Varicose Veins: What They Are, Why They Form, and How They're Treated

What Are Varicose Veins?

Varicose veins are abnormally enlarged, twisted veins that become visible just under the skin's surface. They typically look like rope-like or bulging blue or purple cords on the inner leg, thigh, or calf. Unlike spider veins — which are tiny, web-like lines close to the skin's surface — varicose veins are larger, deeper, and can sometimes cause symptoms beyond their appearance.

They are very common, affecting about 23% of adults, and become more prevalent with age. Women are affected roughly twice as often as men.

What Causes Varicose Veins?

Your leg veins have a tough job: they have to push blood upward against gravity back to your heart. To help with this, they have one-way valves that open to let blood through and then close to stop it from sliding back down. When those valves weaken or fail, blood pools in the vein and creates back-pressure. Over time, this pressure causes the vein to stretch, twist, and enlarge — becoming a varicose vein.

Several factors make this more likely:

• Genetics: If your parents had varicose veins, you're more likely to develop them
• Being female: Hormones can weaken vein walls, and pregnancy increases venous pressure
• Pregnancy: Increased blood volume and the pressure of the growing uterus put extra stress on leg veins
• Prolonged standing or sitting: Jobs that require standing all day increase pressure in leg veins over time
• Age: Vein walls naturally weaken as we get older
• Prior blood clots or vein injury: These can damage valves directly
• Obesity: Excess weight increases pressure on leg veins

What Do Varicose Veins Feel Like?

Many people with varicose veins have no symptoms at all and seek treatment purely for cosmetic reasons. However, varicose veins can cause:

• Aching, heaviness, or tiredness in the legs — especially after long periods of standing
• Throbbing or cramping in the calves
• Swelling in the ankles and lower legs that worsens throughout the day
• Itching around the veins
• Skin changes near the ankles (darkening, thickening, or hardening of the skin)
• In advanced cases: open sores (venous ulcers) near the ankle that are slow to heal

If you have significant swelling, skin changes, or pain, that's an important sign that the venous insufficiency may be affecting more than just your appearance — and a medical evaluation is warranted before pursuing any cosmetic treatment.

Diagnosing Varicose Veins

Diagnosis begins with a physical exam and your symptom history. Many specialists also perform a duplex ultrasound — a painless imaging test that shows the blood flow inside your veins and identifies which valves aren't working properly. This helps your doctor plan the most effective treatment approach and rule out problems with the deeper veins in your legs.

Treatment Options

Conservative Measures (For Mild Cases or Prevention)

If your varicose veins cause mild symptoms, these steps can help:

• Compression stockings (20–30 mmHg graduated compression) improve blood flow and reduce aching and swelling. They won't make varicose veins disappear, but they manage symptoms effectively.
• Leg elevation when resting reduces pressure in the veins
• Regular exercise (especially walking) strengthens the calf muscles that pump blood back up toward the heart
• Weight management reduces pressure on leg veins

Foam Sclerotherapy

For varicose veins, a foam version of the sclerosing agent is typically used (rather than the liquid used for spider veins). The foam is injected under ultrasound guidance so the doctor can precisely target the right vessel. The foam fills the vein and damages its wall, causing it to seal shut and eventually be absorbed by the body. Success rates are 80–90% per treated vein, though some veins require repeat injections.

Endovenous Thermal Ablation

This is the current gold-standard procedure for larger varicose veins and the underlying saphenous vein insufficiency that often drives them. Two main technologies are used:

• Radiofrequency ablation (RFA): A thin catheter is guided into the vein using ultrasound. Radiofrequency energy heats the vein wall to 60–85°C, causing it to collapse and seal permanently.
• Endovenous laser ablation (EVLA): Works similarly but uses laser energy (typically 1064-nm or 1470-nm wavelength) delivered through a fiber inside the vein.

Both achieve 95%+ closure rates with very low rates of the vein reopening over time — superior to sclerotherapy for larger vessels. The procedure is done under local anesthesia in an outpatient setting.

Ambulatory Phlebectomy

This procedure involves making tiny puncture incisions in the skin over the vein and physically removing varicose vein segments using a small hook. It's highly effective for bulging surface veins and is typically done alongside other procedures for the best overall outcome. Downtime is minimal — most people are back to normal activities within a day or two.

What Results Can You Expect?

• Treated veins rarely come back — once closed, they're gone
• Symptom relief (less aching, swelling, heaviness) often happens within weeks of treatment
• Cosmetic improvement continues over 2–4 months as treated veins are absorbed by the body
• New varicose veins can develop in 20–40% of patients within 5–10 years at different locations, due to the ongoing underlying tendency toward venous valve weakness — not because the original treatment failed

When to See a Specialist

• Your varicose veins cause leg pain, heaviness, swelling, or cramping
• You notice skin changes near your ankles (darkening, hardening, or redness)
• A sore or ulcer has developed near the ankle
• A vein becomes red, tender, or hard (this could be superficial phlebitis)
• You're bothered by the appearance of your veins and want to explore treatment options
• You had varicose veins treated before and they've come back

Frequently Asked Questions

Are varicose veins dangerous?

Most varicose veins are not dangerous and are mainly a cosmetic concern. However, when they cause significant symptoms — leg swelling, skin changes, or ulcers — they indicate a level of venous insufficiency that can worsen over time if left untreated. A medical evaluation can identify who needs treatment for health reasons versus cosmetic preference.

Will varicose veins come back after treatment?

Treated veins very rarely come back. But the underlying tendency to develop venous insufficiency doesn't go away, so new varicose veins can form at other locations over the years. Studies show about 20–40% of patients develop new varicose veins within 5–10 years of successful treatment — particularly those with family history or ongoing risk factors.

How is varicose vein treatment different from spider vein treatment?

Spider veins are tiny, superficial vessels that respond well to standard sclerotherapy or laser. Varicose veins are larger, deeper, and often driven by failure of underlying larger veins (like the saphenous vein). They typically require foam sclerotherapy or endovenous thermal ablation — more targeted and higher-powered interventions.

Does insurance cover varicose vein treatment?

Most insurance plans cover treatment of varicose veins that cause medical symptoms (pain, swelling, skin changes, or ulcers) after conservative therapy with compression stockings has been tried. Purely cosmetic treatment without symptoms is typically not covered. Costs range from $1,000–3,000 per session depending on the extent and method used.

Trusted Resources

• American Academy of Dermatology: Varicose Veins
• Mayo Clinic: Varicose Veins
• American Heart Association: Venous Health

Always consult a board-certified dermatologist or vascular specialist before pursuing varicose vein treatment. This article is for educational purposes only and is not a substitute for personalized medical advice.