Dr. Benjamin Lind (NorthShore)
It is difficult to predict who will develop varicose veins. Two factors associated with developing them are a history of deep vein thrombosis, and a family history of varicose veins. Multiple pregnancies may also contribute. Many people who stand for long periods of time find compression stockings are helpful. They reduce swelling in the legs, and encourage the normal return of venous blood towards the heart. It isn't clear, though, if they can prevent varicose vein formation in people who don't have varicose veins.

Dr. Benjamin Lind (NorthShore)
A varicose vein is a swollen, enlarged vein. A spider vein is a smaller, milder form - usually an enlarged capillary. Both are caused by increased pressure in the venous system.

Dr. Benjamin Lind (NorthShore)
Yes. The venous system is highly complex and variable. There may be multiple areas of venous disease, and superficial veins that were previously unaffected can become affected over time. If the varicose veins were due solely to a refluxing great saphenous vein, ablation of the great saphenous vein should be very effective.

Dr. Benjamin Lind (NorthShore)
There are many treatment options availabe, and the choice depends on the underlying problem. Many people have reflux in the great saphenous vein, which runs along the inner thigh, down the leg. Ablation of this vein decreases the flow into the varicose veins. The varicose veins are still present, but symptoms are often greatly relieved. The ablation procedure is minimally invasive and involves sealing the vein with a very fine catheter, inserted through a needle hole. The procedure is done in the office and takes about an hour. Afterwards, if the varicose veins are still bothersome, they can be removed via small incisions in the leg. This is called a phlebectomy, and can also often be done in the office. Some people also have varicose veins treated by sclerotherapy, though sclerotherapy is more commonly used for smaller spider veins.

Dr. Benjamin Lind (NorthShore)
Leg pain when walking is a common complaint, with many possible underlying causes. Pain due to venous disease is often worse when standing and walking, and may be described as a heavy feeling or dull ache in the legs that gets worse as the day goes on. The pain is usually relieved with elevation, and feels better after sleeping in bed. People also describe an itching sensation in the veins as they get larger. Other causes of leg pain when walking include arterial disease, ie peripheral arterial disease, as well as musculoskeletal problems such as arthritis. A doctor's evaluation may be required to help discern the cause.

Dr. Benjamin Lind (NorthShore)
Yes, itching is a common complaint of people with varicose veins. The itching may be related to stretching of the vein.

Dr. Benjamin Lind (NorthShore)
To remove a large varicose vein with surgery, an incision is made and the vein is taken out. It is normal to have bruising where the vein was removed, and sometimes the bruising can be significant. Continued bleeding is a risk, especially if you are on blood thinners. There can also be problems with the incision sites, such as wound breakdown and infection. These risks are low but do exist. If the varicose veins arise from an incompetent saphenous vein, saphenous vein ablation may provide significant relief and no further surgery is required. Before surgery, patients are encouraged to wear compression stockings. Some people find the symptom relief is good enough that no further treatment is necessary.

Dr. Benjamin Lind (NorthShore)
Sclerotherapy involves injecting a small vein with a sclerosing agent. The sclerosant creates inflammation along the inner wall of the vein. This results in fibrosis and closure of the vein. There are many potential side effects. The most common are allergic reactions. Also, the sclerosant may leak outside of the vein being treated and create inflammation of the skin instead. This can result in blistering as well as adverse cosmetic outcome.

Dr. Benjamin Lind (NorthShore)
They are not usually dangerous to one's health. However, some people with advanced disease find the pain and discomfort great enough that they seek treatment. In advanced cases, varicose veins are associated with significant venous insufficiency and patient develop venous stasis ulcerations, which can be difficult to heal.

Dr. Benjamin Lind (NorthShore)
It depends on the type of procedure you have, and your own personal threshold and tolerance for pain. After a saphenous ablation, it is normal to have tenderness along the length of the vein, and this can last up to a week. Some people aren't bothered at all, and others are. Regardless, you can take medication to decrease the pain. Walking is encouraged after the procedure. You can shower two days after the procedure. You should avoid soaking in a bathtub or whirlpool until incisions are healed. I would also avoid strenuous activities, like long distance bike rides or long runs, for a few days after the procedure.

Dr. Benjamin Lind (NorthShore)
It is hard to predict if they will worsen or not. If they don't bother you, there's a low risk that they will need treatment. If they become large and painful you may want to have them evaluated. Likewise, if you develop leg ulcers, you should have them evaluated. I would also have them evaluated if they become red and inflammed, which may be a sign of clot formation.

Dr. Benjamin Lind (NorthShore)
Yes, any part of the leg can be affected.

Dr. Benjamin Lind (NorthShore)
Probably the most effective non-surgical treatment available is a good fitting compression stocking. I recommend seeing a professional fitter with a good inventory of stockings who can measure and fit them properly. This is the first line treatment that I recommend to my patients. Multiple medicines have been tested, and some are available in Europe. I'm not aware of any that are available here in the US, though.

Dr. Benjamin Lind (NorthShore)
You're right, there are many treatment options. The best option is the one that successfully treats the underlying problem while addressing the symptoms you are having. If a patient has varicose veins arising from an incompetent saphenous vein, and the problem is leg discomfort, then saphenous vein ablation may be an excellent choice. But if the problem is more cosmetic, then excision may be needed. Sclerotherapy is generally less effected on larger varicose veins, but may help with smaller spider veins.

Dr. Benjamin Lind (NorthShore)
It is common that varicose veins become more noticeable with pregnancy, and that they may get worse after pregnancy. They may well stay after childbirth. A good pair of compressions stockings may help relieve the symptoms, if they are bothering you. Many women wait until they are done having children before pursuing further intervention, because they may be exacerbated by future pregnancies.

Dr. Benjamin Lind (NorthShore)
It can be normal to have small bruises under the skin, where the veins were removed. These can take a few months to go away. You should let your doctor know of any concerns.