Varicose Veins: What You Need to Know About Diagnosis and Treatment

If you’ve noticed twisted, bulging veins on your legs, or if your legs ache and feel heavy after a long day on your feet, you’re not alone. Varicose veins are one of the most common vascular conditions, affecting roughly 16% of men and 29% of women. The good news is that treatment options have advanced considerably in recent years, and most people can find real relief without major surgery.

What Are Varicose Veins?

Varicose veins are enlarged, twisted veins that sit just beneath the skin, most commonly on the legs and feet. They are part of a broader spectrum of venous disease. At the milder end are spider veins (tiny vessels under 1 mm wide) and reticular veins (slightly larger, 1–3 mm). Varicose veins are defined as those dilated to at least 3 mm in diameter. At the more serious end of the spectrum is chronic venous insufficiency, which can involve significant swelling, skin changes, and venous ulcers.

Why Do Varicose Veins Develop?

The veins in your legs have one-way valves that keep blood moving upward toward the heart. When those valves weaken or fail, blood can flow backward and pool, causing the vein walls to stretch and bulge. Inflammation and increased pressure on the venous system compound the problem over time.

Several factors raise your risk. A family history of venous disease is one of the strongest predictors. Women are more commonly affected than men, and risk increases with age. Conditions that raise pressure in the abdomen, including obesity, pregnancy, and chronic constipation, also play a role, as does spending long periods standing.

Recognizing the Symptoms

Many people with varicose veins notice an aching, heavy feeling in the legs that tends to worsen as the day goes on, especially after prolonged standing, and improves with rest and leg elevation. Itching, burning, tingling, cramping, and swelling are also common. Women are significantly more likely than men to report these symptoms.

In most cases, varicose veins are uncomfortable but not dangerous. However, more serious complications can develop, including skin changes (darkening or eczema), superficial blood clots (thrombophlebitis), infection, and in advanced cases, venous ulcers which are open sores that are slow to heal. Signs of advanced venous disease worth discussing with a doctor include areas of skin discoloration, a fan-shaped cluster of small veins around the ankle, or changes in the texture of the skin on the lower leg.

How Are Varicose Veins Diagnosed?

Diagnosis usually begins with a physical examination and a discussion of your symptoms and risk factors. Your doctor will look at the size and distribution of the veins, check for swelling, and examine the skin for any concerning changes.

When treatment is being considered or disease appears more advanced, duplex ultrasonography is the standard imaging tool. This painless, non-invasive test uses sound waves to map the veins and detect where valves are leaking (a process called reflux). It can also check for blood clots in the deeper veins.

Treatment Options

Treatment decisions depend on the severity of symptoms, patient preferences, and individual health factors. There is no single right approach for everyone.

Conservative (Non-Surgical) Measures

For years, compression stockings were considered the first step for almost everyone with varicose veins. The current evidence tells a more nuanced story: while compression can relieve discomfort and is helpful when venous ulcers are present, research has not clearly established that compression stockings effectively treat varicose veins on their own when ulcers aren’t a factor. Today, clinical guidelines recommend compression as first-line therapy mainly for pregnant women and for patients who are not candidates for or do not want interventional treatment. (It’s worth noting that some insurance plans still require a trial of compression before approving other treatments.)

Interventional Treatments

For patients with symptomatic varicose veins caused by leaking valves, several minimally invasive procedures are now available, and current guidelines say treatment should not routinely be delayed for a compression trial.

Endovenous Thermal Ablation is now considered the preferred first-line interventional treatment. A thin catheter is guided into the affected vein under ultrasound imaging, and either laser energy or radiofrequency waves are used to heat and close the vein. Blood then reroutes naturally through healthier vessels. The procedure is done under local anesthesia, patients can walk immediately afterward, and most return to normal activities quickly. Risks are low, though there is roughly a 7% chance of temporary nerve irritation near the treated area.

Sclerotherapy involves injecting a chemical solution (often mixed with air to form a foam) directly into the vein, causing it to scar closed. It works best for smaller veins (1–5 mm) and is also used to treat veins that have returned after surgery. Several agents are available, and evidence suggests they are similarly effective.

Surgery, historically the standard approach, involving ligation (tying off) and stripping of the affected vein, is now generally reserved for cases where other treatments haven’t worked or aren’t suitable. Modern surgical techniques use smaller incisions and can be performed under local or regional anesthesia. Surgery remains effective, but recovery tends to take longer than with endovenous procedures.

When to See a Doctor

If varicose veins are causing you pain, interfering with daily activities, or if you’re noticing skin changes around your lower legs and ankles, book a consultation with Windflower Vein & Vascular. Most varicose veins are very treatable, and with the range of options now available, finding a good fit for your situation, your symptoms, lifestyle, and health, is more achievable than ever.