous ulcers can cause significant pain and require time off work and frequent visits to the doctor," says Scovell, who believes more widespread treatment could reduce the incidence of venous ulcers by as much as 50 percent. "If we can treat patients with varicose veins early on, we can prevent these ulcers."