As you get older, it’s not uncommon to notice large, twisty veins forming on your legs. According to the Society for Vascular Surgery, as many as 40 million Americans have what are known as varicose veins.
But what causes varicose veins, and is there any way to prevent them? We asked vascular experts to break it down.
First of all, what exactly are varicose veins?
“Varicose veins are the bigger, bulging, twisted veins that you often see running down someone’s legs,” said Dr. Justin Ha, a physician and vein specialist with Metro Vein Centers.
A common myth about varicose veins is that they’re purely a cosmetic issue. Although some people may only experience aesthetic changes, that’s not always the case.
“They can be painful and come with symptoms like swelling, heaviness and even throbbing,” Ha said. “Left untreated, they can lead to serious complications like blood clots or ulcers. They’re a medical condition that might need clinical intervention and are oftentimes not just a cosmetic concern.”
He emphasized that varicose veins aren’t always even visible on the skin’s surface.
“You might have underlying vein damage if you’re experiencing symptoms like heaviness, swelling, aching, or restless legs,” Ha explained. “So if your legs feel off, don’t ignore it.”
Many people also confuse varicose veins and spider veins, but they’re actually different.
“Spider veins are much smaller,” Ha explained. “They’re those thin, web-like veins you often see on the surface of the skin. They’re usually more of a cosmetic issue, but they can sometimes be a sign of early vein disease. If they’re accompanied by leg discomfort, it’s typically the canary in the coal mine, and you should visit a vascular doctor.”
What causes varicose veins?
“The cause of varicose veins is related to the valves in the veins not working properly and allowing increased venous pressure in the veins,” said Dr. Tikva Jacobs, a vascular and endovascular surgeon at Weill Cornell Medicine and NewYork-Presbyterian Hospital. “Veins are thin walled, unlike arteries, and the extra pressure causes the veins to expand and become enlarged.”
She explained that arteries bring blood from the heart to the legs, but veins have to work against gravity to bring the blood back up to the heart. The valves in your veins prevent the blood from going back down to your feet, but over time, certain factors can lead to “leaky” valves or insufficiency ― thus allowing some blood to flow back down to the feet and increasing blood volume.
“When those valves weaken or get damaged, blood can start flowing backward and pooling in the veins of the legs,” Ha said. “This pooling can cause increased pressure in the veins, which cause them to stretch, twist, and bulge, which is what you see when someone has varicose veins.”
But what are the factors that cause that kind of weakening or damage to your circulation over time?
“The number one cause of varicose veins is heredity,” Jacobs said. “If a parent or grandparent has had varicose veins, you are at an increased risk of developing varicose veins.”
Women are also more likely to develop them due to the hormonal changes caused by menstruation, birth control, pregnancy and menopause.
“Other things such as age and working in occupations with prolonged sitting or standing increase the risk of developing varicose veins,” said Valerie Faryman, a nurse practitioner in the Department of Vascular Diseases and Surgery at The Ohio State University Wexner Medical Center. “Excess body weight, or obesity, causes there to be extra pressure on the veins, increasing the chances of developing varicose veins.”
Age plays a role as veins naturally lose elasticity over time, making them more susceptible to damage. But people can develop varicose veins at any age.
“Things like frequent air travel, smoking, and a history of injuries to the leg can all put extra stress on the veins,” Ha added.
Dr. Sheila Blumberg, a vascular surgeon at NYU Langone Hospital—Brooklyn, noted that many people think varicose veins are caused by blood clots, which can be dangerous.
“They are not caused by blood clots but can be seen in people who have a history of blood clots in their legs,” she explained. “I reassure people that varicose vein disease is not a limb-threatening or life-threatening disease.”
There’s also a common myth that crossing your legs when you sit can cause varicose veins.
“Crossing your legs doesn’t cause varicose veins, but it can cause symptoms to be worse if you already have them,” Faryman noted.
Is there anything you can do to prevent varicose veins?
“You can’t change your genetics or stop aging, but there are definitely ways to keep your veins healthy,” Ha said. “It’s all about managing your circulation.”
One of the biggest things you can do to slow the development of varicose veins is to maintain an active, healthy lifestyle.
“Walking, swimming and yoga are great for your veins because they keep the blood moving,” he explained. “If you sit or stand for long periods, take breaks to stretch or move around. Elevating your legs when you’re relaxing can also help reduce pressure on your veins.”
Other helpful approaches include quitting smoking and maintaining a healthy weight.
“Compression stockings are a fantastic option, especially for people who are on their feet all day, because they help improve blood flow and reduce swelling,” Ha said, adding. “Spider veins are trickier to prevent, but the same tips apply ― good circulation is key!”
How do you treat them?
Taking all the preventative measures can certainly help delay or reduce the development of varicose veins, but some still may form over time. The good news is there are many treatment options.
“Treatments for varicose veins vary depending on the size and location and if there are veins under the surface of the skin that we cannot see with our naked eye that are causing some of the veins,” Jacobs explained.
She noted that patients are evaluated with a physical exam and an ultrasound, allowing doctors to look at both deep and superficial veins and see which are working well and which might be causing the varicose veins. Then, the medical professionals develop a treatment plan, which can include a combination of procedures or just one.
“Today’s treatments for varicose veins are much easier and more effective than people realize,” Ha said. “They’re minimally invasive, outpatient procedures that help close off damaged veins and get your blood flowing through healthier ones.”
Spider veins are often treated with sclerotherapy, in which the damaged vein is injected with a solution that collapses the vein and redirects the blood to better functioning ones.
“Phlebectomy is a procedure that uses a micro-incision to remove surface varicose veins,” Blumberg noted.
Surface laser therapy is another way to collapse those small, superficial veins.
“Larger veins may need to be removed under local anesthesia, but sometimes the veins that are causing the varicose veins ― referred to as the axial vein ― need to be treated with an ablation where a heat source is put inside the veins and destroys the vein from the inside out,” Jacobs said.
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In addition to radiofrequency ablation and laser therapy, Ha noted that other common treatments at his practice include injections of VenaSeal, which can seal veins off, and Varithena, a foam-based option that can also cause the vein to close.
Insurance typically only covers varicose vein treatments deemed medically necessary due to painful symptoms. But that doesn’t mean you can’t explore your options if you’re bothered by what you’re seeing in your legs.
“It’s a myth that you should only treat your veins if you are having a lot of pain,” Jacobs said. “If you don’t like the way your veins look, that is a perfectly valid reason to be evaluated and see what cosmetic options are available.”